Dani:

Welcome back to the Handoff from Trusted Health. I'm Dr. Dani Bowie, Chief Nursing Officer of Trusted Health. This season, we're covering all things healthcare innovation and the importance of fearless leadership for change. In this episode, I have the pleasure of speaking with Dr. Rosanne Raso, a distinguished nurse leader who's held numerous leadership positions. Most recently, she was the Chief Nursing Officer at New York Presbyterian's Medical Center and is the current editor in chief of Nursing Management. Additionally, Rosanne is an adjunct assistant professor and serves on several boards and national professional committees, including the American Academy of Nursing, AONL, and AACN. Today, we discuss the core concepts of a culture of inquiry, as well as the key differences between being fearless and fearing less in leadership. We also cover her doctoral work on relational leadership and its impact on a healthy work environment, and how leaders can translate leadership research into practice. Here's my conversation with Rosanne Raso. Welcome to the Handoff. Today we have Dr. Rosanne Raso with us to share her stories around healthcare innovation and also elaborate a bit more on her journey in healthcare in general. Dr. Rosanne Raso, welcome to the Handoff.

Rosanne:

Thank you. And thank you for inviting me. I'm pleased to be here.

Dani:

So, Rosanne, I would love to start the show off by kind of bringing us back to our purpose as healthcare professionals and nurses and, and in specific, and we wanna keep the patient at the, at the center of what we're doing and why we're having these conversations. Is there a particular patient experience or story that has had a profound impact on you and your career that you could share with our listeners today?

Rosanne:

What a great question. To bring us back to purpose thinking about patient stories just over the past few years what comes to mind is, is, is awesome nursing and team collaboration from births to deaths and everything in between. I think what strikes me right now is organ donor stories. I'm thinking of one in particular. And in all of these situations, the nurse plays such a pivotal role in relationships with the family and with every other member of the team and externally for the organ donor network. Trying to pull this all together while maintaining the patient hemodynamically. And the one that comes to mind is really a tough one because it was a team member who suffered a catastrophic brain injury, and his wife was also a nurse. So we were all connected in this journey. And with the exquisite collaboration, nursing support, and team work his wife agreed to organ donation and it was in accordance with his wishes.

And it was just such an emotional time. And the staff organized an honor walk from the unit all the way to the, or Every hallway on the way was lined with staff with their heads bowed for this patient who was our team member. It, it was just so emotional, and it brings me back to purpose, and I don't know if you are an AGT America's Got Talent fan but last week or the week before, there were two women on who sang a duet, and they met because one of the woman donated her son's heart to the other woman's son who needed it. Now, they of course, did not know each other till much later. Turns out they both have voices and they both sang the same song to their son in the hospital. So I was in tears at this that it was so powerful. I think organ donation is such a selfless thing to do, and it brings out the best in nursing.

Dani:

That is, it is really powerful and impactful. And thank you for sharing about how this patient experience was around, you know, the process of organ donation and also brought together the profession of nursing and healthcare workers in general to honor that life and the self-sacrifice of giving in that way. So thank you. I would like to, to pivot and talk a bit more about you, Rosanne and your career. You know, you have a very accomplished career and I would love it if you could share a little bit more about some of the different roles and pivotal moments that you have had as a nurse and a nurse leader that have helped shaped your career.

Rosanne:

Well, there was some interesting pivotal moments in my career. I originally started out on the clinical track. I, my master's degree was in education. I was a clinical nurse specialist at an organization. And I was tapped to take a management role in critical care over seven or eight units. And that was not my career pathway of choice at the time, but I decided I was gonna walk the door. It was opening, I was gonna walk through that door and it changed my whole career. I was in love with it, I loved it. And from there I proceeded to five different chief nursing officer roles from community hospitals to academic ary. So that was a pivotal moment for me and a message really to all when doors open, really think about it and maybe walk through it. Another pivotal moment, which is why I ended up being the editor in chief of nursing management for the last 10 years, is that I was active with the Critical Care Nurse association in New York City.

This is where I live. And from there, I became active on committees, and then I joined something regional and I went to a meeting and met the president-elect of the AACN organization. We hit it off and she became the editor-in-chief of nursing management, asked me to join the board. And probably 10 years later, with that experience behind me, I was asked by the publisher to take on the role. And it would've never happened if I wasn't active in my local critical care nurse association. So that's another life career lesson is being active professionally, open so many doors. I really recommend it to everybody. And I guess the one last really pivotal moment for me was more recently deciding to pursue my doctorate. I only got my DNP three years ago, but in that process I had to do a research project. This is from Case Western Reserve University. And I researched my passions, which were authentic leadership and healthy work environment. And that led me down this whole pathway of becoming a researcher in those areas. So those are three examples of pivotal moments for me and really my three roles in life. One as a nurse exec, one as editor in chief, and the other as a researcher.

Dani:

I love it. I, I like how you kind of offer up these really three tangible pieces of advice for our listeners, which what I heard was, you know, you got tapped a door open and you encourage our listeners, Hey, consider walking through that door, seeing what's on the other side, right? Being open to that to networking. So getting involved locally and nationally in your professional organizations which has also been pivotal in my career as well. And looking for that community a network. And then three is advancement of self and growth, which is, you know, your education and that doctoral journey. I can attest I did my doctoral journey in 2018 and studied, you know, nurse scheduling and did predictive scheduling models and really just took the workforce issues head on to see anything I could find in the literature. So it was transformational in my life as well, and set me up for a different career. You know, we've recently had conversations about A O N L, which A O N L, another great networking group and opportunity, and you're on a work group or you're part of a work group. And I would love it if you can share with our listeners a little bit more about the focus of that work group and what you're hoping to achieve with the work group. So the desired outcomes through some of that professional organization activity that's going on there.

Rosanne:

This is some of my recent work that I have really enjoyed. A O one L, the American Organization for Nursing Leadership set out last year to really dig into best practices and exemplars to help nurse leaders all over the country and transforming their workplaces and stabilizing the workforce. So there were seven work groups, it's all published at this point on their website. Some of the work groups were a positive practice environment, recruitment and retention leadership. The one I was on was a culture of inquiry. So the outcomes of having a culture of inquiry are that we need to change the status quo. We all need that. What worked before is not working now. And to get back to a thriving and environment, we have to look for new processes, create new models of care, be innovative. And in order to do that, we need to have a culture of inquiry. There's no innovation if there isn't. And the compendium, this particular section is really all about how to help leaders create this culture of inquiry.

Dani:

Yeah. And you do, like, we, we wanna talk a little bit more about culture of inquiry. I think that that's something that our listeners would like to know a bit more about. Would you be able to elaborate to our listeners some of the core concepts of what the culture of inquiry is and maybe how you've seen some examples at health systems

Rosanne:

And how that's fostered innovation? Sure. So we really created our own little model for culture of inquiry. It has three major concepts, and the first is psychological safety. Now, we've all heard of psychological safety when it comes to just culture and in that context, but in the context of a culture of inquiry, it's just as important. If you can't be inquisitive and curious and be safe to do that and not be embarrassed by your ideas, you're, you're not gonna have a culture of inquiry. So psychological safety is one of them. It's such a fantastic concept for many, many reasons. Even as a leader, I needed to be psychologically safe, to be effective and to be happy in the role. Another concept is building connections, which I connect to relational leadership. So the leader has to be one who listens, one who seeks feedback, one who is transparent and really promotes communication and connections.

 And that supports a culture of inquiry and makes a lot of sense. The last concept we included was called design thinking, the concept. But design thinking is really about creating new, generating new ideas, being creative about it. It's not about tweaking old stuff, it's about having a, a goal that you wanna get to and starting fresh. And you need a lot of enthusiasm, a lot of creativity. You need an appetite for risk taking. So there's a lot involved there, but it's a, a process to get to creativity that's turns out to be pretty well-defined in the literature. An example of using design thinking was just published in nursing management. I was thrilled when I saw it in New York City, the health and hospitals corporation. They used design thinking to create their professional practice model and their shared governance framework and for ambulatory and acute hospitals and, and correctional, like all did it a little bit differently in terms of the final product, but they did it together and they used design thinking to get there. Another example of innovation in an environment that is psychologically safe, safe with building connections. And design thinking was at Cedar-Sinai. I don't know if you saw this, but they started piloting an Alexis for patients. It's not actually called an Alexa, I don't think Alexa it's but it's a bedside, you know, like an Alexa instead of a call bell, probably in addition to a call bell, the patient can talk into the Alexa and get a response so you're not fumbling for call bells, et cetera. So that's a, a fun example.

Dani:

Those are two really great and different examples. And I just what struck me too, I think the psychological safety and when you mentioned that you're not, you know, embarrassed by your ideas, and I, I was, that was profoundly impacting me when you said that. 'cause I, I do think there needs to be work in creating that space where you can have just idea generation and not be embarrassed by the ideas you're coming up with. Not all of them stick or work, but creating that safe space to just open your mind up and start to think about ideas is, is really powerful. I mean, all the, the three principles that you mentioned were, were key, but that was a really, that was one that really stuck with me. Can you elaborate for our listeners a little bit more around your doctoral work and, and how that was on relational leadership? And just describe a bit more to our leader, our listeners, what relational leadership is and a little bit more about your doctoral work.

Rosanne:

Sure. I became interested in relational leadership and at this really deep level while I was studying for my doctorate and I had to do a concept paper concept analysis, I was, you know, pretty nervous about this theory class and having to do this paper, having, it turns out that I am a big proponent of AACN, the American Association of Critical Care Nurses. They have a healthy work environment model and there's six standards there, and authentic leadership is one of them. So I thought, well, you know, what, what does that concept actually mean? So I dug deep into authentic leadership, find out it's one of the relational leadership models, and that there was an authentic nurse leadership model, which a researcher also in New York created, which adds caring to the model, which is very nurse centric. And so then I had, I had to look into a, what is relational leadership?

It turns out it goes back, I don't know, quite a few decades. It started really in the management literature, but it's based on positive psychology and empowerment and inclusivity and having purpose and focusing on process and having ethical standards. And the bottom line is relationships and connections and people, other types are transformational leadership, which in nursing be probably because it's a magnet standard, but I'm sure for other reasons as well is, is popular honestly. There's also servant leadership, which goes back even further in time. And that is a type of relational leadership as well. And another one, which is fairly new in the last five years is human centered leadership, which was also created by nurses. And it's very holistic model. So all of them, or what we need now, honestly, as we move from the transactional incident command mode we were in during the peaks of the pandemic and the aftermath, and I've seen this written in many places.

It's time we have to get back to relational leadership if we're gonna move this workforce forward. So I ended up doing, my doctoral study was on authentic nurse leadership, looking at that end healthy work environment using aac n's model and seeing was it present and did they correlate with each other? Was authentic leadership really an evidence-based standard for a healthy work environment? And that's what I found that it was. And then I ended up replicating that study on a much bigger scale in the first pandemic year and 5,000 respondents in that. And same thing happened, authentic nurse leadership and healthy work environment correlated positively. And then I did it again in the second pandemic year, 1700 respondents that time, still a very robust sample. And for a third time I found that authentic nurse leadership correlates with a healthy work environment. And I worked with another researcher recently who did that study and did another layer of analysis on it and showed that authentic nurse leadership was predictive of a healthy work environment as well. So that takes it to another level. So one of the things I'm working on now is replicating that study on a much bigger scale to see if that holds up.

Dani:

I love it. I, you know, part of our podcast is around healthcare innovation, but also like fearless leadership and, and you touch on this briefly mentioning like we need this now more than ever to continue to I think, recover and rebuild our environments of, of practice for our workforce. You know, as I was listening, you describe all these different leadership styles and models, and we probably have some listeners who are interested in formal leadership positions, but also just developing as a leader themselves. I know I am, that's an important component of just my self journey that I think is so pivotal to who I wanna be, which is a good leader in looking at all these different models. And is there any advice that you would give to, you know, up and coming leaders of how to develop themselves with these leadership styles? Whether it's reading the research, anything that you've seen in practice that could be helpful for leaders to consider so that they, you know, learn and then put into practice these types of different leadership styles?

Rosanne:

That's a really fantastic question because we need to do a lot of work on leadership development. What works, what doesn't work. I can't tell you that, and again, this isn't research based. It's my opinion that just reading about something or sitting in a classroom, it starts you on the pathway. But unless you practice or immerse yourself in somebody who's using it and see it with your own eyes, it adds a level of understanding and being able to apply. I think the best model, some of them are more academic, where you're in a classroom in a leadership course and you learn about it, and then you also have clinical experience with a leader who is practicing it, and you get to watch it and understand it in real life. And then if you add some kind of a practicum on top of that where you're doing a project where you have to use those skills to succeed, then that's the trifecta of success if you ask me.

Now, can you do that on your own? Probably. I have worked with a mentee who's a staff nurse who was talk about being fearless. She was a new grad and did a fabulous evidence-based project, which was something clinically I was interested in. So I involved her in something else and she asked me like, can I shadow you for a day? I'd love to know what a day in the life of a c and o is like. And she, and then we started doing it every three, four months, she would get on my calendar and spend a half a day a day with me, went everywhere with me. And she did not think she wanted to be a former leader, but she ended up taking a leadership position because she felt like she loved it and she learned it from me in real life. So I, I would be a aggressive <laugh> with shadow days with somebody who practices it. People like me and there's many other leaders like me, relish that just relish being able to bring the next generation up into our relational styles of leadership

Dani:

So needed. And I think that's a really, again, another tangible example of as, as listeners, you know, our, our listening to this conversation of what can I do? And being fearless, even in asking for those opportunities it is important to see it and then also how to put it into practice.

Rosanne:

Yeah, exactly. And it's funny that you mentioned being fearless. I just wrote an editorial, I think it's coming out in September, called Fear Less, not Fearless, but Fear Less. And the reason for it was, I was in a yoga class, and if you go to yoga, you know, the teacher has some kind of intention for the day or, and this particular class, the teacher was talking about being fear less in that don't be afraid to try that inversion or try that pose, have less fear. If you don't make it, you fall over. So what, try it, try something new. Don't let fear take over. And I thought, oh my goodness, what a leadership lesson here. So I ended up writing a whole editorial on Fearing Less, which co I think it relates to courageous leadership as well, but I did differentiate it from fearless, because you do need some fear to make sure you don't put yourself in a situation knowingly that has has, will have a bad outcome for you.

Dani:

That's a really important distinction, actually. Fear less versus fear less. And it is important to know that there probably will be fear and the things that we do that's a normal human reaction, but being able to remove the magnitude of it from crippling us from doing work and embracing innovation and change. You know, I've spent a lot of my career around the workforce, particularly nurse staffing. And what I've seen in, in that space is oftentimes, I call it fear-based staffing. So I see a lot of leaders make decisions outta fear of not having enough resources, but oftentimes it creates like tunnel vision. We're not moving into the space of innovation, embracing technology. And so you know, I'm gonna take away what you just shared, which is instead of fear-based staffing, let's help move our leaders to the fear less staffing, where there still may be some elements of uncomfortableness but hopefully we can diminish and reduce that so we can move into new things, as you mentioned, trying different approaches. So I can't wait to read that editorial piece. And for our listeners, I'm sure that's the same for them. You know, I, we are talking a lot about, you know, recovery and the from the pandemic and how these different leadership styles will move us into that recovery in the future. Would just love your thoughts around, you know, the future of, of nursing and the future of healthcare in general, and what you're seeing today and what you're hoping for in the future.

Rosanne:

Well, I wish I had a crystal ball and the Pollyanna in me, I am an eternal optimist, honestly. I see thriving, but we have to get there. And I think the leadership models is one thing. The culture of inquiry is another, because we have to innovate. We all know we have to do things differently, but we don't know what that is. So everybody is trying in their own world when they are fearing less and not afraid that maybe it doesn't work. But trying different models of providing care, of progressing people through career pathways of providing support. The dynamic workforce we have now, I don't know if that's ever gonna go back to having all your full-time employees that stay for 3.5 years, minimally. I'm not sure we'll ever get back to that. And I think we have to learn how to manage with these dynamic workforces.

And what you're mentioning about staffing and scheduling is a key part of that moving forward, doing it differently. People don't, are not working full-time just so they don't have that commitment to crazy hours in acute care. It's really hard because of all the weekends and holidays and the constant calls for overtime. That's not a model that is appreciated now. So all that has to change and the workforce has to be a lot more flexible and the leaders have to fear less to, to try different things to get there. I do think nursing will thrive in the future. It has to. We are such a critical component of healthcare in the world. There is no healthcare in this world without nurses. There's no healthcare in this country without nurses. So it has to thrive. And I think there's enough momentum for that to happen, honestly.

Dani:

I agree. I would agree. I it has to thrive. It will thrive. The things we're talking about today are components of making it thrive. I think we are touching on a piece that has been missed, which is the, the leadership support and development for particularly our frontline managers and how pivotal that that role is in helping, you know, build a healthy workforce and manage with excellence. And it's a very dynamic role. And I think there's a lot of demand. And I know when I did the role, not as much support as I would've hoped for. And so if we can redefine and infuse, you know, leadership, the types of styles that will bring the healthy work environment and allow our leaders to be flexible, our workforce wants flexibility and we need to be flexible in how we think about our solutions of the future and being open to the way that the workforce wants to work. So I love the e eternal optimism. I'm with you. I believe the future is bright and I'm hopeful with leaders like yourself and others that are arising that you know, rebuilding and reforming healthcare and, and nursing will continue on. Rosanne, where can our listeners find you?

Rosanne:

Oh, I think LinkedIn is the best place. I'm under my name. You can direct message me in LinkedIn or see what my latest editorials are or what responses I've made to other people. That's the best place to find me.

Dani:

Perfect. Okay. Lastly, you know, how we end the podcast with all of our guests is what would you like to hand off to our listeners today?

Rosanne:

So many options from what we've talked about today. I think fearing Less is one of them. I think developing yourself as a leader, no matter where you are in your career is important. I think having curiosity and being inquisitive and being allowed to try new things and try things differently is critical. And maybe that's enough. Three points, <laugh>,

Dani:

It's a nice way to end curiosity inquisitiveness and the, the opportunity to think differently as we fear less for the days ahead. So Rosanne, thank you so much for your time. I really appreciate it and giving us your pearls of wisdom to the listeners for the handoff. And I look forward to hopefully connecting with you in the future and learning more about some of the work that you're doing or any other research that you're publishing in the future. I would love to continue to learn from all that you have been doing over the last years of work. So thank you so much.

Rosanne:

But thank you for all of your very inquisitive and curious questions. They really made me think. Thank you for hat.

Dani:

Yeah, my pleasure.