Dani:

Welcome back to the Handoff from Trusted Health. I'm Dr. Dani Bowie. Today I speak with Dr. Rudy Jackson. Rudy is a system Chief Nursing Officer at University of Wisconsin Health, our regional health system based in Madison, Wisconsin. With over 30 years of experience in healthcare, Rudy has a wealth of knowledge and insights on nursing leadership, staff engagement, and patient-centered care. We'll discuss the challenges and opportunities facing nursing leaders today from workforce shortages to burnout to new care models. We'll also explore the importance of listening to frontline clinicians, investing in their development, and creating a culture of innovation and continuous learning. Here's my conversation with Dr. Rudy Jackson. Welcome, Dr. Jackson.

Rudy:

Thanks, Dani. How are you doing today?

Dani:

Great. Excited to have you on the show and learn more about what's exciting and new at at UW Health. With that being said, can you tell us the listeners, a little bit of your background and what you're doing for UW Health today and into the future?

Rudy:

Sure. So again, my name is Rudy Jackson. I'm the system Chief Nurse Executive at UW Health. UW Health or the University of Wisconsin is primarily located in Madison, Wisconsin the capital of the state. We've got seven different hospitals about 90 plus clinics 16,000 employees that we support and we serve a little over a million lives in our region, in our community. Me personally, I am a southern boy from Texas that married somebody from the Midwest, and so ended up up here with her. My background is I've been diverse. I have 27 years in the military. Some active duty, some reserve time, a lot of work in academic medical institutions, did a little bit of work in the for-profit industry, but have really preferred the academic mission of continuing to support the next generation of healthcare providers. Also gives us the ability to provide care for a population of the, of the community that is oftentimes underserved or underrepresented. And so working with a academic institution is something I've always really sort of leaned to in terms of what I wanna do as a, as a nurse.

Dani:

That's great. You know, I didn't know that we had a similar story of Midwest love. You know, I'm, I met my husband in the Midwest and therefore moved from the West coast and now live in the Midwest due to that. So excited to know we have something else in common outside of our doctoral journey and degree. Now you've created some really innovative programs to recruit nurses into UW Health and address the shortage in Wisconsin, including paying for their tuition. Can you talk about what those are and what are you seeing as early results with those types of programs?

Rudy:

This is gonna be a bit of a long-winded answer, so I'm gonna apologize to the listeners in advance. You know, back in late 2021, early 2022, we started to see a significant shift of our nurses wanting to leave our organization and go into travel programs. You know, we all saw the significant shifts in cost for our travelers and, and the amount of money that our nurses could make. As a result of that, we were losing roughly 30 nurses a month in about five to six months without ebbing, without really having any backup. You know, I, I think all of our listeners earlier here, listeners would agree that we don't have a full of nurses sitting around looking for jobs that we, that they can't find. So when you see a, a significant exodus like that and with having no really backup or no bench strengths to be able to pull from it can be pretty problematic.

So we, we quickly had to shift our idea around what we compensate our nurses with. And we developed a model here that allowed us to have a phase staffing approach with some metrics that we tied to it that would allow us to compensate our nurses based on what our vacancy rate was. And so, rather than losing nurses to tr external travel agencies, we actually started compensating our nurses at basically the rate of an external traveler for allowing them to pick up shifts that we would've normally been filling with our, with an external traveler. The, the program wasn't cheap. I mean, obviously it was expensive. Unfortunately, the money was gonna be spent one way or another. It was either gonna go back to our staff or it was gonna go to the commu to an external traveler. This program allowed us to stop the bleed, if you will, of nurses that were leaving and allowed us to really keep those individuals in in-house.

And we turned that roughly 30 RN monthly vacancy rate down to single digits, which was significant for us, and it allowed us to get caught up with some of the recruitment at effort that we did. Some of the other things that we did we partnered with our local university here, the University of Wisconsin, the Dean for the School of Nursing here, Dr. Linda Scott, has been an amazing partner to work with. And we've been able to develop a program where, as a magnet organization, we strive for a baccalaureate nursing workforce partnering with UW School of Nursing, we've been able to open our doors to more associate degree nurses, and then giving them a free path to getting their bachelor's degree through UW, a school of nursing. And that includes books, fees, and tuition. So at, at no cost to the individual, they're allowed to do a self-paced three year curriculum to get their bachelor's degree, which is important for us as we maintain our baccalaureate numbers.

We've also looked at a few other strategies like increasing our, you know, nurse residency programs. We have a very, very successful nurse residency program, so we doubled the size of that program. We started leaning in on some international nurses. We really want our nursing workforce at UW to really look like our community. And so opening up our doors to international nurses has been something that we've been able to do. And then finally we added we created a new exert program here. Our first TERT program we started was a year ago. We opened up 20 positions. We ended up with 40 applicants. We took them all and converted full 50% of that to the full full-time staff. This year, we've gotten 60 applicants, and we're accepting them all from eight different states around the country. So we're really excited if we can maintain the same conversion of 50%, you know, that's an additional 30 nurses that we will pick up at this point. I would argue that in our state of nursing, we're, we're picking up everything that we can and making sure that we can make those individuals be successful so that they can provide the care that we need for, for our community.

Dani:

I really like what I'm hearing here. Oftentimes, I've worked with health systems around workforce strategy, and you've really layered in some fundamental strategies to build your workforce, develop your workforce, and ensure that you're meeting the need. Kind of point number one that I thought was critical for listeners to hear was in regards to the, the traveler program, or the way that you're designing that is you're gonna spend the money regardless. And so you're investing into your existing workforce, which I think is so fundamental and a wonderful story that UW Health can share with, with the nurses in the frontline. And then additionally, you're really pressing into like the future of nursing report, building the workforce, and moving their academic progression in a way that, you know, meets what we've always known as nurses, which is trying to get our workforce to about 80% B s n prepared and helping them feel committed to the profession. Now, in regards to the internal travel program, and the way that you're, and I hope I'm, I'm describing it right, if that was an internal travel program, but is that where they were picking up shifts at extra shifts at an additional rate? Or was it that they were being paid for some of that flexibility? Or can you just describe a bit more around that program? And then I'll ask some more around your other programs as well.

Rudy:

Sure. The internal travel program was actually the first iteration of the program that we created. The design of this program was to look at what our vacancy rate was within the organization. We created a separate definition of our vacancy rate in that is something a little bit more unique, I think, in a nuance that is different from what other organizations have done. So we started leaning on something that we refer to as a functional vacancy rate. The functional vacancy rate is defined for us as the number of nurses that we have that can functionally manage a patient population. And the difference between that number and what is actually needed is what that functional vacancy rate is. And so, let me, let me break that down a little bit more for you. If we've got a unit that has, say, 50 nurses for the benefit of my ability to navigate math <laugh>, I'm gonna use these numbers, but if we've got a unit that has 50 nurses and we have 25 vacancies, we have a 50% vacancy rate, human resources in our recruitment departments are doing an outstanding job billing those positions as quickly and efficiently as they possibly can.

There's been a lot of work around minimizing the time from interview to start dates. So they can work really, really hard to get those 50 positions filled, but let's just, or those 25 positions, but let's just say that they do, they get all 25 positions filled, and they do it all very, very fast all at once. So today is January, you know, again, I'm making this up. Today's January one, I've got 25 vacant positions. I've got a 50% vacancy rate by January 10th. They've already filled all 25 positions. How nice would that be, right? If this was a real story? Yes. Yeah. All right. They filled all positions on January 10th. Now they're gonna show that our vacancy rate is zero. We are a hundred percent filled. That doesn't mean that I've got a hundred percent of my nurses that can manage a hundred percent of our population.

So we have a functional vacancy rate, and that functional vacancy rate is still 50% until I can get these individuals off of orientation, until I can get nurses that are on parental leave back into the workforce, or that are injured back into the workforce. We have a number, a delta, if you will, of individuals that cannot manage a patient population. In that situation, we would be leading on external travelers to come in and fill positions or pick up shifts. What this program allowed us to do was to utilize our own staff to pick up those shifts. So I may be a 0.9 RN that is working 36 hours a week, and I see that we have a vacant shift, and I happen to be off on Thursday. I'll pick up eight hours there. And during those hours, I will receive a significantly higher hourly rate above my base rate.

 And that hourly rate plus that base rate would be equivalent to what an external traveler would be making. That was the first iteration of the program. We then went back to our nursing councils, because we don't do anything in a silo. Everything is done with our frontline nurses, our direct care nurses, whether they're, you know, inpatient, ambulatory, wherever they may be. We went back to our frontline nurses and said, Hey, are, is this working and does this function? And they said it did, and we filled over 96% of all of our vacant holes when this was occurring. But they wanted to see different phases into this. So rather than having the same amount of money with a lower functional vacancy rate, as we're getting people off of orientation, we've adjusted the plan. So now it's a phase staffing plan. So if your functional vacancy rate is between zero and 6%, you get x If it's between seven and 12%, you get y and so forth.

It's a four phased approach, and each increment of that phase is broken down by roughly $25. So it would be $25 above the hourly rate of pay for the individual nurses. I, I, I want to tell you, and I wanna share because you mentioned that, you know, working with our nurses is really critical. This, this wasn't a plan that I created in an office by myself. This wasn't a plan that I, I took a group of leaders and said, let's make something up that's never been done before. This was truly something that came from a frontline nurse. And I'm gonna share a story without sharing her information because I, I haven't asked her permission, but I was up on one of our units, and I was approached by one of our nurses who said, I need you to convince me to not become a traveler.

And I thought for a moment, how do I do that? How do I sit here and tell you not to become a traveler? So I did what probably all CNOs around the country are doing, right? I gave all of the reasons why you're gonna get really rough assignments. You're gonna go to areas that are in really dire strait, you're gonna be gone from your family. I mean, I, I really laid it on pretty thick, and the nurse said to me, I hear all of that, but what I really want to do is pay off my student loans and buy a car and, you know, start a family. These are the things that I wanna do, and if this gives me an opportunity to do that, then I, I think I, I, I'm, that's where I'm leaning. And I said, well, then let me ask you how would I, what do I need to do to keep you here?

And she said, pay me what you would pay a traveler. And I, I, I'll, I'll be honest, I, I laughed a little bit and said to her, it, it's just financially not possible for us to do that. And so I went back and I spent some time over the weekend thinking about it, and that was really the impetus of this program and where it all came from, was, how do we do that? How do we support these individuals? And what we found was not only were our vacant shifts being picked up, but our nurses were actually really excited because they had just an equal amount of opportunity to earn that dollar or that amount of money that an external traveler did, because now it was them filling their own shifts. So what you find in most organizations is a bit of hostility, if you will, around an external traveler.

And the staffing in this en in this environment, in this case, really that that didn't exist. Because, you know, I may be working with Danny today at her normal rate of pay tomorrow. She may be making significantly more, but I'm still working with a nurse that I know, a nurse that I trust, a nurse that I enjoy working with. And not only that Denny is coming in so that I'm not having to work harder and pick up an extra patient or be stressed out. And so we saw a significant decrease in the relationship between our nurses, and we saw a, a significant decrease in the anxiety of our nurses who were coming into work because they knew that their staffs shifts were gonna be filled. And that was, I, I'll tell you from my perspective, the senior executive team and our board, that was, whereas every dollar.

Dani:

Yeah, that's huge. And, and the way that you're leading too, with leading from the front line, asking the question, pondering the question, and then building a program with the involvement of your frontline with your managers and others, is really a story of transformational leadership and, and how you've been able to bridge a gap in a very tight labor market as well as what's been very competitive over the last, you know, two and two and a half years of the travel industry compared to traditional forms of employment. You know, I, I may ask a little bit of a provocative question, and you, you hit on this a bit about, you know, the, sometimes the animosity between the internal staff and, and, and external staff, a traveler. You know, what is your take on external travelers? Do they have a, a space in your workforce strategy? Do you think that you could operate without any what, what's your thoughts, Rudy?

Rudy:

That's a, that's a great question. And I, I love the way you said that you're gonna ask me something provocative because I, I do have very strong opinions of this on the, on this topic. And honestly, I'll tell you, I don't think my opinions are realistic. I would love to say that I, I will never have a need for external travelers. I, I find external travelers, you know, down in Texas we used to call them mercenaries. You know, you come in, you make a ton of money, and then you go back, call 'em. The reality is, I think travelers are a part of our business, and it's a part of our, it's a necessary part of our business. And I think of certain areas in healthcare, like pediatrics that is seasonal. You know, can I open positions year round for an organization or for a hospital in, in, in pediatrics when their volume fluctuates so dramatically based on, you know, RSV season or flu season, and how it impacts children versus how it impacts adults.

And so having to utilize travelers in situations like that absolutely makes sense. There's also different areas of, of healthcare, like cardiothoracic nursing and perioperative spaces. They are very, very unique. That's a very unique skill set. And if you're down one or two, you don't have a choice but to reach out to an agency to try to bring in some support so that you can continue to provide the coverage that you do. And there are, there are multiple different areas that are just like that. You know, I can think of dialysis or, or other areas. So I think, I truly believe travelers are a part of our, our workforce. They're gonna be a part of our industry. I don't see them going anywhere. I do think there needs to be some safeguards around how they are compensated the, you know, the agency, how much does the agency make versus how much does the, the actual nurse make.

One of the things that I think benefited our travel program the program that we started was that we weren't paying the agency costs. We were giving the nurses what the nurses would be making, but we didn't have to increase it by 30% to cover the cost of the agency. And that was another selling point for, for our nurses as well. So I, again, I do think they're a part of our industry. I don't see them going anywhere. I do believe there is gonna be less use of them in the future as we continue to ramp up our workforce. You know, we've seen a decrease in, you know, what I refer to as some of our bench strength, when there are organizations that work with very, very little meat on the bone, if you will, as it relates to nurse staffing. And you see nurses starting to retire during the pandemic because they've already reached that age, and I've been doing this because I enjoy it, but do what?

Should I really continue? And we see those retirement numbers. We as a workforce, a a and as leaders need to be creative. How do we support them? How do we support the next generation? You know, we're talking at UW about creating a a department of seasoned nurses that are either early retirees or are thinking about retiring and making them permanent preceptors to so that we can bring that bench strength back to the bedside. But that they're not doing so managing their own patient population. They're helping educate that next generation of, of healthcare providers. I think travelers are gonna be with us forever, but I also think we need to be creative about different models to provide the care that we are, that, that our patients deserve.

Dani:

Staffing models and and flexibility are, are key. I truly enjoy hearing your workforce strategy because it is layered, it has multiple facets to it that I think make a healthy workforce strategy with your internal programs, your pipeline, with even, you know international, your externs, building the workforce once you, once you have them to help advance their academic progression. And you know, and I wanna touch a bit more around the flexibility, and I think this is a question that everyone's been grappling with over the last couple years of what as well. And you know, when you talk to them, one nurse about, you know, what would it take to keep you here? She listed out some of her expectations around working for you and, and what that meant to her personally. And so I would just love to understand more from your perspective as you te as you talk with the nurses at your health system, but also as being a very seasoned leader with experience at the bedside in different roles, all the way to a system executive, you know, what does flexibility mean to you, and, and what do you think it continues to mean to the frontline that you serve?

Rudy:

You know, daddy, you and I have been friends for almost 10 years, and I've, I've enjoyed the last 10 years being able to pick your brain on, you know, things like scheduling and staffing and systems that work, and systems that don't work, and, and really what the data says around, you know, just this very issue around being more flexible. You know, my opinion here is that it's very, very complicated and that it's so multifactorial. There's a gentleman that I've gotten to know over the last 10, the last probably six years or so, his name is Joe Ty. He wrote the book the Florent Prescription. And in that book, he has a quote that references what he refers to as the invisible architecture of a healthcare system. I, I bring that up because I think when you talk about things like flexibility, we, you need to understand your culture, your invisible architecture, if you will.

And so many different things mean so many different things to different people. And the example I like to give when I talk about this is wellbeing. If you read the literature around wellbeing for our nursing staff, there are so many references to building out a room so that nurses can decompress. I think they call 'em a zen, Zen zen or something to that effect. But there's a ton of literature out there that talks about doing things like that. You know, I think if you look at the size and scope of your hospital, if you look at the individual nurses and you start having conversations with them to understand what their expectations are, wellbeing, you're gonna find that in some places, maybe the zenden does work and that's a great solution, but that's not a, a one, you know, solution fits all kind of approach.

Because if I went to our main campus, our flagship hospital, which is by far the largest facility I have ever worked in, not by bed count, but simply by air, by square footage, it is unbelievably complex to navigate that wouldn't, that approach wouldn't work. It, it would take a nurse 45 minutes to find the room that they needed to go and relax in. How much anxiety is that gonna cause? So I say that because when you have these different approaches, there is no one size fits all. And so when you look at something like flexibility of the schedule, you know, I shared with you earlier before we started recording that what that means to one person may be very different than what it means to somebody else. So self-scheduling could give you that ability to have that flexibility in your schedule. It may also mean that you have more, you have more ability to shift schedules to turn over or give somebody else your shift.

You know, what does that model look like? What about weekend coverage? How do we define a weekend in our organization that would benefit our employees? How do we meet the needs of our patients, but also meet the needs of our, of our workforce? What are the, our expectations of our, of our employees, our 12 hours, an antiquated model of care that no longer is gonna suffice to the needs of our, our workforce? Do we need to think about 10 hour shifts, eight hour shifts, or even four hour shifts? You know, I think as healthcare leaders, we have to struggle with the needs of our staff and the, the wants of our, of our team, but also the expectations of our patient population. And when we start talking about four hour shifts, there's a lot of data that talks about patients receiving less quality, out better or poorer quality outcomes with having to switch over nurses multiple times.

And all of those things need to be taken into go account. And they cannot be done in a silo. They cannot be done with a group of leaders. We've gotta invest in the time with our frontline and our direct care nurses and have these conversations and open conversations with them to say, what does flexibility mean to you as a nurse working 40 hours a week, 36 hours a week? What does that look like for you? Because at the end of the day, what we're trying to do is, is not only keep you on our team, retain you, but make sure that you're, you have that appropriate work-life balance that you need for yourself and for your family. I oftentimes tell our staff at, at some point of our life, when our, our days come to an end, when we are, are going into the next phase of our existence, and we are no longer here, our tombstones are not gonna say, here lies Rudy Jackson, a an amazing nurse at UW Health, right? It's gonna be, here's a father, here's a husband, here's a grandfather. And, and so it's that wellbeing of our staff that, that ability to have that work-life balance that is so incredibly important for us and things that we have, we have to, as leaders, continue to push on our workforce to really lean on them to tell us what it is they need.

Dani:

Yeah. You hit the nail on the head in regards to the holistic approach to managing your workforce, which is truly sounds like, you know, nursing we're taught holistically to care for our patients, their whole being, right, spirit, soul, body, and that there's a legacy beyond. And that, you know, the, the person in the, in the position of a nursing role, front frontline clinician, it has, you know, impact both professionally and in their personal life as well. So I think that that is a really powerful approach. And that also what I'm hearing you say is customization, tailor made, what fits your organizational culture and being able to understand that and then test out models in your organizational culture. I, y you know, I did wanna touch on one thing, which I, I meant to mention, but it, it escaped my mind in the moment. But I also love how you're addressing the, you know, the knowledge gap.

Oftentimes the advisory board talked about, you know, there's a shortage coming, but it's a shortage around the knowledge and the fact that you're looking at the retiring workforce and potentially offering different types of programs like preceptorship mentorship, and I've, I've even thought about like a gig workforce or having them pick up shifts here or there so that you don't lose that knowledge gap. So I just wanted to call that out and, you know, give you kudos for thinking about also the knowledge and the way to impart that back into your workforce. How should health systems prepare, you know, to stay up on recent trends regarding flexibility? You've talked a lot to your workforce, you've obviously are well-versed in the literature and well read. What would you recommend for our listeners to make sure that we can continue to push the limits in regards to flexibility and stay ahead of the trends?

Rudy:

Yeah, great. Great question. You know, I one of my favorite things to do as the C N E at UW is meet our, our new nurses when they are onboarding. And I, if schedules allow, I have an opportunity to meet with him and just sort of share with them some, some thoughts. And I talk to them about their wellbeing. I talk to them about really finding a healthy outlet. You know, nursing can be very stressful, but I also talk about the fact that nursing is one of the very few professions that is a lifelong learning journey. You don't graduate nursing school, take an NCLEX, and then you're done, right? We don't ever have to take another test or do another, do anything. Again, that's just not the reality. Healthcare is changing, it's evolving. Technology changes the things that we used to do. You know, I I I go back to when, when I was in healthcare in the early nineties and was not using gloves to start IVs, you know, now that's just normal practice.

You know, I think about nurses that are even more seasoned and experienced than I am that used to sharpen needles or used to have chest tube bottles as opposed to one system, right? So my my point is healthcare is constantly evolving, and as leaders, we have to stay apprised to those upcoming changes and all of those things are available. So, you know, my suggestion, which is not gonna be shocking, this is not gonna be one of those pearls of wisdom that somebody's gonna come back to you and say, wow, I had no idea. It's really pretty simple. And that is that as leaders, we need to stay as close to changes as possible, which means that we need to educate ourselves. We need to read our academic journals, we need to read about changes in healthcare. We need to stay on the forefront during some of these conferences, attend conferences, maintain your memberships, because that's where things are happening.

That's where things are changing. I, I tell to people all the time that nursing is the one profession. That it's not only appropriate to steal somebody else's idea, it is encouraged. Yeah. You know, if another institution is doing something that's unique and I hear about it, we need to be doing that at UW Health. We need to bring that here. And there's, so there is nothing that we can't learn from one another or that we can't grow from one another that's gonna improve our processes, make us more efficient support our nursing staff. Because no matter what we do, and no matter what we bring to the table, at the end of the day, it's to improve the outcome of the patients and the people that we serve. And so, for me, the answer's pretty simple. You have to remain astute to the knowledge that's out there.

And you have to, you, you have to be attending conferences, you have to be able to have a network of leaders that you can bounce ideas off. I mean, Danny, I don't know how many times you could probably share with your team that I've called you and said, I've got a question around staffing. How does this work? And, and I remember back at early 2005 when I shared with you my own ideas around staffing, and you were like, what are you thinking that is not, you know, remotely close, <laugh>. And so it's, it's that level of knowledge that I think is important because it's impossible. It would be huberous to think that I could figure it all out, you know? And so leaning on folks like you, leaning on other experts in the industry is critical. And having and having building that network is so important for, for nursing leaders.

Dani:

Yeah. Community is where it's at. I truly enjoyed our debates, you know, for years we've debated around staffing the workforce and it's only made us stronger. It's pushed to think differently. And so I'm glad that the listeners are able to hear a little bit of our conversation today. Today. And this is just really, you know, we get a bit more heated when it's not public, but it's all in good, good faith, good spirit of really testing the limits. And so encouraging our listeners to stay in community. We are of one profession, are we not, you know, we, we are nurses and should support each other and really push the limits here with what we can do in the industry and lead, we're called to lead. And so I'm so thankful to watch you as a leader and just your influence and ability to change the industry and influence and impact the lives of the nurses you serve is amazing. This has really been fun, Rudy, and I just wanna end it with, you know, the, the nor the question that we always ask our guests is, you know, what would you like to hand off to our listeners today?

Rudy:

Yeah. I love the word handoff cuz it reminds me of shift report. But I think if I was to one bestow one thing to all of your leaders that are listening and all of your, your listeners, it's that, you know, as nurses, we take care of people. It doesn't matter what type of nursing we do. You know, people oftentimes will ask me, do you miss emergency medicine? Do you miss trauma? And the reality is that my patients are simply no longer horizontal. My patients are now vertical. And rather than me starting IVs, I'm working on things that are impactful on the lives of our staff. And so that same vigor that we treated our patients with is the same sort of response that we need to take care of our staff. Along those lines, I oftentimes, you know, I said that one of my favorite things is to talk to our new nurses.

One of the things that I share with them is that we have an organizational structure and what they see on the organizational structure from a nursing perspective is a triangle or a pyramid. And my name is on top, but the organizational structure that I have in my office is actually upside down and I'm at the bottom. And I, I, I say that intentionally because we can't know how to solve all of the problems if we aren't connecting with our frontline staff. And so I think the handoff I would like to give is that remember that your staff have the answers. Your ha your staff understand the problems. And nine out of 10 times your staff also have a solution to that. All we have to do is listen. There's some, there's a principle called the iceberg of ignorance that says that less than 4% of the problems are understood, the higher you go up the organizational level at the executive, at the executive level. But at a, at a, at the, at the frontline level, at the staff level, a hundred percent of the problems could be identified and over 90% of the solutions can also be identified. So my handoff for the listeners is pretty simple. Listen to our staff and then help them support them in getting those things done that's gonna make their lives better. And at the end of the day is gonna make my life that much easier.

Dani:

That's so powerful. I do believe the solutions live in the frontline and those living it every day. So thank you for encouraging our listeners and our leaders to continue to press in and speak to those that are doing, doing the work every day. Well, Dr. Jackson, Rudy, it's been such a pleasure having you on the show. I look forward to, you know, future conversations around workforce and other topics and continuing to learn more of the great work at UW Health and how you're impacting the profession. So thank you.

Rudy:

Thank you. It's been an absolute pleasure talking to you and I'm sure I'll be calling and reaching out in the next week or two with another question for you,

Dani:

<Laugh>. Please do. Thanks for everything. Please do. All right.