Dan:
Welcome to The Handoff, a podcast about the most critical topics in nursing. We are excited to test out a new live format today. So thank you for joining with us and bearing with the new version. We thought this topic was really important, and we would like to talk about how to stop nurse burnout, specifically some tangible tips that healthcare leaders can implement tomorrow. We have Dr. Courtnay Caufield as my guest today, she was on the first season of The Handoff, and was a wonderful guest and talked about all things leading innovation within health systems. Courtnay at that time was at Cedars-Sinai hospital, and now she has since moved to the Kaiser Permanente Sunnyside Medical Center as the chief nurse executive, and I'm really excited to have you on the show today, Courtnay.

Courtnay:
Hey, thank you so much for having me. It's lovely to be here live.

Dan:
Yeah, it's live. No holds barred. So, what I want to do first is talk to you about Trusted Health, and just do a brief overview of what we're up to since Trusted Health sponsors The Handoff, and then we'll dive into how you can stop burnout and do wellness activities with your team. So, I host the podcast that's available on your latest Apple iTunes, Spotify, wherever you get your podcasts called The Handoff. We talk about all things, healthcare innovation, and we're in season two, we have about 30 episodes on track for this season and you can check us out on trustedhealth.com or on Apple iTunes.

Dan:
You might want to know what is Trusted Health. Well, Trusted Health is transforming the contingent clinical staffing space. We are a marketplace where we match nurses to job opportunities out in the world. We do that very efficiently through a technology platform. Think of a LinkedIn profile built for clinicians matching to jobs in real time out in the world, we have about 2000 healthcare systems that we serve. We have an awesome team experienced in all the latest technology and in healthcare leadership. We have about 20% of our team are nurses, including myself, I lead up the clinical innovation work and we're a recognized business. We made Forbes next billion dollar startup, and we've received numerous awards, including the ANAs Nursing Innovation Award, which we got last year for our nursing team.

Dan:
We have about 117 employees, we're in San Francisco, and most importantly, we have about 150,000 nurses on our platform that we help manage their career, everything from just managing their license to helping them find opportunities in the world. So, I want to just shout out to Trusted Health for letting us have this platform and allowing us to talk about some of the critical topics impacting healthcare leaders. We've also built a guide which launches today. You may get an email about it, or you may have already gotten the email about it, but we have created a mental health landing page for leaders specifically. There's a ton of resources on there. The recording of this podcast will be there as well.

Dan:
We have not only podcasts content, blog content, we've built a PDF guide that you can download and take into your setting tomorrow with tips like you see on the screen, just conversation starters for talking to your team one-on-one. We have some team tactics and we have ways that you can lead up and help your supervisors understand how your team's impacted by stress, burnout and mental wellness. We even have a little badge holder, you can cut out and put behind your badge with tips and tricks for healthcare leaders to help their teams support mental wellness, because we are in a crisis.

Dan:
Finally, I'll just put up the website if you want to check it out as you're listening to us chat, but it's just launched, it's trustedhealth.com\team-mental-wellness, and you can check out that, it's live as we speak. But enough about Trusted, let's talk about mental wellness. So, Courtnay, you are a chief nurse, you have led teams in massive health systems in the most chaotic of times, including COVID and natural disasters and all kinds of stuff. But first, how do you keep yourself well in your own personal life?

Courtnay:
Thank you for the question, and just as I'm watching the precursor to this in the screen. Just like I think most of us on here have a sticky note out and you're writing it down, and leads into to one way that I try to take care of myself is making commitments to myself to set up time, to do things like this mental wellness check in, outlook can be your friend or your foe, and one thing that I try to do is block time that is precious and reserved for internal and external development and being able to have a morning inspiration, having links that pop up on my screen. I go wherever outlook tells me to sometimes. If it's telling me it's time to stretch, I need to make a commitment to myself to listen to that. Also, that brain stretch, giving yourself the opportunity to look and see what's out there today.

Courtnay:
I'm so thankful for this podcast, just having the opportunity to talk through and permission for leaders to say, "Hey, I need some help and I need to know what others are doing." So, I give myself permission. It's okay to not be okay. It's also okay to not have the answers, and knowing that leadership, let alone nursing, let alone healthcare, is an involving sport if you would say, where we are trying to do the best that we can, but also setting a good example and at times being vulnerable. So, for myself, I make the time to check in with myself and try to keep those commitments.

Dan:
I love that tip and trick that you mentioned too, is like literally schedule it, especially in some of these roles where we're running around all over the place, we need to put time on the calendar for five minutes to chill and check in with ourselves. When we were prepping for this, you sent me a long text message, which I loved and actually used one of the quotes on the website because it was so awesome. But you likened your ability to provide great patient care and assess your patients to help leaders assess their teams, and I think that was a critical aha for me, which is you're now a nurse leader for the team, use those same assessment skills and figure out what's going on and actually address it like you would with your patients potentially. Can you talk a little bit about how you assess your team's mental wellness and how you might start to intervene when you sense something's up?

Courtnay:
Thank you. Yeah, and I appreciate being able to brainstorm with you. I mean, that is a great opportunity and I hope all the leaders you have, if you don't have through a professional organization or a mentorship opportunity, that with each other as well, being able to throw ideas out there, I feel that many nurses, many nurse leaders know their practice area, we have professional certifications. One thing we were talking about in a professional development senses, your specialty now is leadership as a leader, so what are you doing to become certified? Look at what other teams are doing, look at logistics, and I'm sure every nurse leader has a whole cabinet full of self health and being the best leader that you can be books, but what worked well for me is getting my nursing brains. When I went to my floor when I was being a clinical provider and setting up my day for success, staying organized, the best that I could and knowing what I needed to provide the best care.

Courtnay:
One tactic I've done with my leadership team is try to have my leader brains, which ... take it with a grain of salt, this is live, by having your script for the day, you have what you have to do, you have all the stuff you want to do and you have your vision board maybe, but as I make time and check in folks, having something very scripted for me so that I'm not introducing anything overwhelming to them, but also going in and seeing what are the top three things I need to know about you and yourself to help you today, and then how are we doing your "discharge planning" for leaders? How are we going to get you through this week, this day or this month. So, I try to address it that way, and it seems very relatable.

Dan:
Yeah, I love that, going in prepared, even if it's just a sentence to remember. So you're not in the moment humbling through. That's one of my problems, is you get kind of ... you work yourself up in these situations. I know there's something wrong and I don't want to say them, and within the moment you just-

Courtnay:
Exactly.

Dan:
... feel like you're on some sort of cartoon, just totally bombing and falling off the cliff or whatever. I love that tip. What are some examples of things you've seen in teams where you're like, "Oh, something's wrong. Like that leader's totally burned out or they're acting out, but I know there's something deeper." Can you talk about a couple examples maybe?

Courtnay:
Oh, sure. I think pre COVID, this is a daily, weekly sometimes thing. I guess it's situational where is it something that I know about that's going on and it's a known issue or warranted acting out of control or is it something's up and I want to pull that person aside and check in with them? But back to scheduling time for myself, asking my team members, "It's okay to miss this meeting, we're a team, we will check in with you, go outside, get some fresh air." Giving permission to, again, not be okay and say we are human, so is your team. And knowing that sometimes we need to take the time to be able to recognize what are we doing, is this the right thing to do today? Am I going to show up with my best and being honest and gentle at times where you're not showing up the way I know that you want to.

Courtnay:
I'm going to tell you that because I care about you and I care about your professionalism, let's take a moment to reflect and give them the time that they need. Does that mean you miss part of your finance meeting? Maybe, but this is an investment in your people and your time, and with teams now, one thing that we were talking about the other day is where nurses ... we have a code, you run in there, you know what to do, the adrenaline's pumping and the adrenaline has not stopped since coded. We are burning out of our essential fight or flight hormones to deal with the fires of the day, and then still now trying to conduct business as usual, and then there are external community factors as well.

Courtnay:
So, I'm seeing leaders having a real hard time stopping one subject and starting at another without becoming robot like. Again, the followup and trying to allow say, "Hey, later on today, we're going to come back to what we experienced this morning and talk through that, give you time to process that because what I find is myself and others will take it home and you're not your best outside of work either." So, giving yourself permission to try to decompress that and put forward, what do I need to approach? What's the fire that needs to be fixed today? And next time that fire comes up, how can I maybe address it differently?

Dan:
Yeah. So, I think leaders get a lot of adrenaline and renews that adrenaline and the crisis of fighting that fire and fixing it, but if it keeps coming up, then it's going to continue to wear on you and you're going to stop. So, it's about fighting the fire, but then zooming out and fixing the system so the fire doesn't happen again and not just going fire to fire. I think that's a great tip.

Courtnay:
Yeah, and I think like what you mentioned, if that fires today, for anybody listening to this podcast, I know it's being recorded and you're thinking I just need something to inspire me for, one of my top tricks and tips for myself and for others is, saying it round, take a deep breath saying it is okay to feel this way and recognizing, how am I breathing? How am I sitting? How am I showing up? Do I really want to send this email right now? And think about, "Okay, by the end of the day today, how do I want this problem to be handled?" I'm hoping that we at least have a handle on the situation and then put that down for yourself and just aim towards that goal. Think small sometimes rather than thinking big.

Dan:
That's another good point. Throughout this live podcast, we're going to be sending a few polls to the audience, so I'm going to launch a poll here, and they're anonymous. So you can answer however you like, but this first one is, "Does your system intentionally support mental wellness?" That was a survey that we sent out right at the height of COVID, we got about 1500 nurses to respond and they, basically 95% of the nurses said that they felt their hospital or their health system did not make their mental wellness a priority or didn't support it. That's overwhelming.

Dan:
I've spoken to a lot of nurse leaders, nurse executives, and they've said, "No, we try, we try." But there is definitely a disconnect there, and sometimes burnout is that elephant in the room. So, as I launch this poll, I'd love to talk to you, Courtnay, about how do you address mental wellness and burnout as the elephant in the room? What are some tactics that you use to just even broach that conversation?

Courtnay:
I think if I have to answer that question which I will as well, I know where there's an EAP program, I know there's a website, if I have time to figure it out I'll get to it. I know I can go in, maybe, a calm area. In my opinion, taking the time and permission, back to permission around taking a moment. What does mental wellbeing mean? Does that mean I'm going to be able to get through the day? Does that mean I'm going to be able to show up to work tomorrow or does it mean that I have some tactics in place? So, talking through with other people and making it okay, again, to not be okay today, what have you done and ask your peers, "What are you doing when you're not feeling your best?" But I know I have to get through my day and show up. What does that look like for me?

Courtnay:
Then being honest with yourself and giving yourself time to say, "I really had a hard day today and here's some of the reasons why I did what I did, and I would look a little bit differently on that." But utilizing services, I guess, is what I would say as well.

Dan:
Yeah, right. And knowing there are some support services, and we also found that the nurses wanted peer support. So, do you have any tips on creating a clinician to clinician support network within your hospital to help people that may not want to talk to the EAP, because they don't understand nursing. That's kind of the excuse I hear is that ... That's some person that they're not going to get the fact that I just watched someone die or that I'm dealing with this PPE stuff or whatever. I want to talk to like a nurse. So, do you have any ways that you've done that in the past?

Courtnay:
Well, you're looking at it I think. This is a fabulous way. I have done a few happy hour zooms with colleagues in a closed room where I know I can be free to talk and there's permission sharing of, "Oh, you're living that too, I'm not alone." In addition, the other folks on my team saying, "How have we paired each other up as peers?" You see little groups of people who just get along, but trying to change that up a little bit and say, "Hey, I want to connect you with somebody who's in a role like yours in another organization who there's no drama behind talking about this person in another unit, there's a lot of organizations that have mentorship programs. I've been a part of them as a mentor and a mentee, some work well, some don't. It's sometimes relying on the folks who are paired up to do that.

Courtnay:
So, even making your own little matchmaking across another facility in your area as a meet and greet and a tour, get out a little bit and then have a phone, a friend type thing, but programs just like this and having a zoom to be able to talk through things I think is huge. People need a forum, people need a voice.

Dan:
Yeah. We found that as well. We had partnered with Ohio State and actually had mental health nurse practitioner faculty supporting some of the nurses in the hotspots of COVID and it was just really, really well received because there's that instant rapport. Not that everything has to be nurse to nurse or physician to physician or a team member to team member, but there's definitely a resource there. Then I think the theme that I keep hearing from you is like, you have to think about the system, you can't just go around and half-bake these things. You have to be able to understand the patterns and zoom out and zoom back in and solve, and then see if the patterns happening and come back in and solve it again. In a chaotic, crazy hospital that is understaffed, hit with COVID, with competing demands, how do you make time as a leader for that?

Courtnay:
I think just like any day, it is integrated into the meetings you have to go to, meetings run minute to minute, there's no walk time. I know folks have been a little bit better about maybe making them 45 minutes introduction type of thing, adding in the beginning, "Hey, at the end of this meeting, I just want to talk through how everybody's approaching X and how you're feeling about that." The feelings come out a lot right now in meetings, I've noticed people start with their feelings and their stress. When you have a room of people who say, "My team is burnt out, my team can't take one more thing." We know the tidal wave of potential reductions or less patients or more patients or less supplies is coming in and that anticipatory stress is the elephant in the room that you were mentioning before.

Courtnay:
So, putting time for it when you still have to deal with the issue at hand or the meeting that you're coming to address, and also inviting people who don't normally work in roles such as yours from maybe your revenue cycle, your finance department, have them invited into meetings that they might not normally be into. So then when they are a little bit more understanding of the issues that are being handled right now.

Dan:
Yeah, that's great. So get awareness of the stresses on the teams from people that may be that one sphere of influence outside that meeting so that the budgeting team can see the stress on the team from XYZ decision. I think that just provides that relationship building, but also the insight into, "Oh, this decision has consequences, and maybe there's a better way to think through it with the team."

Courtnay:
And additionally, I would say we've learned through the current situation how many meetings can be virtual, but how many meetings do not need? We had out ribbons [inaudible 00:17:09] that could have been an email, let's look, did the project finish? Then stop meeting. Let's do pulse checks, and you talked earlier about stepping back in, it's like a rapid PDSAs type thing. So, how are we doing that with our people as well and the things that we're asking them to spend their time on?

Dan:
One tactic that we use at Trusted as well is, every quarter we reset the meetings and we re-examine, "Do we need to have this standing meeting, this huddle? Is this team done and now it needs to change?" We don't even schedule meetings past the quarter, which is a practice that you could definitely have especially around some of those standing ones where you show up and you're like, "All right, we just talked about this for the fifth time and that's five months, and we're not moving the ball, maybe we need to take a break or maybe this needs to be a quarterly or yearly meeting instead of a weekly one."

Courtnay:
There you go, there's a whole great opportunity for power, giving them the power back. You feel helpless right now, here's the power for you. "Do you feel like we need to continue to meet? And if so, what are we going to do? Otherwise, everybody had to leave."

Dan:
I love it. That should be the first question of every single meeting ever I think.

Courtnay:
How [crosstalk 00:18:11] being recorded?

Dan:
That would help my wellness I think, that's really great. So, let's get tactical for just a second. Walk me through your best team huddle. How do you start it? How do you deal with the emotion that may come up and how do you wrap it up so the team in 15, 30 minute huddle's ready to just go tackle the day?

Courtnay:
It's a tough one. I guess things I've seen and ones that I've walked out and everybody felt really good on the same page is really clear, simple, aligned goals of what we're here to accomplish, mutual respect, putting our phones down. They're going to find you if they need to find you the next half hour. We really want to talk through this accomplishment, we want everybody to have a voice, and at the end of this, if we have a solution wonderful, if we don't have ... because we're fixers, right? We're nurse leaders, we have to fix something by the end of the meeting, or a team huddle that we've had and we talked about let's say, today we are talking about mental wellness and health, let's talk through this and allow everybody to share what they have done that works well and help each other, phone a friend, don't suffer in silence.

Courtnay:
When we're at the end of this meeting, folks being respectful, coming out of it with, "I have a plan for myself and I know my buddy right here is somebody I can lean on when I need that help." If I don't feel comfortable doing that, feeling comfortable reaching out to somebody else and saying, "You know I noticed that you might need some help, I'm just here for you if you need me, and this is how you can reach me, and I'll be available for you and not an empty promise."

Dan:
Yeah. That's great. Yeah, building that camaraderie and the connection so that people feel supported.

Courtnay:
Yeah.

Dan:
I'm going to put another poll up on this screen. So, the statement is, "It's easy to bring up mental wellness to my leadership team." And so you can answer nope, sort of, yes or they would blankly stare at me. You choose your answer. These are all responses that I've personally seen. When a team comes to you and says, "I'm burned out." And now you're tasked with like, "Okay, I got to figure this out, there's some merit to it, there are some processes that are broken that we need to address as a system. Now I got to go to my CEO or my chief nurse." How do you do that? I've been looked at blankly when I've said the team's burned out they can't handle one more thing, and then the leader's just kind of like, "Oh, well, this is work, you've got to do it." So, do you have any tips on bringing that up to leaders?

Courtnay:
I think I've been the blank dare before, I've received it and I've given it because you think, what else do I have to give? Or what other advice? I've run out of the playbook. We're all in this together, but that's when I do see the spark sometimes of innovation happen where, let's just sit for a ... let's be okay, let's sit here together and say what's happening or this is not working. I can escalate this and commit that and say, "I want you to know I have done X, Y and Z. I've also tried this and this. What other things would you guys suggest that we might do?"

Courtnay:
If there is nothing, say, "Okay, if this is something we're going to live with, if you're living with a process that is not working and is not going to change living with a toxic leader, that's not going to change your living with something that is stressing you and you can't make a difference in that role, how are you going to process through that and still thrive with yourself and be able to use the tactics around." Here's how I'm going to address this person. Here's how much permission I'm going to give them or this process to suck the life out of me, let alone being able to show up for my team.

Courtnay:
About making those self commitments to yourself and then back to, the outlook and back to making those commitments and promises to yourself that the fire that's coming on the building, is it a hypothetical fire, are we really going to evacuate? What do I need to do? When do I need to panic, and I need the energy for tomorrow and for my family?

Dan:
Yeah. I think you mentioned the big piece which is, commit to it and follow up. I think one of my favorite things that I talk about is in the absence of information, people will make it up. And so if you promise something and say, "I'm going to address it." Then you do it, and even if you don't communicate it back that you had that conversation good or bad, whatever the outcome was, people will think, "Well, we're just saying this into an empty box and it goes nowhere."

Courtnay:
Yeah.

Dan:
So I think that key leadership piece is the followup, which is so important.

Courtnay:
Yeah, and I've seen that work with the younger leaders, have some really great tactics electronically. I mean, I used to use a big dry and white board of, here's the things that we're working on and here's the date that we did something about it, and staff just want a turnaround, same thing with leaders, same thing with us as executives or in academia or any nursing leadership, you sometimes assume that I fixed that so they know it's fixed, but rather than I escalated that and here's what I've done, I'm just circling back. But yeah, again, back to mental wellness, it takes that concern that the fog of what if out of the hypothesis of what we're dealing with today.

Dan:
Exactly. They take away the ambiguity, which definitely leads to stress. So it looks like our results are back, and sort of, again, wins the show. I might never put sort of as an option again, but there is a little bit of no, and they blankly stare at me, which is there. Then yes was one, and then a couple of people said sort of. So, it definitely seems like there could be some tools on what's the right way to bring it up, but I want to go the opposite way just because I like having fun, and you're awesome, Courtnay, what is the wrong way to approach you about an issue with the team? What's the way a healthcare leader should never go to their boss and say, "My team is burned out?"

Courtnay:
Oh, and this is live, so it'd be very easy.

Dan:
[crosstalk 00:23:34]

Courtnay:
So, sometimes people need to come to the office and say, just start ranting and pointing fingers is probably not a great tactic and blaming, even though you recognize maybe they're in a state, but sometimes it's vegus. Do you need to vent or do you need me to help you fix something? But I'll say out of all of that yell and scream all you want but the ignoring it would be the key to not the way to approach it. So, ignoring and just assuming and hoping something happens and it never will.

Dan:
So I think that's really cool because you're definitely not a toxic leader. We wrote a chapter on that, on toxic leadership. Courtnay and I in our latest book, it's actually chapter 13, which I think is like the perfect symbolism for the toxic leader chapter. But I think what you just said there is that just bring it up. If you're emotional and stress and you need to scream and you have that relationship with your boss, just getting it out there is probably better than ignoring it. We wrote this in the chapter, ignoring it lets things fester, and then you get a team that's septic and toxic and that's even worse than having emotional moment where you may not be your most professional self.

Dan:
So, I think that's a really cool nuance thing, is as a leader can you see through the emotion of it and get to the heart of why that person's coming to your office or meeting or whatever, and just let that happen and then say, "And how do we move forward?" So, I really like that. So all of these questions I've asked have been submitted by the registrants, and so these are from you, but I would like to open it up to the people we have on the live show and see if there's any questions they would like to ask Courtnay. You should be able to unmute yourself, and if there's an issue with that you're welcome to type it into the chat and we'll get them answered.

Dan:
So, as you're thinking about that question, I'm going to ask one more, which is, how do you keep morale up when it just seems like another thing, how do you couch the next focus area or the need to fix falls this week or whatever in the context of the constant change that people have been experiencing and keep them excited about continuing to move forward?

Courtnay:
Yeah. I'll admit it's a challenge. I call it the fire of the week. It's the problem of the week, but now this was pre COVID as well COVID has just brought different things to light and more meetings focus on one type of problem. Having fun with it a little bit is great. If we have to have our falls meeting outside, maybe we'll be more productive today. Try to just spice it up a little bit and change up the norm. Having different people present, asking people, "I want you to help me make the agenda in our fall." Let's say we'll use the falls committee as an example, rather than just reporting out data, that again, we can get an email, bring pictures, bring some examples. Let's do a tour and show and tell today, let's talk around some reasonable things that are real life that, "Oh, it makes sense."

Courtnay:
I do say, back to my nursing heart, going back to the professional practice model, looking at also where the scope and standards of nursing, how do we bring what we're doing back to the love of our patients, the love of care. Also, in nursing leadership competencies, you should know how are we guiding our teams in structuring that and bringing it to the family and the patient centered care that we all desire to do, but we drift from when we are dealing with statistics and problems. So in addition to trying to have the atmosphere of the meeting a little bit different, you don't have to have the same structured agenda. You can mix it up a little bit and start at the end. Let's start at the end with, what does this solution look like that we want? Let's work our way backwards a little bit, but again, bringing it back to why we are here.

Courtnay:
Some organizations put their mission statement at the top of every meeting. A lot of the Magnet facilities, I know, have their professional practice model at the top, asking someone to randomly read it without reading their papers stressful, like, "Tell me why you're a nurse isn't?" I think everybody loves that and it brings them back to, "Okay, now I'm engaged in the topic that we have to address."

Dan:
All right. So, let's see if there's any questions from the audience. You can type them or you can unmute yourself. All right. One of my favorite people wrote in the chat, "What has been your experience when the person above you in the organization is less focused on people's mental health than needed. Some key leaders are great with all sorts of crisis, but not the emotional health ones? Consider that you are in the middle of people who have needs and then a non-hearing boss.

Courtnay:
Okay, well this is again live, so I'm being very politically correct. However, I will also rely and loop back to that toxic chapter that you were mentioning. I have experienced this type of situation before, and you are politely trying to translate that our superior leader in this role, whatever role that might be, they really do care about your mental wellness, it's just that maybe they don't get it. So being that middle person, it doesn't come across the way that the teams would like, they need that message through, and if they don't feel that you can convey their message, what I've seen happen is, I'll just go straight to the source and tell them how I really feel, which doesn't usually end up in the best outcome.

Courtnay:
What I've seen that has worked well is as the translator putting it in the terms that the key leader can understand, trying to relate to how they understand, how do they learn? How do they speak the language of healthcare and mental health as a doctorally prepared nurse, I'm always going to look at the evidence and look on research and say, "Here's some statistics on how the mental health and burnout in our system is impacting our leaders and inability to provide the leadership and the tactics to meet our goals." I've seen X, Y, and Z, here's what I need from you as a leader, because maybe that person doesn't have those, "Oh, this is what we should do." They're going to need help."

Courtnay:
Sometimes framing it that it came from their perspective is a win, and then carrying it down to the team, but also bringing that senior leader along to say, "Together we discussed some of your concerns and here's some tactics that we would like to bring in." If they're not willing to do that and there isn't much you can do about that, still portraying the organization and saying I'm speaking on behalf of the senior leader and myself, and this is what we'd like to do.

Dan:
Yeah. That's a good point. I think it's the translation which is key. Then putting it in terms that that leader may understand. You're not going to be able to change overnight the way that leader processes information or reacts or decides or values a certain thing, but you can change the language you use to translate it. So if that leader is hyper focused on the budget, put it in terms of the budget. My team's burned out, I have 15 more FMLAs and sick calls per month now that I'm noticing that translates into X many thousand dollars a month, we have to address the underlying cause. Like just that simple thing I think could be really crucial for leaders, understand it's not about you at that moment, you need to be able to translate it to them, and there's different ways to do that, and you got to figure out what the flavor that person likes. But I think that's really, really good advice.

Courtnay:
Yeah, and both ways, you say I'm the platinum role, right, treat others how they wish to be treated. That means reporting up how you're going to deliver that message and not come in and be, "I'm just complaining to you, but here's some significant things, and here's what I think we can do together and why." Then the same way back down, rather than just saying, "This is what they said to do, it is coming up with a group think solution.

Dan:
Yeah. So we have another question from another one of our participants, "Developing nurses emotional intelligence and preventing burnout, how do you do that?" How do you develop your leaders emotional intelligence? You just send them to the EQ class or do you coach them or is it a combination? How do you do that with your team?

Courtnay:
Actually, I do think that this is something in nursing leadership and nursing in general, that we've talked about more recently, but how many people have this as part of their orientation? How many people have structured programs? Here's some tools that you can take with you as you get into a stressful job, here's how you check in rather than here's the number to call if you think that you're burning out or I never want to call that line because I can do this. I mean, to show I can do this. So, bring the information, again, it's okay to not be okay today. But also as Alexandria had mentioned here, emotional intelligence, what does that look like? What does it sound like? What does it do to prevent burnout, and how are we as leaders embedding that in our schools, in our orientation and as leaders in our routine rounding rather than the check in a month? "Anything I can do for you as I'm walking out the door?"

Dan:
Right, right, right [crosstalk 00:32:15]

Courtnay:
[crosstalk 00:32:15]

Dan:
It's about the actions and the words, right? It's like, "Hey, anything I can do? I got to go, I got to pick up my kid?" Or is it standing, focused, present, what can I do for you?

Courtnay:
Just like we do with our patients. We're not going to ask them, "Is there anything else you need before I leave [inaudible 00:32:31] at them and leave. No, I'm going to hold my bladder and I'm going to fall in the bathroom [inaudible 00:32:34] Same thing with your team. I know I don't want to bug them, I'm just going to go over here and do the best I can and have some wine tonight.

Dan:
I just don't toss the urinal through the room as you come by and say, "Hey [pee 00:32:47] in this, I'll be back."

Courtnay:
Yeah. And as nurse leaders that does create a burnout as well in another level where you want to give ... you're a fixer, you're a giver, you want to give all the time to every employee. So again, structuring that and trying to build that time in, but again, giving yourself permission.

Dan:
So, we're going to take a few more questions. If you want to type some, please put them in there, I'll take a few more, but how do you set boundaries for yourself? I know as the chief nurse, it's a 24/7 job. It's a 100 hours a week if more, it takes a lot of you because the hospital's on 24/7. How do you set boundaries to say like, "I feel good enough right now to just disconnect, to turn my phone off, to not answer that email at 1:00 AM." What is your tactic for that?

Courtnay:
Well, I mean, and I'll be the first to admit that I have had struggle with this and I've had that struggle of, "What did I forget at 3:00 AM?" I don't know if anybody listening to this has a notepad next to their bed for things that they have thoughts or great ideas in the middle of the night or things that you want to remember or you choose your notes up. But again, being okay with waking up in the morning and saying, "Okay, I have a couple of things I have to get to." But again, scheduling self time with yourself to do a mental check-in, whether it's listening to something on your drive to work, whether it's doing just five minutes outside, clearing your brain, clearing your air.

Courtnay:
I do yoga, I love yoga, but I also like breathing techniques, and it's okay if you don't feel like doing it today, but giving yourself that permission to check in with yourself, scheduling time, I run out of hours in the day every day, there's a meeting I'd have to decline every day. But knowing that you're going to do the best that you can to hit the higher priorities, then circling back with people things, thoughts, meetings that you weren't able to get to, but knowing you can't be everywhere at once, but absolutely doing the best you can when showing up where you are.

Dan:
And pausing your notifications and taking off your Apple Watch and physically removing the things from your auditory, like, bubble, you can't hear him, you can't see [crosstalk 00:34:51]

Courtnay:
[crosstalk 00:34:51]

Dan:
You got everything, right?

Courtnay:
Yeah.

Dan:
Even just taking that away is good, and then my personal one is just being okay with people not being able to get ahold of you for a little while, and then anything around the water got to get on the water.

Courtnay:
Yeah. Putting it in your out of office messages, even at the end of the day is okay. Here's an automatic message. I may not be available, they will find you. I feel like there'll be a bat signal in the air. If they need you, I was struggled with people wanting to do a work from home day, which we implemented to try to give some environmental space. Maybe we'll write better emails if we're in our pajamas, the computer is there. You can connect to people, when you're there, be present. If your meeting day looks like you're not going to leave the whole of your office all day, could you do in a more comfortable environment whether it's outside? We saw great responses from that.

Courtnay:
However, surprisingly, a lot of people didn't feel comfortable doing that because they felt that they weren't being a good leader or a good team member. So, it's just breaking those barriers as well.

Dan:
Yeah. It's breaking down the assumptions, right, that you don't feel like you can stay home, you got to be there, there's balance in all of it. So, Joyce wrote, "Have you linked high-reliability principles to the need for staff to help one another if someone seems like they're in trouble?" I know Kaiser does a lot of highly reliable organization stuff, have you made that link?

Courtnay:
I've seen it in some aspects and I see some opportunity for that as well. Helping people connect with each other. We have, I think, really great programs, many organizations, a new grad program with a buddy. You have an orientation person for a couple of days, but then what? So having those support groups that can be ongoing outside of your arena and then having leadership really have some framework for them to say, "Let's do a circle back on this." Give them some tactics, the things to work on and or to circle back the principles of high reliability in organization where we are aiming towards the same goal.

Courtnay:
When we can get people who are maybe from different areas, but they can have the same vision starting off the conversation, it really seems to grow a great relationship on ideas, innovation sharing, but also sharing stories of how, "I'm not doing okay with this, how are you handling this?" And encouraging that and not requiring people to have to do it on their off hours either.

Dan:
Yeah. I think in the HR principles to building it into the daily briefings, like not just operational stuff, but how are people feeling, and what's the stress and then check ins with the team to say, "What's up today?" Then being transparent as well to say like, "I'm having an off day, there's somethings going on. I'm not fully present and that's okay, and I'm just letting you know, and so let's balance this out together and figure out a way that we can get through the day." I think all of that transparency is great.

Dan:
Joan also wrote, she was asking, "What are the greatest barriers to nurses meeting these things?" I think you answered your own question. It's not yoga and meditation by itself. I think we found in our survey the nurses while they may love those things, those are not an answer, and there're systemic issues both in our nursing profession and in health systems that stop our healthcare professionals from being able to feel comfortable about speaking up about these types of things or having space to do it. I think you're exactly right. We need to teach people to say no in service of their wellbeing.

Dan:
One of the things that I led with Trusted was, when nurses were going to the front lines of COVID in New York, we held a webinar and we basically gave them three easy principles just to help them manage through this massive battleground. One, protect yourself, and we gave them some tips related to saying no, making sure they feel safe, making sure they take the time to train themselves up on things that their hospital may not be able to give to them in a crisis situation. Two is protect their license. So taking assignments that felt safe and those types of things. Three is ultimately protecting your patients. If you take those three principles and think about your own mental wellness, if you don't take care of yourself, you're not going to be able to give to the team or to the patients.

Dan:
So I think number one is that, and then ultimately as a nurse leader, your license is to practice nursing with your team. So taking care of them, protecting them and their license and their mental wellbeing all relates back to patient care. So, I think those are some really important tips, but if you can just distill it down into a couple of things, it doesn't have to be all this stuff. You don't have to have apps for all of it, literally just space and transparency. Some of these things you could them all with your team, start the conversation and then you can back them up with those other tools I think.

Courtnay:
Yeah. Well, and if you're looking for the small wins, I think Joan made a very great, great statement in regards to permission to protect yourself, and that means mental wellbeing as well as physical wellbeing. So, what is your bandwidth? Nurses are chronic. Yes. I will take care of that, I'm going to fix that. Nurse leaders are sometimes expected that it's a yes, and no doesn't necessarily mean no I'm not going to do it, it just mean no I can't do that right now. I don't have the bandwidth and I am going to make sure that I have made this commitment to myself and have that critique.

Courtnay:
So, having self awareness to see I'm starting to feel overwhelmed, I'm starting to get behind and feel behind what's this something I can do right now to look tomorrow or look this afternoon to catch up, feel better and be able to put myself first, and so I think that permission and teaching that as a nurse, a leader, healthcare in general, that is something that is a critical need and a core part of learning and being in a leadership role.

Courtnay:
Additionally, what is something that nurses need right now I saw and what you mentioned as well, and that leadership ... today's a weird day and age, everything's on fire, everything's in crisis, everything is high stress and more than ever looking for some stability. So, is there any stable things? Are there anything that is solid that we can provide reminders to and say, "Here is something that is given for us. Here is something that we've made some progress on." Look for some small wins. I think everybody needs some small wins right now, and in addition to that, the check-ins, how's it going? Who's made some progress? Have you made progress? Check in with yourself to look for those opportunities to see some success.

Dan:
Great advice. Like we talked about, the clinical staff need a different level, I think, sometimes of support. So, find those peers, find the resources and bring them together. Even in the live podcasts, we like to do the tradition of the end of the podcast which is handing off that one piece of information that you want our listeners to take home. Courtnay, what would you like to hand off to our listeners in The Handoff live?

Courtnay:
Handoff live. I think maybe at the beginning of the podcast, I would have said something a little bit differently than now. I appreciate the opportunity and the conversation, a piece of advice, do something like this with your teams, have a conversation, put it out there that it's an open and willing topic to talk through, and we don't have to have a solution at the end of it. Let's just talk through some tactics and back to, I think, that what I said earlier is, make a point to make it okay to not be okay sometimes and say, "I am tapping right now, I have to phone a friend." That's okay. Commit to yourself and know that as a leader saying that out loud is sometimes needed, because we may think it's assumed and it's not.

Courtnay:
So, I guess an ask would be try it with your teams at least to one person, and rather than, "How are you doing today? Is everybody feeling okay? I'm not doing that great. Is it one of those days that you need to phone a friend or hand something off?" Maybe today's not the day you're going to say, "I'll fix that for you." Let's get some help, and I'm committed to you.

Dan:
Yeah. So, committed to the team and committed to yourself, I think that's a great piece of advice to Handoff. Courtnay, thanks so much for being on the show. Everyone, I'll put the last poll up just to see how you'd like to consume more content like this. We're excited to be doing more leadership focus content at Trusted to support healthcare leaders in building the best teams possible. So, we've launched our website for those of you that may have joined later, it's trustedhealth.com\team-mental-wellness. You can check out all of our resources, our guide with a lot of the tips that Courtnay talked about today and blogs, podcasts, articles, videos, every type of way you want to consume it, we've got it there in a really cool format. So you can take it to work and use tomorrow.

Dan:
Courtnay, thanks so much for being on the show. I know this is going to help a lot of nurse leaders out there. You can check out Courtnay on LinkedIn, where else can we find you, Courtnay?

Courtnay:
I have a Twitter pednursegeek.

Dan:
I love it.

Courtnay:
That's my informatics background.

Dan:
Check out Courtnay on LinkedIn, on Twitter @pednursegeek, and then check out this recording if you want more, it'll be up on our website, and check out The Handoff, a podcast about healthcare innovation, anywhere you like to get your podcasts. Thanks everyone. Have a great rest of your day.

Courtnay:
Thank you. Thanks for having me.