Episode 9: Nurse Retention Hinges on Leadership

Leigh Steiner:

Welcome to the Vitals and Vision podcast. I’m your host, Leigh Steiner, a Partner for Behavioral Health Solutions at Relias. I recently had outpatient surgery on my thumb and there were at least eight different nurses involved in this procedure. They were all wonderful, and they all played an important role in making my surgery very easy and successful. And I thought of those eight nurses when I was preparing for this podcast, because most of us have had these experiences and understand how critical nurses are in our health care system.

This series of Vitals and Vision is focused on retention in health care, and we’ve been talking to this amazing group of thought leaders in the field looking at different aspects of retention. Since the nurse workforce is the largest of all working health care professionals. We decided to do a deep dive today into nursing. We’re going to talk about nurse leadership.

We’re going to focus on some of the soft skills that we don’t often attend to. We’re going to focus on how we get nurses to stay. What, in fact, promotes retention. We’re joined today by Felicia Sadler, a partner of acute Solutions at Relias. Felicia has been a registered nurse for over 35 years and has served in a variety of nurse leadership roles.

She’s a certified professional in health care quality, a Lean Six Sigma black belt in health care. And she served as an examiner for the Tennessee Center for Performance Excellence. She’s interesting, which we’ll get back to in one second here, holds a Bachelor of Science in nursing from South University and a Master of Jurisprudence in health law from Loyola Chicago School of Law.

Felicia, welcome. I am delighted to sit across the microphone from you to start out a little bit before we really jump into this topic. Talk with us a little bit about the intersection of nursing and law with that background that you have. How has that informed your work?

Felicia Sadler:

That is a fantastic question. So certainly my foundation was in the area of nursing. I really gained garnered an interest in improving quality and improving healthcare as a whole through my different experiences, both as a frontline nurse as well as in leadership roles. I went on and completed my bachelor’s with the ultimate goal of really looking at something that would set me apart a bit in being able to empower me to kind of accomplish that task, if you will. And so thinking about when I was looking at what types of master’s programs were out there. I really had a strong interest in the health law tract, the master jurisprudence health law.

There’s certainly a difference between that and a JD. But the Master of Jurisprudence and health law was really centered around quality, risk, and compliance. And analyzing those regulatory drivers of health care at the time that I completed this program was when the Affordable Care Act was fresh hot off the press. So I actually got to dive deep into the regulatory components of what was coming forth as we think about value-based care, value-based purchasing, pay for performance. And it’s only grown and strengthened. I then pursued CPHQ and really developed a strong passion, and I feel like with the knowledge and skills I have the abilities to really to roll that out, so that’s really where I started and certainly there’s been a lot of growth as a result.

Leigh Steiner:

Oh, thank you for sharing that, thank you. So when you were talking about that, you were talking about that you chose that path in a way to empower yourself.

Felicia Sadler:

Yes.

Leigh Steiner:

And of course, empowerment is a soft skill. And so let’s jump in from there. I know that you have said that every nurse leader adopts a different leadership. style, but regardless they all have to find common ground. And let’s jump into talking about nurse leadership skills. Let’s start with the soft skills and we’ll move on from there.

Felicia Sadler:

So when we think about, soft skills, and just to complete that story around the MJ and health law, really developing skill sets and growing so that you can empower others. So when we think about leadership, it’s really giving back, empowering others to be their best selves, if you will. And soft skills is absolutely foundational to that. You have to have trust, you have to be able to build a relationship. Leadership is not really about being a better boss, but really it’s to empower, to inspire, to engage, and lead high performing teams to deliver highly reliable, safe, and effective patient care every single time, with every single engagement.

Whether it’s with the individuals, and then ultimately with the teams. And so soft skills is critical in leadership as it relates to being able to effectively resolve conflicts, communicate — communication is absolutely number one. You’ve got to be able to communicate effectively, but you’ve also got to be able to listen just as effectively, and maybe even more so, and be able to pick up on cues the individuals may be sharing, whether they’re verbal or nonverbal. Being able to collaborate with individuals and with teams is absolutely another essential component. And those are just a few, certainly not all encompassing, but certainly foundational to an effective leadership.

Leigh Steiner:

Felicia, talk a little bit about how you teach those. Because often when we think about those skills, we think, well, somebody is born with them, and they either use them or they don’t. So are they teachable? How do you teach them? And what role does, I would say, the culture play in encouraging people to use and to develop those skills?

Felicia Sadler:

There are individuals who certainly have natural attributes and already possess many of those soft skills and are already from an interpersonal competence standpoint, they’re already there and they’re able to effectively execute on those.

Those individuals who find it very easy to create relationships, meaningful relationships, very quickly, they’re able to pick up on cues – whether it’s patients, colleagues, or individuals — they’re able to easily pick up on cues and be able to adjust conversations accordingly. Those are people that seem to have that natural innate ability. And that is true. There are people that are already, that already possess that. Whether they were born with it or that they acquired that through their own personal life. Growing up, they actually had strong mentors or strong role models they were able to identify with, if you will. We think about, is it a teachable skill? Is it something that we can actually teach? and hopefully others will emulate.

Certainly there are successes there and yes, to a point, the individual would have to be open to be able to learn, to be able to adapt their own personality, their own particular style or preferences, to be able to tap into some of those skills. A lot of times through teaching it occurs just in modeling of the behavior, of being able to demonstrate how individuals interact with others. If they were never taught or never saw anyone who was strong in interpersonal skills or possessed emotional intelligence, they may not have ever experienced that. And so being able to pair them with folks or individuals who are strong in those particular areas can be certainly a very effective way of teaching them in experiences rather than just the textbook components.

Leigh Steiner:

So we opened with the topic that, or the focus, that we’re focusing on nurse leaders. And it makes me think as we’re sitting here talking, even if you weren’t a nurse, I would think you were a wonderful leader, knowing you. So is there, what are the, are there distinguishing factors between nurse leadership and let’s say non-nurse leadership that we ought to focus on or is that many of the skills, the soft skills you talk about, obviously seem to be relevant to all leaders, regardless of what their professional background is?

Felicia Sadler:

Absolutely, I think you picked up on a great point because there are core skills and abilities as it relates to emotional intelligence and interpersonal competence that are common among industry, across industries. What makes healthcare so unique is that we are in a patient-centered, patient care environment and many times — well, almost every time in a patient care situation — a healthcare provider or clinician, you know, they’re self, they’re not self-serving. They’re actually there for the patient, for someone else. So it’s critically important — and I think it’s foundational to effective practice — to have a strong interpersonal, those strong interpersonal capabilities, because the patient experience is all about that. It’s all about communication. It’s all about being able to connect with your patients.

The reason that we have HCAPS for example, is because quality, patient quality, high patient quality care, patient outcomes are positively impacted (or negatively) through a positive or negative patient experience. So when we think about growing into a nurse leadership role, certainly that frontline experience should, we should empower the frontline and enable them with the skill set they need to be able to connect with the patients one on one.

And then also with other team members because there’s an interpersonal opportunity, as you think about collaborating with other team members, and they grow through those experiences so that when they are able to be promoted into a leadership role, they already have some of those foundational components and then they can begin to continue to grow as a leader and we should enable our leadership or our leaders, our managers, directors, we should enable them with the same soft skills, interpersonal competence, how to lead teams, how to connect with your team, how to resolve conflicts, how to enable and empower your teams, ensuring that you have clear, effective communication but that they also possess those same attributes.

And sometimes we can do that through learning, you know, online learning or in the literature we can certainly give them the theoretical components but also there’s a simulation component as well when you think about providing specific scenarios so they can actually simulate some and execute on some of those scenarios and learn. Again, it’s about that culture of learning as well. It just all goes together.

Leigh Steiner:

So jump into a little bit more you were talking about working together as a team. So what is it that healthcare professionals do to form a more collaborative atmosphere with supervisors and peers and colleagues?

Felicia Sadler:

That’s a very good question as well. You’ve got great questions today, by the way. When we think about where it begins with, as leaders, it’s really, it begins day one, bringing them to the organization, connecting them to the mission, vision, and values of the organization so that they understand that there’s a common shared goal together. So you’re beginning to acclimate them to the culture and the environment. At the same time, it’s important to hone in on those individual preferences and needs as well.

We think about personalizing the onboarding experience so that you understand what are their passions, how do they envision themselves in the organization year one, year two, and so on, and then inspiring them and then providing them with a clear pathway on how to get from point A to point B. All at the same time, role modeling all the positive attributes and behaviors as leaders so that they will emulate those as they began to grow in the organization.

Leigh Steiner:

So I think of, I know you do a lot of consulting, and I think of when you walk into an organization, if they said, we need to strengthen our nurse leadership, what are some of the first things that you might do or you might have the organization do? I mean, how can leaders best identify in their organization places I think both where they’re really superlative and they can build on that, but also where they have vulnerabilities.

Felicia Sadler:

Yeah, you know, when we think about organizations that… when they’re trying to learn where they are as an organization and what are the needs of the organization, certainly, and in taking an outcomes-focused approach, certainly it’s important to recognize that each and every organization is different, each culture is different, market’s different, but each individual is different as well. So looking at it from a systems view, you would certainly want to do an organizational leadership assessment, understand where the strengths of the organization — or where everyone’s strengths are — but then also identify where are their opportunities for growth.

And then even to the point of looking at individuals so that you can help them grow as leaders, as individuals in the organization, because when we elevate one, we elevate all. So certainly doing an organizational self-assessment is a great place to start. Once you’ve identified those strengths and opportunities for improvement, you can then capitalize on your strengths as well as optimize them, and then begin to develop a strategic approach to addressing the gaps, providing, you know, whether that’s through learning — I know that one organization that I worked with, they, when we did an organizational analysis, one of the areas that we were able to identify was around staffing, knowledge of staffing and HR, human resource areas where they, they really needed some additional training in those particular areas to strengthen.

And the reason being is they had all new leaders. And I think at coming out of COVID, we see that nationally where we’ve lost a lot of nurses, a lot of folks. Individuals got promoted into new roles, and so we certainly need to support them and make sure that we’re being very intentional on that while we’re building new leadership programs. And I want to stay on track for our conversation, but I wanted to note that because that’s the reality of where we are.

Leigh Steiner:

That leads me to think about, often, I don’t know what the percentage is, when we have turnover, people may leave because of their own manager. And you’ve addressed, we’ve talked about this a little bit, but let’s jump into that a little bit more. So how do we focus on that? How do we help ensure that managers are true leaders with the best interest of their staff and the organization in mind?

Felicia Sadler:

Absolutely. So certainly investing in the future of workforce, whether it’s, you know, frontline nurses, those in unit service line departments, etc. But also investing in your leadership workforce, because your leaders are the ones who are developing the new stars. They’re developing the new, you know, promoting folks, they are the ones that are leading the collaborative efforts among your units, departments, and teams. So it’s important that they get what they need in professional development. And sometimes it’s very difficult because they’re so busy with meetings, they’re tied up, they’re going from one meeting to the next meeting.

And it can be very difficult for them to find time, but we do need to set aside time where it makes sense for them to be able to grow, as well as receive self-care in addition to that because many times, you know, we can’t serve from an empty cup, and I know I’ve said this on many of my webinars, you can’t serve from an empty cup. You’ve got to be able to serve from that full cup, if you will, but you’ve got to be able to fill it up from time to time. So it’s important for leaders to get that, for self-care to be elevated. And we saw through some of the data that came out through COVID, during COVID and beyond, it was concerning where leaders felt drained.

And it’s because they’re constantly turning over workforce, we’ve got new people in, we may not even have a continuous staff, you’ve got a lot of temporary staff, you know, in your unit, department and so it can be very challenging. So I think one of the focal areas for leaders when we think about growth is understanding how do you connect your staff to their purpose and that was one of the things and one of the findings we found in the American Hospital Association Workforce Scan recently and I just got through doing a webinar on that. And it was really connecting them to their, getting them back to their purpose, which we seem to have lost our way a bit, especially with the disruptions in the recent pandemic. How do you coach your staff? How do you unlock their motivation, their professional motivation? What are they interested in? I just recently did a webinar on retention.

And one of the areas that I focused on was not only connecting their passion to their purpose, but really understanding where do they see themselves in the organization year one, year two, and beyond. Even if that means they transfer out of the department or out of the unit. Where do they see themselves? Because it’s all about retention within the organization, and not just in the unit or the service line. We want them to grow, we want them to feel like they have that autonomy. So those are just a few things that leaders can do to really help boost retention efforts within their organization.

Leigh Steiner:

Thank you. And by the way, I’m going to make a new bumper sticker that says, You can’t serve from an empty cup. I love that. That’s wonderful.

Felicia Sadler:

Well, I do have to say, I think that’s part of a quote too. I’m trying to remember who the person was, but yes, it holds true, it stands true. You can’t serve from an empty cup, and I think maybe the term they use may be vessel, but you know, you can’t serve when you’re empty, when you’re drained out, and so it’s important.

Leigh Steiner:

So we know when you’re talking about retention, there are other factors that have been identified, like flexible work schedules. Talk a little bit more about what are some of the other variables that we’ve identified in terms of retention.

Felicia Sadler:

Yeah, I think one of the, that’s a loaded question, just to say, and I know for the purpose of our short time together, I wanna just highlight a few things when we think about providing autonomy. Some of the research and the studies that came out, the surveys. And I’m happy if anyone wants to reach out, I can provide them supported documentation around all of this. But some of the components that came out of, you know, the pandemic was, you know, lack of flexibility, the work-life balance, of course. And the pandemic really just exacerbated these issues.

These were already pre-pandemic. It wasn’t anything new, but certainly was augmented because of the pandemic, to a point where it became, you know, at crisis levels. It was a wake-up call for organizations to really rethink how they are, how they’re providing not just the benefits, but providing autonomy and flexibility for a better work-life balance for nurses.

Not everyone has the same needs but certainly looking at shorter shifts for those nurses who may not need to work full-time or they want to work in a different capacity, being able to bring back the retired nurses, nurses who left the workforce, in a different way, serving as virtual preceptors at night, for example, or new staffing models, even hybrid models to the team-based nursing that was in play when I graduated (way back) from nursing school. And so those are some of the ways that organizations are really rethinking, as well as bringing in additional ancillary and supportive staff to support the registered nurse, individuals who can do more of the task-oriented so the registrars can really lead and guide the care plan for the patient.

Leigh Steiner:

I’m going to ask what one quality would you say stands out in the best leaders that you have worked with?

Felicia Sadler:

I think it goes back to my passion for transformational leadership and really, authentic leadership. It’s the ability for a leader to be able to translate, communicate their vision and empower their teams for that vision to become reality.

Leigh Steiner:

And it would seem to me that if leaders were on a journey to possess that skill, it would certainly contribute to retention within organizations. We like to follow good leaders.

Felicia Sadler:

Yes. Yes. Yes, and you’re right, many individuals, sometimes folks do not leave because of the leader that they’re following. And if that leader leaves, then they will have a tendency to follow. So we want to build leaders across the organization, not just one or two, but you want, across the system, you want leaders that can do that and do it well. And then while they’re connecting and empowering their staff, their team, to the mission, vision, and values, to the organization, and ultimately to high reliability and great outcomes.

Leigh Steiner:

Felicia, you talked a little bit at the beginning about what has personally inspired you to devote your professional life to this field. You want to add anything else to that?

Felicia Sadler:

I think, you know, we are in such a great time right now in health care. I know we have a lot of disruptions. We have a lot of fallout from a recent pandemic, but it really is a great time to really circle back and be focused on quality and on improving patient outcomes. And just being able to give back. And that’s what I hope for any organization that I work with and have worked with.

I devote 150% to ensuring they’re getting to the outcomes that they’re looking for in their organizations and really sharing back the expertise and experience that I can bring from working with other health systems, but also my own experience, and just giving that back to them and making a difference. And that’s really why we choose nursing. Most nurses, I would probably say 99.9%, nursing to make a difference in someone’s life and that’s what I feel like I have the privilege of doing today.

Leigh Steiner:

That’s beautiful. Thank you. You want to leave any last thought with our listener today, emphasize something we’ve talked about or say something new.

Felicia Sadler:

I would just say that whether you’re a leader or you’re on the front line — which you are a leader even on the front line — you’re leading your patients to better outcomes.

I think leading by example, whether you’re in a leadership role with a title or a leader on the front line, leading by example is absolutely something that you can do now, today, become an influencer, become someone who’s actually coaching others, challenging others, whether on the front line or whether you’re a leader, and having that genuine concern, thinking interpersonal competence, soft skills, but having that genuine concern for others, listening to them, helping them to seek out self-care, should they need it, or helping them to grow, should they be pursuing that. We all have opportunities wherever we are, and it’s just optimizing and taking advantage of where you are, making your world and someone else’s a little brighter in the moment.

Leigh Steiner:

Thank you, Felicia. I’ve heard, I think it was Ronald Heifetz who said, a leader is anyone who wants to make a difference at this time. And I’m so struck by that, by what you say, that any of our listeners out there today, whether you have the title or not, whether you hire and fire and do annual evaluations, whatever, we can all be a leader and we are all in leadership positions. Yeah, thank you for saying that. It has been wonderful being with you. I believe that for our listeners, they probably hear your wisdom, your intelligence, your compassion and your genuineness. So thank you so much, Felicia, for joining us today.

Felicia Sadler:

Thank you for having me. Thank you, Leigh.

Leigh Steiner:

Thank you for listening to this episode of Vitals and Vision. We hope our conversation about leadership and soft skills to promote retention has not only been insightful but has also inspired you to explore the qualities of nurse leaders who successfully engage and retain their nurses. Remember, success starts with a clear vision and vital strategies. We can’t wait to have you back for our upcoming episodes.