Nurse Leadership

In this podcast episode, host Nicole Weathers and guest Rose O. Sherman, EdD, RN, NEA-BC, FAAN, an experienced nursing leader and coach, discuss the challenges and opportunities in nurse residency programs. Rose brings her expertise in leader development within health systems and highlights the evolving landscape of the nursing workforce and workplace. They delve into the significance of nurse residency programs in supporting new graduate nurses amid the changing healthcare environment, increased patient volumes, and higher acuity. The conversation emphasizes the need for nurse leaders to adapt their coaching and support strategies to effectively guide new nurses in this dynamic environment. Rose's insights and practical strategies provide valuable guidance for nurse leaders and educators looking to enhance their support for new graduate nurses.

GUEST:
Rose O. Sherman, EdD, RN, NEA-BC, FAAN, is known for helping current and future nursing leaders develop leadership and coaching skills. Rose is an emeritus professor at the Christine E. Lynn College of Nursing at Florida Atlantic University and currently serves as a faculty member in the Marian K Shaughnessy (Shawnessy) Nursing Leadership Academy at Case Western Reserve University. Before becoming a faculty member, she was a nurse leader with the Department of Veterans Affairs for 25 years at five medical centers. Rose edits a popular leadership blog, www.emergingrnleader.com, read by thousands of nurse leaders each week and is editor-in-chief of Nurse Leader, the official journal of the American Organization of Nurse Executives. She is a Gallup certified strengths coach and author of the books The Nurse Leader Coach: Become the Boss No One Wants to Leave and The Nuts and Bolts of Nursing Leadership: Your Toolkit for Success and her newest book, Rebuilding Nursing Teams: Tactics for Working Better Together. She presents nationally on nursing leadership topics and conducts nurse leader coach workshops for frontline nurse leaders. Rose is a fellow of the American Academy of Nursing and an alumnus of the Robert Wood Johnson Executive Nurse Fellowship Program. In 2020, she was selected by the American Association of Critical Care Nurses for their Pioneering Spirit Award in recognition of her groundbreaking work in nurse leader development.

Rose O. Sherman  |  Rose O. Sherman, EdD, RN, NEA-BC, FAAN  https://www.linkedin.com/in/rose-sherman-aaa67510/ 

https://www.amazon.com/Nurse-Leader-Coach-Become-Wants/dp/173291270X
   
https://emergingrnleader.com/the-impact-of-social-determinants-of-work-health/ 

https://emergingrnleader.com/what-your-new-graduates-need-from-you/  

https://emergingrnleader.com/new-social-determinants-of-work-health/ 

To learn more about our nurse residency program and other offerings, please visit our website: https://nursing.uiowa.edu/ionrp

Transcript

Nicole Weathers

You're listening to the Beyond Nurse Residency Podcast, an educational series where we interview experts on all topics related to the transition of new graduate nurses into practice and beyond. I'm your host, Nicole Weathers, director of the Iowa Online Nurse Residency program. Thanks for joining us. Let's jump in. 

Nicole Weathers

So as nurse leaders and educators, we recognize that transitioning from academia to clinical practice can be both exciting and challenging for new graduate nurses. Nurse residency programs are one solution implemented to support this transition period and improve the engagement and retention of new graduate nurses. Many leaders think implementing a program can be a magic bullet solution that will fix a lot of their issues, while nurse residency is a great tool, it goes far beyond what happens in that classroom each month. Our experience shows that buy in and support from all levels of nursing leadership are essential for success. In this episode, we are going to be talking all about the nurse leader as a coach, their role in supporting new graduate nurses, why coaching is important, and how to get started. My goal for this episode is that our listeners will walk away with some actionable steps they can take to improve their work. I have with me today our guest Rose Sherman. Hi, Rose!

Rose Sherman

Hi, how are you doing, Nicole?

Nicole Weathers

Good. Rose O. Sherman, EdD, RN, NEA-BC, FAAN, is known for helping current and future nursing leaders develop leadership and coaching skills. Rose is an emeritus professor at the Christine E. Lynn College of Nursing at Florida Atlantic University and currently serves as a faculty member in the Marian K Shaughnessy (Shawnessy) Nursing Leadership Academy at Case Western Reserve University. Before becoming a faculty member, she was a nurse leader with the Department of Veterans Affairs for 25 years at five medical centers. Rose edits a popular leadership blog, www.emergingrnleader.com, read by thousands of nurse leaders each week and is editor-in-chief of Nurse Leader, the official journal of the American Organization of Nurse Executives. She is a Gallup certified strengths coach and author of the books The Nurse Leader Coach: Become the Boss No One Wants to Leave and The Nuts and Bolts of Nursing Leadership: Your Toolkit for Success and her newest book, Rebuilding Nursing Teams: Tactics for Working Better Together. She presents nationally on nursing leadership topics and conducts nurse leader coach workshops for frontline nurse leaders. Rose is a fellow of the American Academy of Nursing and an alumnus of the Robert Wood Johnson Executive Nurse Fellowship Program. In 2020, she was selected by the American Association of Critical Care Nurses for their Pioneering Spirit Award in recognition of her groundbreaking work in nurse leader development. And as I'm reading this introduction, Rose, I can't, I just like my minds going and you're here talking to us about nurse residency and the nurse leader, coach. So I am just so grateful to have you here with us today sharing your immense expertise as we were visiting prior to hitting record on this episode I was sharing with you that I had the opportunity to see you talk a couple of times. I had the opportunity to read those two books. I've got all of these pages marked of things that I thought ohh this is good. I need to come back to this. I didn't, for some reason, want to highlight it. I wanted to mark the pages so that I actually flipped right to it. So again, thank you so much for being here, and I can't wait to get started.

Rose Sherman

Well, thank you for having me on the program today, Nicole. You know a significant part of the work that I'm doing right now is in leader development with health systems across the country. And what I call this new world of work. And when you think about what's happening out there right now, Nicole, it's not only the work itself that has changed. But it's really the workforce and the workplace, and I think leaders including nurse professional development specialists, residency program coordinators, they're really struggling to help new graduates transition into an environment which is not only extremely turbulent because there's a lot of change, but is also accompanied by probably the highest patient volumes that I've seen in in four decades of nursing leadership and much higher acuity that we've than we've seen in the past. So I'm really excited to be able to really delve into this topic and hopefully give some of your audience some strategies and tactics that they can use in their own practice.

Nicole Weathers

And I think what you said there is so true. You know, I think back I've been a nurse only for 18 years, which sometimes seems like a long time. But then I meet people like you who have been doing it for much longer. And I think that you know. It is so much different now than it was 18 years ago when I started, and so it's really important I think that we are learning about all of these new things that are happening and how we can start to do things differently if we're really going to start to meet the needs of this newest generation that's entering the workforce. So, you know, one thing that's been around. Now for a while. Is this concept of nurse residency programs and providing transition to practice support for new graduate nurses as they begin applying all that knowledge that they learned in school into their daily practice on their unit. So we want to help them become safe engaged, and of course, retained clinicians and a lot of nurse leaders think this is something that happens in the residency program, right, that this is something that happens in that classroom, that there's something magic that happens in there. And while, you know, you know, this is great. And there's a lot of good that comes out of that “classroom time”. It's more about what happens there. So let's have you start off maybe by telling us about the role of the nurse leader, specifically unit leadership in supporting new graduate nurses during this transition to practice time.

Rose Sherman

You know, I couldn't agree more with everything you've said there, Nicole. And I think when I talked to leaders today, I talk with them about the fact that it really takes a village to onboard new graduates and that frontline leaders really need to be very hands on. They need to know what's happening with the orientation. They need to know what's happening with the residency program. They need to be aware of what that relationship is between preceptor and new graduate. I can't tell you how many stories I have been hearing and continue to hear that managers tell me a new graduate starts about 3 weeks into the residency program. They come to the manager and tell the manager that it's not working out and that's something that I have to say. I have not seen before. I think that's a phenomenon that we've really begun to see probably over the last two to three years. And there's many reasons why novice nurses are coming and saying that some of it has to do with poor onboarding. And it's related to unrealistic. They're sometimes they're unrealistic expectations about the RN role. Sometimes it's about scheduling requirements. I mean I I think a huge issue that health systems are confronted with right now is that new graduates don't want to work nights and they don't want to work weekends, and oftentimes they are hired for these positions and they come in and let the manager know almost from right, right from the get go that they they just can't do it. So I think it's hard the way that I frame it is it's really hard to resolve problems early if you're not doing these weekly check-ins. I often hear from nurse leaders that new graduates are not work ready, which I think is absolutely true. It's probably always been true, but I think probably more so today because many of these new graduates have spent a lot of time in simulation versus clinical hands on there when they come in, they're very focused on their skills development and they're not going to develop these critical thinking skills through osmosis. You know, it really happens through good coaching and every year I write a blog around this time of year about what new graduates want and need from their leaders. And I have to say, in looking at the blog statistics it is probably one of the most highly read blogs that I write and in this blog I always talk about the importance of compassion and hope, as well as helping new graduates develop a growth mindset. I think so many of them in the New York Times had an article about this just a month ago, about how many young people have this really perfectionistic mindset. And so, you know, in their minds, there's only two dimensions. I'm either failing, or I'm excellent. And they don't see often the Gray zone. And if leaders come to them and try to have a discussion or give them constructive feedback, sometimes they they push back on it and they I'm sure they push back on their preceptors as well. So you know the the idea is that in addition to everything else that nurse leaders need to promote, they need to promote a growth mindset, which is you know you can't do this yet, but you will be successful with some professional development and socialization.

Nicole Weathers

I think that is so spot on and I and I wrote down two things while you were talking there. But first was first is expectation. So that's something that we talk a lot about, not just what are the expectations that the new nurse has for what work is like, but also from a leadership standpoint, what are our expectations? Are we expecting them to come in and fill a role of somebody who's been doing this for the last 20 years and be at the same level or are our expectations realistic to where new graduate nurses really are? And I think we've got a lot of expectations for new nurses as we have these workforce shortages as we're trying to plug some of these holes as quickly as we can. And so I think it's just so important to have some really good conversations about what is it that we are expecting these new nurses to be able to do when they enter practice and is that realistic for them?

Rose Sherman

Well, for sure. I think that you've you know, you've really kind of nailed part of the problem and that is that you think about the average unit right now, acute care unit particularly, 70 to 80% of those nurses might have less than two years experience. So they are really not seeing the expert practice that they had once seen their preceptors may have just a few years, if that more experience than they do. And then you look at the volumes, the amount of admissions, discharges and transfers taking place on this, on these units and the acuity of patients. And you know even managers talk to me a lot, Nicole, about the the level of moral distress that they feel leaving patients and assigning patients to new graduates. That they really are not ready for. So you know it's just it's part of the turbulence and the reality of where we are in our environment today. But it's made new graduate transition I think so much more challenging for everyone that's involved in it.

Nicole Weathers

Yeah. And and I I agree with that, I could see where from a leader standpoint, you know that they're maybe not ready to take this patient, but what other choice do you have? Do you have another choice because the experienced nurses are leaving so quickly, right? And just like you said, maybe two years of experience is what that preceptor has, and maybe they haven't even actually been trained on how to be a good preceptor either. And so it it's kind of a little bit of them figuring it out together almost.

Nicole Weathers

You know, this idea of growth mindset too, you know, this was something that I think probably 2-3 years ago, I had the realization was missing in a lot of new graduate nurses, you know, they came, they come into nursing sometimes thinking that the NCLEX is the finish line when really we talk about it as this is just the starting line, right? Like this is just the beginning. While you thought that maybe graduating from nursing school and becoming becoming a nurse was like that ultimate goal, we're just beginning. And there are so much more that's left to learn.

Nicole Weathers

From the time that you become a nurse, and so we've actually started talking in our residency program with our new nurses about what a growth mindset is and how you can grow a growth mindset. You know, if that is something that you can do. So I love that you bring that up as well because that is definitely something that we've seen a lot. And I even see it in my own kids. Right, that aren't quite at the workforce age yet, but I don't know what it is, but it they come with this mentality of if I can't do it perfect the first time, then it's not worth doing.

Rose Sherman

Yeah, yeah, yeah. And and the other trend that we've seen, Nicole, whereas historically, you know, I think leaders were used to new graduates going home and kind of reviewing cases that they were unfamiliar with. Going back to those textbooks, doing some research on the Internet about, you know. Patient situations that they're unfamiliar with, they're they're telling me that there is this extreme reluctance to use any of your personal time for increased professional development. So I think that's another challenge that we have right now.

Nicole Weathers

And that's a great point. And I guess I don't know, like I go back and forth sometimes on if that's a good boundary to have or a not great boundary to have, you know, I mean, I think there's something to be said for this idea of “work-life balance,” and you know, having some boundaries around work, you can go that. So that whole other extreme, where you're constantly working, right, and you're constantly thinking about work and what you need to be doing, and you can't sort of disconnect. And so I think we just need to find a happy medium between those two extremes.

Rose Sherman

Right. I couldn't agree more there is definitely a fine line between, you know, expectations of what you're going to do in your personal time when you really do need that downtime and having some skin in the game on your own professional development.

Nicole Weathers

So in your book, The Nurse Leader Coach, you talk about individualized coaching as a key tool for nurse leaders to become that boss that no one wants to leave. So why do you think coaching by a leader is so impactful? And maybe you can share some examples of how you've seen this impact both, you know, the new graduate, but even the experienced nurses.

Rose Sherman

Well, I think the first thing is that you know, there's some really good evidence-based research out there, predominantly from the Gallup Corporation, who's been doing 50 years worth of research on the workforce and what they're telling us is that particularly Millennials and Gen Z really want their leaders to be less traditional boss like and more coach like in terms of their leadership. So I think the big question for the leaders is you know what does that really look like when you when you say that well, I think the first thing to realize is that coaches focus more on professional growth and constantly pointing out performance issues and so you know, when I entered nursing many decades ago. No news was good news. If your leader did not come to you with a problem, that was a good thing because the feedback was inevitably focused on what it was you really needed to improve. Well, coaches like help me as a nurse if I'm if I have a leader that's coach like. That leader helps me identify my strengths. And helps me to use them in my practice and so that means the leader has to be attentive enough and look at each one of their new graduates or any new nurse that's onboarding and say, you know what, what does this nurse do that's really maybe so easy for them versus other new graduates and and those would be strengths that that new graduate would have. So leader coaches, the other piece about being a leader coach that's so important with new graduates today is that leader coaches are interested in my career if I'm a new graduate that leader Coach is going to ask me what my career plans are and that career plan may mean leaving you leaving that leader. Maybe your plan is that you want to go back to school and become a Nurse Practitioner, but the leader coach realizes how vital that career development really is. So there are some keys to becoming a great leader coach. The first thing you need to be is less Superman and more Yoda, and that's something that leaders I find as I do leadership development really relate to because their tendency, and I'm sure the tendency with preceptors and residency program coordinators may be very much the same, their tendency is to kind of swoop in to solve the problems for the new graduate and I think too often what what they're doing and we have research that indicates that when researchers watch leaders and a leader thinks they're coaching but they're not coaching, they're telling the staff member what to do. And so then it becomes frustrating for the leader and many, many leaders. Tell me. That the new graduates are in their office asking them about a situation or a problem, they help them solve it or think that they're helping coaching them to solve it. Next week they're back in the office with the same problem and and what they've done is they're just telling them what the answer is rather than coaching them to the answer. What we do know is that younger staff definitely don't want leaders who are advice monsters. And I think that leaders tell me that their kids who are Gen Z do not want parents that are advice monsters. They really want to figure things out on their own, and they're going to be much more successful if it's their idea. The research tells us that our younger staff are much more inclined to believe their peers and social media than they are taking advice from leaders. So if you can get good at coaching as a leader, I think you're going to be much more successful and achieve the kind of culture that you want to see in the unit. So being the key to being a good coach is first of all, stay curious a little longer. Don't don't just jump in to solve problems. Yes, you have the expertise the preceptor had might have the expertise to do that. But hold back and rather ask the new graduate what they think they should do in this situation. If you hold back a little bit which does take a little more time, leaders tell me that they notice that sometimes their novice nurses have really good solutions and they've really thought through it, sometimes remarkably well. But they don't have the confidence in their own decision making. And so being a being a great coach also means really honing your listening skills. And I think asking great questions, great open-ended questions.

Nicole Weathers

And I can see where this can be, maybe a little bit more difficult for nurse leaders specifically because we're fixers, right? Nurses as a profession, we like to go in and we like to. We see things that need fixed and we do it so to to take that minute to kind of step back, ask those good questions. Might just take a little bit more intentionality for a nurse leader. Then maybe leaders from other disciple. I want to circle back real quick to this idea that you talked about a couple minutes ago about strengths and identifying strengths in your practice, because this is something that I have taken a keen interest in because of all the research around, you know, positive psychology and well-being and this idea that if we use our strengths more, whether it's personally or professionally, we are going to live a more a life of higher well-being, perhaps. And so I just love this concept of identifying what these are in our staff because if we can help them use those strengths at work, chances are they're going to find more purpose, more meaning, they're going to like what they're doing better, right? And they're gonna want to show up and do the work. So do you have specific? There's lots of different obviously tools out there to identify strengths. But do you have any in particular that you like, obviously used in your introduction, it said that you were a Clifton Strengths Coach, right? So that's probably one tool. Do you have any other others that you like to use?

Rose Sherman

Well, there's there is one free tool, it's VIA values. You know, it's more of a free strengths tool which they can do, but I think if you look at what's really evidence-based, I think the Gallup Clifton Strengths is probably the most evidence-based coaching strict tool we have to look really look at strengths, and I would recommend in fact I recommend organizations and some health systems are strength based organizations but I think particularly with new graduates you know I think that there that there is a case to be made for having every new graduate take the strength finder. And they can take that strengths finder and then learn what their top five or their top ten strengths are depending or maybe possibly their top 38. I mean, depending on what, what version of it you use, but the the beauty of that particularly for residency coordinators and professional development specialists, once you know what that graduates new graduate strengths are, you can help that new graduate learn to use their strengths to really help them to navigate the challenges and show them how they can leverage this strength to help them in their transition, it's really remarkable when that that what one of the things that we have learned, Nicole is that people aren't good at identifying their own strengths. That's that's what Gallup finds, you know that you'll ask people to identify their strengths, that they think their top five strengths, and then you'll have them do. The Gallup strengths report, and oftentimes there's not the kind of match that you might expect. But once they do, the strength report and they read about their strengths, very often, nurses will say to me, gosh, I feel like they're just sitting inside my brain as they write this because this is so much who I am. So it's it's not an expensive investment for organizations. I'd like to see more of them do this as part of the residency. program.

Nicole Weathers

So, about a year and a half ago, we actually implemented having our residents that go through our residency program do the VIA character strength. But that's free online because that was an an easy way to get it incorporated into our program. I think it it a lot of the newer nurses that are coming in have never done something like this before. So I think it's very eye opening for them and you know even kind of using like you said, you encouraging them to use these strengths or helping them figure out how they can use these strengths to do different things. So for instance, when we have them do their residency project or we call it a professional experience, how can you take these strengths that you haven't leveraged them in this activity so that you get the most out of it? Right. And you are so ideally successful and you feel good about what you did.

Rose Sherman

Sure. Kudos for you for doing that.

Nicole Weathers

So I just, yeah. Yeah, well, you know, and it's even something too. You know, we have incorporated a lot of well-being activities throughout the program and this was just sort of one one piece of that. And yeah, it's just been very interesting to see peoples feedback on that activity. But I do love the Clifton Strengths. I actually took that for the first time last summer and a leadership course that I was doing. And it is. It's like you're inside my brain. So this is the why this is the reason I am the way I am right that these are the these are the things that sort of shine through so.

Rose Sherman

Yeah, yeah.

Nicole Weathers

Awesome. So we talk a lot about professional development, the continuum of a new grad. So going from sort of onboarding to orientation to nurse residency and then ideally ongoing career mentoring or coaching, you've shared coaching is not a one and done activitiy. So what are some key strategies, nurse leaders can leverage at maybe various times. So maybe onboarding and orientation are different than later on in nurse residency, but what are some some different strategies that nurse leaders can leverage at various times throughout that first year to help the new nurse achieve their desired goals?

Rose Sherman

Well, I think I I have to agree with you know, sometimes leaders when you talk about coaching staff, they'll tell the first thing they'll say to me is I don't have time to do that. And what I'll say to them is that you know, I'm not asking you to want to add a one hour conversation with every new graduate to your day, because that would be very unrealistic, but I think setting up some touch points with some key questions to really track how things are going. Many leaders today, as an example, are really frustrated with the level of individualism shown by younger staff where they are really hyper-focused on their own needs, and social researchers tell us that that is true because of the environment that they've been brought up in. They look at how individualistic or certain generational cohorts versus how much do they think about the team. And so we know that this generation. Doesn't most of them not all, but most of them don't automatically come in thinking about their other team members. So that's an example of a conversation that leaders can have with younger staff to help them develop more of a teamwork mindset. The other thing that is really coming up, bubbling to the surface as being very problematic in our healthcare environments today is really just this social navigation of conflict and Versant has actually they actually tracked this. Why? Why do you new graduates leave positions and and they have found that the number one reason that new graduates leave. Positions is because they're having conflict in the environment. They don't know how to navigate it, and the idea is I can't get out of this situation without leaving this organization. So you think about younger staff today, our new graduates and they've grown up in a social media world where you essentially kind of defriend or block everyone that you're not interested in having a conversation with. And you can't do this at work. You know you have to learn how to work with other people. You don't have to be friends, but you do have to learn to work together. So I think that's another example. The other thing I discuss with leaders is sometimes leaders think that they have to have all of these conversations with new graduates themselves. And I think that's highly unrealistic. I think that nowadays we have in most of our, I I've been really amazed in doing some research with AONL. How many organizations now have not only the nurse manager, but assistant managers or clinical managers. They have charge nurses. They also have unit-based educators, so I talk with leaders about that. That's your leadership team. Your leadership team is your unit-based educator, your assistant manager, your charge nurse and yourself. And so you can really divide up the responsibilities to make sure that these conversations really take place. And so that means that the the nurse manager should meet with their unit-based educators should be meeting with their charge nurses and their assistant managers and talking through, you know, what's happening with each one of these staff. That we're trying to onboard right now and that you know, I think that that is a way for nurse managers to really do a more effective job of leveraging their time and having these conversations.

Nicole Weathers

You know, I think that it it does take a village, right? It it can't just all land on one person. So it's not just the residency program coordinator. It's not just the manager, but you've got lots of hopefully team players that can kind of help with this. So I love that idea of sort of dividing and conquering, you know, another I guess I guess.

Rose Sherman

Mm-hmm.

Nicole Weathers

If you call it a strategy that we talk a lot about with our coordinators and leaders that we work with is, you know, it doesn't have to be a meeting just for this, right. Like you can be checking in with them or rounding on them related to other activities or other things that are going in and then just sneak in a couple sort of coaching questions or ask them, you know, how is residency going or I heard you were talking about you know communication this month, you know let's talk about that briefly, right? It doesn't have to be like you said an hour long, nobody's got an hour to have those conversations, especially if you have a unit full of new graduate nurses. So I just really like that idea of, you know, taking advantage of the time that you do have with them. And like you said, taking advantage of the full leadership team for sure. All right. So just like all things how we support new graduate nurses will continue to evolve over time. So, as you look at current and future trends, what are some new things you encourage nurse leaders to think about? What new or different things do you see when it comes to the future workforce development needs and the role of the nurse leader as a coach?

Rose Sherman

Well, I think the the, we are definitely seeing some major changes in the workforce that really that really have to you know have to evolve into the leader thinking differently about strategically what they need to spend their time focusing on and what they might need to coach around. So I have mentioned the challenge of teamwork, and that's definitely a challenge, but I think another new area that leaders are really talking about is this whole communication piece. In fact, on many units, if you look at their HCAP scores, the nurse patient communication is really declining. And so I think that you think about our new graduates today and they've grown up in a phone text based culture. Some of them have done a lot of their clinical work in simulation. Their communication skills are really not that strong and leaders tell me that the number one area that they're spending time on. In terms of service recovery with patients and families really evolves around the way the nurse is communicating with these patients and families. Things like not maintaining eye contact because we know a lot of our younger staff are looking down at their phones all the time when they talk to one another. But that can be interpreted very differently in a healthcare setting, not introducing yourself, not asking questions that help make a connection with the patient and family, not even knowing how to start a conversation. So I think we have to be much more intentional about coaching to improve communication. That's something you can't assume right now that new graduates are coming in with that skill set. They may not have it. So you need to watch them.

Nicole Weathers

Yeah, and that's probably shocking. I mean, when you probably think of a lot of the, the nurses that are in leadership positions, that's got to be hard for them because this is a skill that I think we probably just assume everybody has, right. It was just a part of us in nursing school, probably growing up long before that to have these sort of communication skills. So this is this is definitely I think a new trend that unfortunately we're probably going to see more of and probably need more focused communication around something that seems very basic for most of us, but for this whole generation and probably generations to come after, it it's just surprising/not surprising.

Rose Sherman

Yeah, I I've had. Well, I've had. I've had some really. I have to tell you, I've had very interesting conversations with leaders who tell me that they going to talk to patients and family. And they'll ask a question and then nurse will just say I Don't Know and that's the end of the conversation. And it's not. I'll go find out or let me let me see what I can do to get you an answer. And so I think some of one of the things we need need to think about Nicole is that some of the patient violence and incivility that we're seeing with patients and families, I think a good part of it is that it's coming in from society. But the other piece of it is that if we have younger staff that don't know how to have a conversation, that don't know how to deescalate patients. It will become far worse and so we have to look at both ends of this, not only our expectations of patients and families, but what are our expectations of staff in terms of communication, in terms of being able to deescalate behavior. But I think the second big challenge that I'm seeing that I'm hearing about right now. Is really about this mental health and well-being, and leaders have been asking me for the last probably 3 years. Is it just that our younger staff talk more about their well-being or do they in fact have a lower baseline of well-being? And I didn't have a good answer for them until about a month ago when there was a book published by Jonathan Haidt at NYU called The Anxious Generation where he's really crunched the data. And he says that from all of the data that he's examined that the baseline mental health of anyone who went through their formative years after 2010, this means childhood or adolescence has a much lower baseline mental health. And he attributes this to the kind of the combination, the trifecta of being in a cell phone based culture, that 24/7 connectivity and the social media, and I think our leaders, Nicole, are seeing this play out every day in their clinical settings with much more panic attacks, meltdowns and what Haidt said is that a significant percentage of probably the new graduates that we're getting not only in every work area they're entering  the workforce with much higher levels of stress, anxiety and clinical depression at the same time we're not seeing the changes in bipolar or schizophrenia that are more genetically induced and I think this is even kind of translating into the academic environment. I'm on a panel actually next month with some academic teams and they are very frustrated with the level of accommodation that they're providing right now at the university level under the American with Disabilities Act for students that have stress, anxiety and clinical depression because they say thing you know you can't bring your support dog into a clinical setting and be able to work. You can't tell me that you can't take a patient down to radiology because you're claustrophobic. You can't tell me that you can't work nights because you have a sleep disorder and so that would prevent you even if after you take a position. So you know, there's no easy answers and no easy answers to any of this. And I talked to leaders a lot today about this fine line between being a leader coach and being a therapist, nurses know just enough to be really dangerous in terms of these discussions and some leaders have told me that they really find that their younger staff really overshare, so I think one of the things that we have to realize is that this deterioration of mental health has occurred even before this new graduate has entered our turbulent and stressful healthcare environment. And it's why I think so many new graduates are hyper-focused on their well-being right now because they know this about themselves and from this deterioration from a societal perspective in mental health becomes what I call a social determinant of work health. We didn't cause it in health care, but if we if we don't have supportive environments, we can make it even worse.

Nicole Weathers

I love that concept of a social determinant of work health because that is I think that is so true and we've been looking a lot at the last 10 years of offering this program and really have begun to recognize that. Yes, it's it's the knowledge, skills and abilities to do the job. It's the social, you know, connections throughout the workplace. But the concept of psychological capital and the ability to, from an interpersonal standpoint, cope with some of these things like that is a huge piece that has been, I think, missing more so now, probably because of these things that you just talked about, right, the cell phone based culture, the social media. Now, everybody's putting out there a filtered version of themselves. What they want people to see. And I think adolescents sometimes. And I even talked to my kids about this. That is not reality, but we see it all the time. So we begin to think that is reality and it it's kind of scary to think about how much impact that little device has on so many facets of our life.

Rose Sherman

So true and and it also changes the level of expectation that these new graduates have when they come in the work environment. If they're expecting, they're going to get this Instagram perfect job. And so every time I see somebody or a parent put out, my kid just got their dream job. It worries me a little bit when I see that.

Nicole Weathers

Absolutely. I know because they think again what they see on social media is reality. And there are a lot of great jobs out there and dream jobs and great employers and but there's it's not all rainbows and sunshine all the time, right? There are going to be some aspects of that job, whatever it is that aren't going to be picture perfect. And we've got to have our expectations in line with reality. And and I don't think that this the cell phone based culture and I'm as guilty probably of it as anybody is helping anything. OK, Rose. Well, we have talked about so many great things today. We've talked about nurse residency programs, the role of nurse leaders as coaches in those residency programs. You've shared some really great strategies and we've started to talk here a little bit about the future and what to expect. But before we go, I have one last question and I like to ask this of all of our guests, but when it comes to transitioning to practice and our topic today, what is one thing you see organizations may be doing wrong or wasting resources on that you don't really feel is making much of a difference or on the flip side, what do you see that they're doing that really is is making a big difference for their new grads?

Rose Sherman

Well, right now I'm a little concerned about the whole, you know, the future of nurse residency and professional transition programs because health systems nationwide right now are in serious financial trouble, and so leaders are really talking to me about the issue of organizations really wanting to shorten the transition time at a time when we should be probably lengthening it instead shortening it, and that's really a huge mistake because it puts new graduates into situations that they really don't have the competency to manage and they don't have the expert nurses out there on the units to really help them with the management of it. And as we look at this patient acuity, nurse experience, gap widening and widening and widening. I think this idea that many leaders have is that a nurse is a nurse, is a nurse, I think you kind of lead off with this in the very beginning that you don't bring a new graduate in and expect that that new graduate is going to walk into a role that a nurse with 15 years of experience has and be able to pick right up. It's not going to happen and so. I think this trend toward or the pressure to shorten orientation is a step in the wrong direction, and I hope that organizations will realize it's just going to lead to really higher turnover. I think a second thing is that we sometimes fail to realize that coaching and mentoring. And and support doesn't end at the end of a residency program that the 6-12 month period of time is really the most vulnerable because this is when the new graduate is really out on their own, but maybe not fully professionally socialized. And so this is a time when they still need professional support and if they don't get it, some of them are going to become very depressed and probably leave. Because they're not getting the support. The flip side of this is that you've got a lot of young new graduates today that think they've mastered nursing after six months and they're ready to move into travel positions. And and unfortunately some of the travel companies will hire them with as little as six months experience. And so there's this danger about full professional socialization. So those are some of the downsides. Some of the things that I think organizations are doing, are starting to do that I think really help new graduates and I'd like to see more of two things specifically I think. One is building a strength based culture which we talked about earlier and the 2nd is really getting a a better understanding of the social determinants of work health and understanding how to respond to those, things like childcare and how expensive childcare and unavailable it is right now. And what kind of an impact that might have on new graduates that have young kids at home. I think that's something that organizations really need to be thinking about in. Much different way, but the second area is just the financial debt that a lot of our new graduates are in. I'm familiar with one organization that schedules every one of their new graduates as they as they enter their system has a one hour planning session with a financial planner and the whole goal about that session is really to set themselves up to really realize, look at their debt, look at what they need to accrue in terms of savings, how you do this, how you can leverage a benefit package that an organization has. And so those are things really recognizing the social determinants of work health and what those are with new graduates today that could look very different I think are are some of the bright spots that that I think organizations are starting to move into.

Nicole Weathers

I love that. Those are such great things I think to consider and a great way to sort of give us some food for thought for the future. So thank you, Rose. So much for visiting with me today, sharing your immense expertise around this topic. I really appreciate your time.

Rose Sherman

Well, it's been a pleasure being with you and thank you to everyone who's out there listening and I hope we've given you some nuggets and ideas to take back into your own practice.

Nicole Weathers

Wait before you go, I want to make sure you know all about our suite of resources you can use to support your new graduate nurses. This includes our Academy, a coaching program designed for organizations as they prepare for the implementation, and ongoing sustainability of a nurse residency program. Work one-on-one with residency program experts to make sure your organization is residency ready. Our clinician well-being course is an asynchronous online course that aims to enhance the well-being and resiliency of healthcare professionals, equipping them with the necessary psychological capital to navigate challenges inside and outside of work. Supporting nurses is another asynchronous online course for preceptors, mentors and coaches. To learn the skills they need to support any new hire. Both of these offerings can be used as a stand alone professional development opportunity or to augment any nurse residency program. And we can't forget about the program that started it all, The Online Nurse Residency Program. This includes a comprehensive curriculum designed to support new graduate nurses, applying all the knowledge they learned in school to their practice. We focus on professional skills, personal well-being competencies, and new graduate nurses even get the opportunity to create real change in their own organization. Offered completely online and in a blended format, this program is highly adaptable to all clinical practice settings. You can learn more about all of these programs and more of what we offer using the links in the show notes below.