Beyond Nurse Residency

Professional Identity and Leadership with Dr. Lindell Joseph

• Nicole Weathers, MSN, RN, NPD-BC • Season 2 • Episode 3

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This episode examines the crucial intertwining of professional identity, leadership, and innovation in nursing. Dr. Lindell Joseph shares insights on how societal influences and work environments can significantly shape a nurse's professional identity while advocating for an empowered and reflective nursing workforce.

• Discussion on the importance of professional identity formation
• Exploration of societal perceptions and media portrayals of nursing
• Emphasis on the pivotal role of nursing leadership in professional growth
• Insights on how to foster innovation and challenge the status quo
• Importance of reflective practice and lifelong learning

GUEST: Dr. M. Lindell Joseph, PhD, RN, FAAN, FAONL

Dr. Joseph is passionate about advancing nursing leadership and innovativeness through thought leadership, research methods, and extensive publications.  She is the Editor-in-Chief of Nurse Leader, the Official Journal of the American Organization for Nursing Leadership, a Clinical Professor, and the Director of DNP & MSN in Health Systems: Administration/Executive Leadership Programs at the University of Iowa College of Nursing.  

From 2019-2024, Dr. Joseph served on the Advisory Council of the International Society for Professional Identity in Nursing (ISPIN). In that role, she co-led the development of the Conceptual Model for Professional Identity in Nursing and chaired the committee Nurse as Leader.  An outcome of this committee is a position statement titled “A Call for Dialogue to Advance the Concept of Nurses as Leaders within the Profession and the Public.”  The American Nurses Association recently endorsed the paper. She was appointed to lead a future workgroup, The Public and Professional Identity in Nursing. 

She is a fellow in the American Academy of Nursing and participates in the Building Health Care System Expert Panel and the Nursing Theory-Guided Expert Panel. She is also a fellow in the American Organization for Nursing Leadership. Dr. Joseph’s other areas of expertise are leadership effectiveness, innovativeness across academia and practice (IA-APHPS), and the General Effectiveness Multilevel Theory for Shared Governance (GEMS). Lastly, she co-edited the seventh edition of Leadership and Nursing Care Management. 

Professional Identity in Nursing Conceptual Model  

Supporting nurses is our priority. Visit https://nursing.uiowa.edu/ionrp to explore our resources for new graduate nurses and beyond.

Nicole Weathers: 0:02
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. Thanks for joining us, let's jump in.

Nicole Weathers: 0:26
Three years ago, I made the decision to return to school to achieve my terminal degree. As I explored different options, I kept coming back to the importance of obtaining a degree that would allow me to apply my experience, knowledge and new learning to solving real world problems. I therefore chose to pursue a doctorate of nursing practice in health systems and leadership from the University of Iowa College of Nursing. I must say that I've learned a great deal through this program, taking classes on topics like innovation, healthy work environments and various aspects of leadership, among many other valuable subjects. Sometimes, though, when you're deep in schoolwork, completing assignments and working towards that finish line, you don't always take the time to adequately reflect on and discuss how these topics really apply to your current work environment. That's why I thought it would be fun to sit down with none other than Dr Lindell Joseph, the director of the Health Systems and Leadership Program that I'm currently in, because she's been instrumental in shaping my understanding of these critical areas, and I would love to kind of discuss how these topics intersect with our topic from last month on professional identity and nursing. So in our previous episode, I had the pleasure of interviewing Dr Nelda Godfrey on the topic of professional identity in nursing.

Nicole Weathers: 1:45
If you haven't caught that episode, I strongly encourage you to go back and listen to our February episode. We explored its history, what it is, why it's important and, of course, the role of nurse residency programs. In this episode, I want to delve even further into the practical aspects of professional identity and discuss the intersection of leadership, work environments and innovation in the development of professional identity formation. My goal for this episode is that our listeners will walk away with actionable steps they can take to enhance their work environments and support the ongoing professional growth of nurses. So I have with me today our special guest, as I said, Dr Lyndell Joseph. So, Dr Joseph, thank you so much for being here with me today, where I get to take a little bit more time to reflect on some of the things that you've taught me throughout this program. So why don't we start off by having you just take a minute to tell our guest a little bit more about yourself.

Dr. Lindell Joseph: 2:47
Oh thank you, Nicole.

Dr. Lindell Joseph: 2:49
Thank you for this opportunity. I am a clinical professor at the University of Iowa College of Nursing. I'm also the director for the MSN and the DMP in health systems executive leadership and I'm currently the Editor-in-Chief for Nurse Leader. My purpose and my passion as a nurse leader is really to ensure that all nurses can think and lead optimally for change. I'm really an innovator, Nicole.

Dr. Lindell Joseph: 3:15
You will see in a lot of my publications that I create frameworks and I study nursing leadership so that nurses and nurse leaders could reimagine the work of nursing. That's my vision and that's my goal. What I think these frameworks you'll see in a lot of my work. What they allow us to do is to question the status quo, to thrive as individuals in health systems and really reshape the profession, which I think is necessary. So I'm really excited to have this opportunity and I would like to also acknowledge Dr Nelda Godfrey, because Nelda tapped me to when I attended the initial think tank and the subsequent think tank. She asked me to co-lead the conceptual model for professional identity in nursing. At the completion of that she says Lindell, can you lead the nurses leader work group? And then she's also tasked me with the public awareness work group. So I'm thankful for this opportunity and I'm happy to share my knowledge.

Nicole Weathers: 4:18
Excellent.

Nicole Weathers: 4:19
Well, I think you know having you talk about you know your passion about re-imagining nurse, reimagining nurses work and questioning the status quo.

Nicole Weathers: 4:27
I think that's why we get along so well is because I feel like that is very much at the core of how I, you know, feel and think about my role in nursing as well.

Nicole Weathers: 4:36
So it's very exciting to be able to get down and talk with you today and it's been so interesting too to kind of follow your work, along with Dr Nelda Godfrey, around this concept of professional identity. So you know, as I said, we did sit down last month with her to talk about professional identity and get a little bit more about the history and kind of how that think tank came to be and what you guys discovered through that work. And so you know, again, I just feel so strongly about this topic in the work that we do with nurse residency that I think it was really important to dig in even further. So you said that she tapped you to start focusing on public awareness. So I think that might be a great place to start is to have you share a little bit more about how society and workplace cultures impact the growth and development of professional identity in nursing, yeah, so one of the things.

Dr. Lindell Joseph: 5:41
When we developed Cole Edmonson and myself, who is the CEO of Nurses on Boards, when we co-developed a conceptual model for professional identity, one of our learnings were the contextual factors that influences the nurse's professional identity, and those were about culture, demographics, history, politics and society. And it was not shocking if you think about it, because when we think about who we are as nurses, a lot of that information we've learned because of society, right, society's impact on who we are. If you think about the stereotypical images that exist with who nurses are, when you ask someone, you know what does a nurse do? They always talk about the caring and compassion, which is great because we're so trusted, right. But when we think about the learnings from this work, the professional identity work, we realized that nursing is defined differently. Nursing is defined within these four domains and this is new knowledge for the profession, right, and these domains of values and ethics, knowledge nurses lead, and professional comportment. So the hope is, if we asked our grandparents today or in the future, what is a nurse, the vision is for our grandparents to say, well, a nurse is a leader, or a nurse uses knowledge from sciences, et cetera. So the impact of society has been not the greatest for the discipline of nursing and our hope is that this work will shift that perception of the nursing brand to one that is more desirable and one that is more consistent with the message that we would like to create and craft for the general society at large. So, basically, I want, when I asked, when a child goes home to grandma and grandma says and says I would like to be a nurse, I want grandma to be able to say those are the facets significant in terms of one's professional identity Because, remember, the culture within an organization and what the organization focuses on, what the organization thinks is important, drives how people think and perceive themselves.

Dr. Lindell Joseph: 8:29
So, when we think about the work environment, one of the things we've learned from the conceptual model for professional identity in nursing is that, even though formation formally begins in nursing school, the work begins in new roles and other settings. Whether it's your first job or whether it's your last job before retirement, it's the spectrum it needs. Professional identity needs to be reinforced in all roles and in all settings and that's really significant. So it's important that nursing leadership, because they drive culture, it's important that they demonstrate, they show nurses that they value their professional identity.

Dr. Lindell Joseph: 9:17
And how do you do that, Nicole? Well, you have to say I know you need knowledge so I'm going to invest in your professional development. Say I know you need knowledge so I'm going to invest in your professional development. They need to model those ethical behaviors and lead with ethics. They can't be wishy-washy in terms of showing preferential treatment. They need to be consistent in terms of how they treat people and fairness and respect to individuals and, of course, they need to acknowledge to the nurse that I'm acknowledging you and I recognize that you are a leader. So that is really significant and important that the leader drives that culture in the work environments so that professional identity is being reinforced in all roles and all settings.

Nicole Weathers: 10:04
So I want to pause briefly and talk about a couple of things before we move on. So first is when you talk about society, right, so you talk about media. One thing that I see and I brought this up a little bit in our conversation with Nelda Godfrey briefly, but was around the impact of even social media. So we talk about, like TV shows and things like that, where nurses are portrayed a certain way, but then when we have new grads out there on social media, and it's not just the portrayal of a nurse in a TV show, but these are real nurses who are portraying themselves a certain way on social media and it's not always positive, right. But I would love to know sort of your take on social media's role in some of this professional identity of nursing.

Dr. Lindell Joseph: 10:50
So I think it comes back to this is a team effort in terms of fostering professional identity and being intentional about reinforcing and uplifting nurses to know who they are and what that identity is, and that's why when we see nurses do things on social media, we're shocked, right? We, as a discipline, we have to take this whole new movement of professional identity, nursing, and be intentional about it. Recently, one of the opportunities that I had was Nelda Godfrey had asked me to lead the work group on all nurses as leaders, and I led that with the Institute for the Brand Image of Nursing, and what we did was that it took us about a year and a half in terms of trying to figure out do we need an elevator pitch in terms of what nursing is or what do we do? So we created a position paper titled, 'A Call to Dialogue to Advance the Concept of Nurses as Leaders Within the Profession and the Public', and one of the things we did was that.

Dr. Lindell Joseph: 12:05
One of the things that I did was that I'm like I'm taking this to nursing associations and I went to Tri Council.

Dr. Lindell Joseph: 12:11
So the good news is, I went to the American Organization for Nursing Leadership and they've endorsed that position paper because it says what needs to be happened, even at the individual level, at the association level, in academia. And then I also went to the ANA and I asked them to endorse this work that all nurses are leaders. Well, finally, last week I heard from the ANA and the ANA said we are endorsing this position paper, it will be shared in our e-news and it will be on our website. So the good news is we have to come together with one voice so the new nurses and the experienced nurses can know where it is, or where are we headed as a discipline and what message, what is the brand image that we need to share with our children and social media. So I think we have started the work with the ANA and I'm really excited about this accomplishment. So I invite people to look out for the ANA e-news about the importance to recognize and acknowledge that all nurses are leaders.

Nicole Weathers: 13:23
Well, and I think this will be really helpful for nurses as they transition into new roles as well. I think when I first made that transition from the bedside in a hospital to outside of the four walls of providing patient care, you go through a little bit of an identity crisis in a way. You begin to question like, yes, I'm a nurse, but I'm not a nurse in the context of the way society sees nursing and therefore I question sometimes my own value to the profession. And so I think the fact that you're getting some of these large professional bodies to sign off on this message is so important to all of us as we go through our own career progression and we take on new roles and we do new things, that even when somebody asks me what, what do you do? You can say that I am a nurse because I am still a nurse, even though I might not be a nurse in the way that you you as a you know societal member maybe sees us.

Dr. Lindell Joseph: 14:25
Absolutely, and I think I can't I mean not be able to reiterate it, but when we went back and forth it was like what is that elevator pitch? And in the end it was about saying I am a nurse who influences patient care, or patient care delivery and cardiology. I am a nurse who influences future nurses in academia. So that word influence, we believe is really critical in terms of messaging and sharing our message to all levels, to colleagues and to society at large and to legislators, to everyone that we encounter.

Nicole Weathers: 15:02
So you started talking here a little bit, too, about the role leadership plays in professional identity formation. We know nurse leaders have a major role when it comes to creating positive work environments where their teams can thrive. One of the articles that I've read about professional identity in nursing you actually wrote it or were part of the team that wrote it, and you described nursing leadership as being a conduit of professional identity formation and sustainability. So maybe you could talk a little bit more about that concept and what does it mean to really be a conduit in this context?

Dr. Lindell Joseph: 15:39
Right, so when we, as we were exploring this body of work that we were engaged in, I felt that it was necessary to begin to think about what is the role of leadership and what does it mean to be in the space, because it was all about the nurse. So when I started to think about leadership, as you know from the literature, the leader or the nurse manager is they're able to influence outcomes, workforce outcomes and patient care outcomes. Right, that's huge and I don't think it's something we recognize or we acknowledge many times, but that level of influence is so important. So who best, who best, can role model professional identity in nursing, so that other nurses can model what it is that they see and what it is that they need to continue to do in future roles and future work settings? It is the leader of the organization and, as you know, the leader, as we mentioned, drive culture. So, when you think about the domains of professional identity, when we think about ethics, we have to think about how do we demonstrate and how do we use ethical leadership practices so nurses could see that we're modeling, that we have to be expanding our knowledge so, as things change in the environment, we're able to say have new knowledge so we could ultimately support people in driving outcomes.

Dr. Lindell Joseph: 17:13
We have to be able to show that we know how to navigate the work environment, work of different people, internally and externally. We have to model that we're politically savvy and we know how to work with people and we most importantly, we need to consistently empower nurses. I mean that's huge. We need to say I recognize you are a leader, I recognize you have a body of knowledge, I recognize that you are a human being who needs to thrive and I am going to empower you so you can make decisions at the point of care and at the top of your license. So it's all about showing respect and showing that you trust the nurse, because when people feel respected and when people are heard, they thrive. And that's the important part and the role of nursing leadership and professional identity. It's about how do we elevate the nurse so they can ultimately thrive, aspire to do their best.

Nicole Weathers: 18:16
I mean I really hear you saying in this you know, role modeling, right, role modeling the behaviors that we want our nurses to have is number one, most important. We can't expect them to do something that we're not doing ourselves. So I mean, that is one sort of key, I guess, takeaway from what you just shared. And then I think the other piece that I'm hearing you say is helping position these people so that they can thrive, and helping them up the rung of the ladder or whatever metaphor you want to use there, and letting them do what they do best, kind of playing on their strengths and trusting that they are going to show up and do that work. You know, when we think about leaders whatever the context, I mean I think those are two really applicable actions I think people can take. Right is that you know we're walking the talk and we're helping others to bring them and kind of shine a light on them and help them have the platform, if you will, to do their work.

Nicole Weathers: 19:18
So I appreciate you sharing those very practical examples of how leadership really can influence this. Okay, besides, I guess, the leader being a good role model and bringing them into different aspects of the work and getting them positioned so that they can do their work well? Are there other actionable, I guess, activities where we can really help nurses to begin to develop this professional identity formation? I mean, when I think about residency programs, when I think about professional development activities, is it just a matter of getting them into these types of programs and then that is just kind of an outcome of them, or are there tangible things that we should have these nurses doing as part of these programs to really begin to help them form that professional identity?

Dr. Lindell Joseph: 20:14
Yeah, it's really twofold right. So I'm not sure if you're familiar with Judy Godsey and Tom Hayes. They're from the Institute for the Brand Image of Nursing and in their research they you know, they had a study and they recognized that nurses had a desired image, right. Nurses wanted to be autonomous in practice. Nurses wanted to be empowered with decision making. Nurses felt that they wanted to be leaders in practice, education and research. That was a desire, but when they did their work it was clear that that was not the reality, right? So because Tom Hayes is in the field of marketing, he goes it's a collective effort. We have to work together, like I said before, to change a brand image of nursing.

Dr. Lindell Joseph: 21:07
And the thing about when you're trying to change a brand in the perception of people to a desire brand, there are specific things that you need to do. You know it's about the messaging, right. That's the first thing we have to figure out. What is it that we want people to know about the nurse, about what nursing is? The message has to be positive, it has to be relevant. It has to be relevant, it has to be accurate, it has to be desirable and it has to be consistent over time. We cannot be changing. So that's the big aha right. It's working together as a discipline at all levels which is the micro level, the meso level and the macro level to be able to push that message in.

Dr. Lindell Joseph: 21:54
The second thing is when you think about the organizational level, your team, as a nursing leadership team, you need to get together and say what is it that we want to communicate organizationally? What do we want physicians, what do we want the Department of Radiology and Respiratory Therapists to know about nursing? How do we want? We know they have these stereotypical images, but we need to change that perception to a new brand image. So we have to collectively say so. We have to collectively say well, you know, as a nursing leadership, we want nurses to be respected and we want nurses to be perceived as leaders within the entire organization. So what are we going to have to do? We need to empower nurses with decision making. If we don't have, like professional shared governance structures or forums, we need to make sure nurses are engaged in decision-making. So those are things you could do and those for some people. It depends on your approach to leadership right. That may be a little difficult for you, but we know that works, so that's important. So what about the residents, the nurse residency programs and nurses, new graduate nurses who come into your organization?

Dr. Lindell Joseph: 23:19
Well, I think the first thing is that we have to be intentional. We now know that nurses are coming with a body. Nurses know ethics, nurses have a body of knowledge, nurses are leaders and nurses know how to work with people that professional compartment piece. So with that, there's a level of respect that we need to provide to nurses. We have to say these individuals, this is who they are, this is their identity, and how do we respect that?

Dr. Lindell Joseph: 23:55
You know, sometimes you graduate from nursing school and immediately you transition into the workforce and in some organizations at that point, basically, you feel like no one is listening to you, right? That can't be. We need to elevate the nurse, because that nurse may have been in school for the last four years. That nurse may have had family members that they've been helping and supporting with nursing care. They're not ignorant, they have knowledge.

Dr. Lindell Joseph: 24:26
So we have to respect nurses. We have to show that we value the integrity, what they bring to the table. We value their knowledge and we are going to tap into their knowledge for decision making. We want the ideas, we want to hear their voices. We want them to feel empowered and we want them to thrive. So that residency program, whether it's six months or whether it's a year, it's about elevating the nurse and providing that work environment that says I see you and I hear you and I value you and you can challenge anything that you see, because you need to feel safe in this environment. So it's back to what is the type of work environment that we're creating for these nurses who are transitioning to practice. That's important because that will help them thrive for the future.

Nicole Weathers: 25:23
And you know, when I think about our nurse residency program curriculum and I'm always like, okay, are we doing enough? Right? I mean this constant like quality improvement, how do we, how do we continue to improve what we do? And so, as we talked last month with Dr Godfrey about this, you know I've been thinkinga lot because we're in the middle of our curriculum revisions or, I guess, review this year to make some revisions in the future, and so I really want to make sure that we're intentional about this. But as I hear you talk about some of these things, I think that there's probably a lot in our program that we're doing already, and one of the things Nelda and I talked about was just that the languages may be different. Prior to this work I didn't have the language to talk about the things that I felt were important, right for our new graduate nurses or what even you know, the research and the literature sort of shows.

Nicole Weathers: 26:16
So one of the key things that we do in our program is require what we call a professional experience, and this is a new nurse's first taste at getting involved in change work at their organization, so they can lead a change, they can do a case study where they propose a change to like an existing committee or they can get involved in some committee work existing change.

Nicole Weathers: 26:40
That's already happening. They're contributing as a team member, and so the whole goal behind that was for them to begin to see their role outside of the tasks at the bedside. When it comes to patient care, that I can see a problem, I can see something that's less than ideal, and I have a role in helping to bring about change and improve things for the patients that I care for, and so this is just an opportunity for them to get a little bit of a taste of that. We don't want it to be huge. We want them to be successful, of course, and so we want to give them a small experience to work through. But, as you're kind of talking about the practical strategies, to me this is a great example of something that we can do to begin to engage them in these decision-making activities, to help get their ideas and their voices heard and empowering them to continue to do these sorts of things into the future, because that's what we really need as a profession, right as these engaged nurses who want to participate in these types of activities.

Dr. Lindell Joseph: 27:44
Yeah, absolutely, and you know what occurred to me, and I think Nelda and myself may have co-published an article. I think it's important for nursing leadership to look at these four domains of professional identity and even use it as an opportunity for coaching. You know it's interesting. You know, traditionally, when we were like, oh yes, I helped a nurse, I went to the bedside and I helped them pull up the patient, I think there needs to be a shift. You know when you, if you're doing patient roundings right, how can you round with those four domains of professional identity? When you hear a situation, maybe focus on wow, wow, Jill, it's really wonderful that you were able to use your knowledge to problem solve. Look at the ethical components of this situation. That's profound. Look how you were able to work with people in terms of professional comportment and, wow, look how you were able to lead in this context.

Dr. Lindell Joseph: 28:44
So what I think professional identity has provided us with is new language, not only to speak, but also to coach and also to mentor people with those four domains. So what then happens is that you're reinforcing this new way of being in different contexts, and I think that's where the message is. We now have system levers to help us problem solve and to help us think through situations, and it's important that we tap into those as leaders to convey what it is that we see. And it gives us an opportunity to coach others and coach our peers and to think about our behaviors in the context of a situation. You know reflective practice is really important in the context of a situation. You know reflective practice is really important and I think if nurses or nurse leaders reflect on our practice, at the end of the day, utilizing those four domains will help us develop more and it will help us to own this new language of professional identity in nursing.

Nicole Weathers: 29:48
I really love that idea of using it as a framework for coaching because I think what better way to help nurses feel seen? Because, as you're giving this example, it's like wow, that would be so impactful to have a leader say, you know, I saw that you handled this situation or you did this thing. That must be a really important value of yours and you used your knowledge to make this better for a patient. And I can just I can. You can almost see how much impact that would have for a new or experienced nurse to have a leader sort of point those things out to them and I think contributes so much to that formation of the professional identity.

Dr. Lindell Joseph: 30:31
Right. Because, remember we said, it begins in the classroom and it needs to be reinforced in practice, in all roles and all settings, so that intentionality is so critical in terms of reinforcing what it is and modeling what it is and coaching with it and counseling with it, whatever it may be.

Nicole Weathers: 30:57
So I mean, I think from a nurse residency perspective, really kind of looking at our program through this lens. And where do these sort of things come in play? Whether they are in our you know monthly discussions with the new grads, whether they're being talked about in the curriculum, or whether you know if we have mentors, if we have leaders doing these check-ins using those four domains as a framework for those check-ins, to make sure we're paying attention to each one of those areas, because so often it's knowledge-based.

Nicole Weathers: 31:25
right, we're talking about what do you know from a competency standpoint, but there's so much more to this professional identity formation than just the knowledge that they have.

Dr. Lindell Joseph: 31:38
And it's really, I think, throughout our conversation. It's really a call to nurse leaders to make sure they're aware of the definition and they need to reflect on how best to use those domains so it's relevant in their work.

Nicole Weathers: 31:54
Talking now about, I think, lifelong learning. As a nurse, this is a huge part of who we are. You know we talk to new grads a lot about. You know, just because you're done with the NCLEX doesn't mean you're done learning. Just because you're done with your residency program doesn't mean it ends right. There's that continual need for ongoing professional development, whether we're talking about informal sort of activities like ACLS or, you know, formal academic progression. So how do you think this concept of being a lifelong learner, of engaging in informal educational activities, how does that continue to, I guess, impact professional identity formation?

Dr. Lindell Joseph: 32:36
Yes, that's a great question because with the conceptual model work that we did, we recognized that lifelong learning transcended across all the nurses trained in the US and all nurses trained internationally. So that is huge. I sit on the HPAC, which is the Healthcare Advisory Policy Council for the American Association for Colleges of Nursing and in that group one of the messages that we are developing for deans of colleges and the legislature is about lifelong learning. You know, traditionally when we would go to, when we would propose bills in Congress it was. It was like a one size fit all. We would be like we need to educate more nurses. That document for legislators will be available for the deans to take to the Hill in March. But part of that is about lifelong learning and what it is and that because of the complexity of practice, we can begin with an associate degree, but we need more degrees to manage the complexity of healthcare and all the challenges that we've been confronted with. So the conceptual model has verified that lifelong learning is core and we need to own it. And I do believe, Nicole, that we own it Because when you think about I think I'm thankful for some board of nurses. You know, every two years we have to do continuing education, and that's a good thing. I think, as we transition into new roles, we recognize we do not have all the knowledge and tools. So that's learning Right, and I think the key thing is, how do we ensure that people have the capacity and the openness to grow, which is what you're tapping into, and I think that's our responsibility, right? We model that, we teach that in class, we invest in them when they come into the practice environment to demonstrate and to show that learning is important. But, most importantly, I remember as a GN, at the end of my shift, when I reflected and I realized I didn't know a specific content. I would go home and review my work. So I think reflective practice is so important in terms of how we evolve as clinicians and how we evolve as leaders.

Dr. Lindell Joseph: 35:05
So these behaviors or these, they're not really behaviors, really, some of them are behaviors. But some of these things that I just mentioned are so critical in terms of how we engage in lifelong learning. I think it's also ethical at some levels because, when you think about, we have a social contract with society and our social contract with society is about enabling health.

Dr. Lindell Joseph: 35:35
Well, if you think about patient care, it changes every day. The complexity of patients evolve. So if we have to meet that societal mandate, we have to develop, we have to engage, we have to provide resources, we have to engage in formal and informal opportunities of learning, because how else? And as a peer, at the end of my shift, I'm expecting you to have provided the best level of patient care to that patient, because when I get that handoff, I need the assurity that you did your best. We need to be accountable to each other. It's not about choosing to do whatever you want. It's about a societal mandate and the ethics of that.

Dr. Lindell Joseph: 36:23
So I think what the domains of professional identity have taught us is that knowledge, we're knowledge brokers and that knowledge domain has to continue to expand in new roles and in the new work for nursing practice and nursing leadership in all different entities. So, I just want to make another point. You know, I think we could all relate. You know we are now bombarded with the world of Ai. Right? And everyone, it doesn't matter who you are, whether you are in academia, or whether you're in practice, or whether you are on the frontline. You have to think about, how does Ai inform my work? And how do I learn about Ai to improve work outcomes? It's necessary. We have to be able to be open and know that the world is changing and with that, the type of role we have. We have to engage in continuous learning and lifelong learning.

Nicole Weathers: 37:28

You know, I mean, your're preaching to the choir here, right? Because I am, you know, my background is nursing professional development. I feel so strongly about how important the role of the nursing professional development practitioner is in practice. You know, academia is hugely important, to get people the knowledge that they need to enter the workforce and then, of course, those things like the terminal degree that I'm going after. But so many nurses stay in practice and we need that same level of knowledge and evolving the knowledge that we have every single day. And that's really where the nursing professional development practitioner comes in right. They are developing these role, transition programs, they are working on competencies, they are helping them to apply, you know, research and quality improvement.

Nicole Weathers: 38:22
All of these things in the practice setting and a lot of that requires new knowledge, new information all of the time, and so I mean they play such a huge piece, I think, in this professional identity formation and I think that's why, as I've learned about this, as I've had conversations with both you and Dr Godfrey, that is why it sticks with me. I think so much because I see how important all of that work that I've done for the last 10 plus years has been on this specific topic, and reflective practice is a huge piece of that, because if you never slow down to take the time to reflect on what do I know, what am I seeing now, what am I missing, you don't ever kind of garner that desire to continue to learn and develop. Because you're just so focused on the here and the now that you don't think about anything sort of beyond that. So I know reflective practice is a thing we've really tried to instill into our residency program to get people thinking about the work that they do, not just checking a box that I can do this thing, but thinking about you know, what do I do well, where can I maybe improve? What do I need more knowledge on? And and I think putting that, yes, nursing professional development practitioners can help create education and things to help with this but also I have a duty as the individual.

Nicole Weathers: 39:43
If I don't know something, it's my responsibility to position myself to be able to learn more about that thing. And I would say, as a new nurse, that was not, that was not a mentality that I had. I kind of just expected that if there was something I needed to know for my job, my employer would provide me with that information or that education, that it wasn't necessarily up to me as an independent person to do that, and so I think that's a really important, I think, take home message and something too when we think about the profession, we want to begin to instill sort of that level of reflection on what it is that we need, and then the ability to take action independently outside of my employer to continue to grow.

Dr. Lindell Joseph: 40:32
Exactly, and that's a profession, right, it's not about the job, but it's about the discipline and what we're tasked to do, which is to enable health. So there's a level of commitment that comes with such a societal mandate. So how do we continue to say to people it's a societal mandate and you need to take ownership at the individual level and collectively. You know, that's why it's good for people to be in different groups. These different groups and these different communities can help reinforce that message. So, absolutely I agree.

Nicole Weathers: 41:15
And I mean, I think with each level of education that I've obtained formally, there is that realization, I think that like, oh, I need to know more to be able to do this job. 

Nicole Weathers: 41:27
So when I moved from working clinically at the bedside to being in more of like a nursing professional development role where I'm doing orientation and all of these things, you take that time to reflect, you realize that like, oh, there's a lot more to this than maybe what I originally thought when I took this position.

Nicole Weathers: 41:45
I need to enroll in that master's program so that I can learn this additional information that I need. And the same thing, even with this role and my desire to jump into this DNP program, is that as that role evolves, you begin to realize and reflect that like, oh, there's still more that I need to know. And I think the more that you know, the more you realize you don't actually know much at all. And I think that is almost that. I guess trigger, if you will, to continue that lifelong learning, is having people coach you up into different positions to try new things, and so it. I mean I'm sure there's some very intellectual words to say about how you have that tension between where you are and where you need to be, and that is really the driver to continue your education.

Dr. Lindell Joseph: 42:36

Absolutely. Well stated.

Nicole Weathers: 42:39
Okay, so, given that innovation is one of your research areas of interest, you've probably thought about sort of this intersection of professional identity and nursing and innovation. So what can you tell us about this? Where do you see innovation really coming in to the picture and how can it be leveraged to maybe build this important concept?

Dr. Lindell Joseph: 43:01
So, to be honest with you, Nicole, I had not truly put much thought in terms of innovation and professional identity because I've been working on all these other parts and pieces, like I mentioned before. But if you recall, when we think about innovating, it's coming up with an idea or a new product, a new process, right. And when we think about professional identity, we've spoken for a while about the importance of helping people thrive. When I think about the organization many times the role of the healthcare system I always think about it in the context of it's a classic book called Images of the Organization, and I think about the organization with a brain metaphor, right. So when we think about needing people to come up with ideas and needing people to come up with new processes, new ways of doing things, it's about how do we increase the confidence and the self-efficacy of our workers? How do we ensure that our workers feel psychologically safe? And it comes back to when that new GN or that worker comes into your work environment. What are you going to do to make them feel that they're valued? You recognize who they are, what it is that they show up with. They show up with knowledge, they show up with a body of ethics. They know how to work with people and their leaders, right. So it comes back to making people feel valued and respected so they could say, oh my, I feel psychologically safe. There is something wrong in the work environment. Why is this piece of equipment not working the way it's supposed to work? Why haven't we figured out how to work well as a team? We need knowledge in those different areas. We need to ensure progress with our work, whether it's functional progress, social progress, emotional progress and how you know the ability to ask yourself that question. That something isn't working properly.

Dr. Lindell Joseph: 45:11
It all depends on how you feel psychologically at work, how safe you feel that you could question what's been done for 100 years, challenge your status quo and for people to say I hear you, what can we do to provide you with a team. And remember, innovation is not about working in isolation. Right, innovation is putting yourself with people. So you could look at that problem, that thorny problem, that problematic process that you can't figure out. It's putting your team together, people around you, and say how do we make this better? What is the solution? But all these people it's not only you, they must all feel safe that they could challenge the status quo and you as a leader need to provide them with the forum and the resources to take that idea to another level.

Dr. Lindell Joseph: 46:10
So, identifying and recognizing that nurses show up with those four domains, we're elevating how they think about themselves. So they could question practice, they could question some of the things that's done in nursing leadership right, some of the things that's done in nursing leadership right, and with that, with that stronger professional identity in nursing, we will have more innovation. We will have people that are not going to be feeling sorry for themselves or saying, oh, it's been done that way forever. Let it be no, because now we have a new cadre of people in the workforce that feel more confident about who they are and who they can become. So they will begin to mobilize, get new jobs, come up with new ideas and become more entrepreneurial because they're allowed to think. So that brain metaphor that I speak about, I think it's so critical in our future because, at the individual level and the work of nursing leadership, in terms of the work environment, how these two come together to enable a discipline that could continue to be transformed. So I think that intersection is so important.

Nicole Weathers: 47:28
I mean I hear you saying good leadership that fosters professional identity, provides a forum for people to challenge the status quo is going to naturally evolve into more innovation. I mean we talk about nurses being uniquely positioned to innovate because we are at the point of care and we see all of the problems right. We see all of the system impact on what it is that we're dealing with at the bedside or wherever our practice setting might be. And with good leadership that provides forums and cultivates professional identity, we're going to just naturally have more innovation happen because of how nurses are being supported.

Dr. Lindell Joseph: 48:13
And you know, Nicole, I wanted to say you know, we know nurses and natural innovators. They do all these walkarounds right, but they would speak up and say this does not work, because they feel safe and they feel valued, that someone will listen to them. So absolutely, that there is that intersectionality between how people see themselves, how people feel valued, and the work of nursing leadership to elevate that.

Nicole Weathers: 48:41
Well, Lindell, we have talked about so many great things Like. I've loved this conversation because we've talked about the role society plays, we've talked about our workplace cultures, leadership's role, we've talked about practical strategies like getting nurses involved in change opportunities and reflective practice, and we've talked about lifelong learning. I mean there's so much. And then, of course, innovation, right. So I really just appreciate this conversation with you today because it does kind of help me as a student even click all of these things into place right, and begin to see sort of that system impact and how each of these things sort of feed into one another. But before we go, I do have one last question, and I asked this of all of our guests. But when it comes to this topic today, whether we're talking about leadership's role or innovation or lifelong learning, what's one thing maybe you see organizations doing that you think makes a significant difference in the development of professional identity that you wish maybe more organizations would do?

Dr. Lindell Joseph: 49:48
Yeah, good question, Nicole, and I think this response will capture everything we've discussed so far, and I think it's about recognizing and acknowledging that all nurses are leaders. It doesn't matter where you are in terms of in the organization, it doesn't matter where you are in terms of your practice, because you influence at every moment and every day. So I think if we respect the fact that nurses are influencers, it would be very impactful for practice. And I really want to say there are so many organizations who have professional governance and shared governance forums in place. Some leaders have invited nurses to the boardroom and I applaud them for that. I think those are the behaviors that say we believe your voice is important in decision making. I think if we could continue to see that modeled and repeated with intentionality, healthcare would be in a better place and the discipline of nursing would certainly be in a better place.

Nicole Weathers: 51:06
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.

Nicole Weathers: 51:45
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 standalone 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.