Building Esteem Through Feedback and Support

Over the past season, we've explored the conditions that support nurse engagement, including infrastructure, healthy work environments, competency, safety, and belonging. In this episode of the Beyond Nurse Residency Podcast, we turn our attention to another essential element: esteem.

Host Nicole Weathers is joined by nurse leader, educator, speaker, and human skills advocate Rachel Kelter for a conversation about the role esteem plays in shaping a nurse's experience, growth, and engagement. Together, they explore both self-esteem and organization-based self-esteem, examining how a nurse's belief in their own capabilities, and their sense of being valued by their organization, influence confidence, resilience, and professional development.

In this episode, you'll learn:

• Why confidence and competence don't always develop at the same pace
• The relationship between esteem, self-efficacy, and self-advocacy
• How belonging and psychological safety contribute to self-belief
• The role human skills play in personal and professional growth
• Practical strategies for leaders, educators, preceptors, and colleagues to help cultivate confidence and esteem in others

Whether you're supporting new graduate nurses or developing seasoned clinicians, this conversation offers valuable insights into creating environments where nurses feel capable, valued, and empowered to make a meaningful impact.

Guest: Rachel Kelter, MSN, RN, NPD-BC, CPC
Nurse Leader, Speaker, Coach, & Educator

Rachel Kelter, MSN, RN, NPD-BC, CPC is a dynamic speaker, nurse leader, and human skills educator who helps healthcare teams—and professionals beyond healthcare—strengthen communication, build trust, and lead with grounded confidence during times of change.

With more than a decade of experience in nursing professional development, Rachel designs and delivers high-impact learning experiences focused on leadership growth, workforce development, and meaningful practice transformation.

As a master’s-prepared registered nurse and board-certified Nursing Professional Development specialist, Rachel combines clinical expertise with evidence-based education, coaching, and leadership development to create practical, relatable strategies audiences can immediately apply in both professional and personal environments.

How to find Rachel:
Website
LinkedIn
Disruptor Diaries podcast

Article:
Human Design and Nursing Professional Development
A New Approach to Preceptor Support

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

Transcript

Copy Transcript Copied

Why Esteem Drives Engagement

Host Nicole Weathers 0:00

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. Over the past year, we've explored the conditions that help create engagement. We've talked about infrastructure, the work environment, competency, safety, and belonging. Today we're shifting our focus to the concept of esteem. When I think about esteem, I think about it in two ways. First, there's this idea of self-esteem, or our belief that we are capable of handling challenges and more worthy of growth and success. Second, is this concept of organization-based self-esteem, or the degree to which employees believe they are capable, significant, and a valued member of their organization. For me, it's this combination of how we think about ourselves and the feelings of respect by others that become a critical ingredient for engagement. It's the difference between simply showing up to work and truly believing that our contribution matters, that our voice has value, and that we are capable of making a meaningful impact. So today we're going to explore the relationship between self-efficacy, confidence, and esteem. We'll talk about why confidence and competence don't always develop at the same pace, how self-belief develops over time, the role competency, safety, and belonging play in the development of esteem, and how human skills and relationships help shape the way we see ourselves and what we're capable of becoming. My hope is that our listeners will walk away with a better understanding of how esteem develops and some practical ideas for how leaders, educators, preceptors, and colleagues can help cultivate these concepts in others.

Meet Rachel Kelter

Host Nicole Weathers 2:00

To help us explore these questions, I'm joined by Rachel Kelter. Hello, Rachel. How are you? Hello. Good. How are you? Thanks for having me. Thanks so much for joining us. Why don't we start off by having you share a little bit more about yourself with our listeners?

Rachel Kelter 2:15

Yes, we'd love to. So hello, everybody. Um, like Nicole said, my name is Rachel Kelter. I am a Masters Prepared Registered Nurse for the past 15 years. Um, most of my nursing career has been spent in nursing professional development and leadership. And over the past, I'd say five years or so, have really um gained an interest in studying what Nicole had mentioned, human skills or soft skills. And I don't like to say soft skills because I think they're anything but soft, but they certainly are very human. So I do um lots of different speaking engagements and um a podcast of my own that I co-host with other nursing professional development specialists. And then I also work at a large healthcare organization in the Midwest as a education project manager for our accredited provider unit. So I do lots of different things, um, but I love it. And I love being able to uh kind of share this message of human skills and leadership and um really and where I go. So excited to be here.

Host Nicole Weathers 3:16

You know, you do wear a lot of different hats in your nursing professional development role. And, you know, uh, as I was kind of thinking about who could come and talk about this topic, I think so much of what we're gonna talk about really does come back to those that concept of sort of human skills and how those really shape who we are, you know, becoming as nurses. So really excited to jump into this conversation and get started.

Rachel Kelter 3:43

Me too.

Host Nicole Weathers 3:44

Okay, so when we hear terms like confidence, self-esteem, self-efficacy, what kind of comes to mind for you? And how do you think those concepts kind of relate?

Self-Efficacy Versus Self-Esteem

Rachel Kelter 3:54

Yeah, so I thought about this and I think it might be helpful to start maybe with a basic understanding of each concept, at least how I understand them. So please jump in if you have different thoughts on this. But when I think about first starting with self-efficacy, I think about, you know, do I have capability to do a specific thing or a task? So can I facilitate this keynote? Can I have this hard conversation? Can I be a guest on this podcast? Um, and self-efficacy is really interesting because, you know, I think you can have self-efficacy, um, a high self-efficacy maybe in one area and lower in another. And we know from research that self-efficacy is really built through these mastery experiences or deeming the hard being successful. And then when I think about self-esteem, so I it's really interesting your intro, Nicole, about esteem and self-esteem. I really see it from a self-worth perspective. So I, you know, am I worthy of love and belonging? Am I good in it? And I definitely think about B rene Brown's research a lot with self-worth. And what's interesting, uh, she talks about that most of us have been taught that our self-worth is conditional, or it's like tied to these external validators, such as our grades or our weight or titles or income. But really, self-worth is inherent. It's not transactional, it's not based on these external experiences. But when we tie our self-worth to, you know, how much we can achieve or what success looks like, or even, you know, meeting other people's expectations, we are significantly more likely to experience anxiety, depression, eating disorders, and burnout. And, you know, when I think about this, like, well, why is that? Why do we experience that? And when we tie our worth to what we do, because you know, tying it to what we do with our identity, the moment we fail or even take a pause or shift directions or pivot, you feel like you're you're nothing. You feel like a failure. And um, like when you tie, I know for me, I definitely can tie my value a lot to productivity. So when I rest, I feel like I'm failing or I'm not moving forward enough or enough. But we know from Brene Brown's research that worth is something that we carry always with us. It's not something you hustle for. So that's where that's kind of what I think about with this theme and self-worth. And then when I think about confidence, um, I maybe see that more as what you are your definition with this theme, but uh, this general like trust in oneself, um, you know, my ability, maybe my capacity to handle challenges. And um recently I do a lot of uh my own studying and searching with uh definitely with Brene Brown's research . I've I've gone through the Dare to Lead training. And I, with her new book, Strong Ground, she talks about this concept called grounded confidence, which she introduced in Dare to Lead. Um, and it's just evolved and more into her next book, Atlas of the Heart, and then this book, Strong Ground. But um I thought I'd just read the definition. So grounded confidence, how she defines it as this brand of confidence that's not built on arrogance or posturing, but rather this solid ground of self-awareness and courage and practice. And it's interesting because it's full of paradoxes. So, like these two seemingly opposite truths that can be, you know, how do we hold both of these together at the same time? So it's both accepting and embracing learning and also unlearning and it's practicing and failing. And she says that at the core of all of it, though, you know, it's really driven by discipline and the joy of mastery. And it's built on this solid ground of having these skills or human skills of self-awareness, courage, and then continuing to practice. So, you know, it's interesting how all of these, you know, all these concepts kind of intersect and and influence one another. So I'll I'll pause there, but that's how I see each of those first kind of independently, um, and then can kind of share how I see they they interact.

Host Nicole Weathers 8:21

Yeah, I mean, I think as you're kind of talking there about all of the different different definitions, I mean, they are all different, yes, but they do have a lot of sort of related factors, right? So if self-esteem is sort of that just inherent worthiness, I guess, because I am who I am, and then self-efficacy, so mastery of a certain skill leads probably to confidence in that skill. And so they do build on each other and support one another.

Rachel Kelter 8:52

Yes, yes, I agree. And I think that exactly what you said is this self-ethicacy becomes that building block for confidence. So, you know, every time we do something hard, we learn a new skill, we work through a challenge successfully, it's we gain this evidence that, hey, we can handle the hard things, we can do difficult things. And over time, I think those mastery experiences help us develop this a broader, broader sense of confidence. It doesn't mean we can't uh that we're always gonna feel confident in everything we do. Um, and what I love about the term grounded confidence, it's really on the premise that, hey, I can have these skill sets and still have things to learn at the same time, right? I can practice curiosity and maybe, you know, know what I want to do in this situation. And it is not being able to, you know, I think pull on those skill sets even in the face of uncertainty. So confidence to me doesn't mean, you know, oh, I'm only gonna be confident when I know the outcome, because you know, most of the time we probably don't know the outcome. I think, especially in healthcare, right? Um, it's a lot of navigating uncertainty right now.

When Competence Outruns Confidence

Host Nicole Weathers 10:05

So when we think about confidence and competence, because these are two big topics that come up a lot when we're talking about new grad transition and nurse residency and all the things that we like to talk about on this podcast. And I think back to several nurses that I have known over the course of my career where they're competent. Um, they know the skills, they know, they have the knowledge, but that confidence isn't quite there. So they don't always maybe develop kind of simultaneously or at the same pace. So, have you experienced this? And what do you think is happening there?

Rachel Kelter 10:47

Yes, I definitely have personally experienced this, and I think still do at times. I see myself as someone who has high self-efficacy and and can have lower self-esteem or maybe even confidence at times, depending on what it is. Um, but I think we often as people assume that if we're competent, then we should we should, like that in quotes, automatically feel confident. Um, but I think what's happening is that this competence is often visible to everybody else before it is for ourselves, right? Um, other people can pull and recognize our strengths and skill sets and expertise. But I think as people, we tend to uh seek out the the negative or what we're not doing right versus what what we are getting. And I think especially maybe for high achievers, this competence doesn't translate into confidence a lot because we're constantly moving the goalpost of like what we want to achieve, right? So we achieve one thing, we are probably blowing through even celebrating that or acknowledging this growth, and then we're on to the next thing that you know we haven't quite mastered yet. So it's interesting with with those, especially with I think high achievers, I think that can be especially hard. And then I think about again, maybe more self-worth and how that plays a role. So if my worth is tied to my performance, then this competence never feels like enough because I'm again, I'm constantly looking for that next thing to prove my worth or my value. And with that, it's not a confidence problem, but a self-worth problem. So I'm really curious like, do we struggle more with this deeper sense of worthiness versus maybe a lack of confidence? But we're labeling it maybe as confidence or lack of confidence. I also was thinking about confidence and this concept of preparedness. And I've had some experiences recently where I have felt I'm a person who likes to prepare as much as I can. And some people are really great at doing things on the fly. I'm not always one of those people, but I have found that when I have time to prepare or I can, which I know we can't, we don't always have that luxury, but if I have time to prepare, and the more I do, it it almost provides this sense of confidence because I know that if maybe the conversation shifts or pivots, or we need to spend more time talking about a topic, like if I'm presenting, for example, then that preparedness gives me this capacity to really be be a better facilitator in that instance, where I can really leverage the learners and and and you know ask them to, you know, maybe share more of their stories. But I have this kind of a bank of resources that I've kind of collected. So that helps me, even if I'm going off script, so to speak, or I'm not following all the slides, which this happened recently. I had a whole presentation prepared for um for a retreat for something. And we got we had such great conversation about the first few concepts that we didn't get to any more. And I thought about this, I'm like, oh my goodness, that shoot, that I have core time management. Like all these things first came to mind. And then I paused and thought, but you know, what did the learner get out of that? And so that those situations, I think maybe part with self-ethic to see, like, okay, we kind of navigated this hard thing and maybe not the way I expected it, but the outcome was still good.

Host Nicole Weathers 14:41

Well, I think that's a sign of like a very skilled facilitator or teacher is that you can do that, right? You can pivot, you can follow the needs of the learner that's in front of you and navigate that well. And even though it doesn't go according to plan, you know, that's still very beneficial. I want to go back to a couple of things that you mentioned earlier. So, first, this idea of negativity bias being a factor in our competence, even though we have the competence. And I haven't thought about that, but I do think that that is true. Like as a fellow high achiever, um, it's very easy to look at and focus on sort of deficits rather than strengths. Uh, so it, and I think self-awareness is probably a big piece of that, right? Having awareness enough to know that maybe our negativity bias is taking control of the situation here. Um, but we need to have self-awareness on where our strengths maybe actually lie. So that was one thing that sort of stuck stood out to me as you were talking. And another thing that I want to kind of run by you and get your thoughts on are around maybe it's a paradox of confidence and competence not developing maybe at the same pace. And we usually think of, you know, they're competent, but they're don't have quite have the competence. But I think what we also sometimes see in new nurses, and I think the thing that nurse leaders struggle with a lot, um, maybe more so, is the nurse who has the competence, but not yet developed the competence. And so I'm just curious if you have any thoughts on that.

Rachel Kelter 16:19

Yeah, I know it's interesting, right? Because I think we probably tend to see, at least when I was more at the bedside as an NPD, more the lack of confidence versus competence. But when you have that overconfident lack of competent, um, that can be scary, right? And I was thinking about earlier today, actually, I presented on the disk assessment. And uh so if the listeners don't know, it's uh stands for it's like a behavioral communication type of assessment tool that looks at uh DISC is the acronym and it's dominance, influence, steadiness, and conscientiousness. And uh when you were talking, I was thinking about, I wonder if some of our, I don't know if innate, because it's not really personality, but it's more behaviors and preferred maybe communication style plays a role in that. Um, and I'm curious about that. I'm because with the D-dominant personalities, I could see them, how they play out is a lot more confident and focus on outcomes. And maybe with competence, they need to learn more, take a step back and learn the process of things. And they haven't quite done that yet. So I don't, I don't know. I'm I'm curious too. I'm I wonder if, you know, just some of our both personality and preferences for and even learn, right? Behaviors play a role in Siddat too.

Host Nicole Weathers 17:50

Yeah, I mean, because definitely you you see both types of of new nurses, I think, come through your doors. More so the first one that we talked about, I think, for the most part. Um, but it is interesting just how these things don't necessarily develop in sync with one another. And you have pointed out a lot of interesting sort of factors that maybe come into that.

Building Self-Trust With Small Proof

Host Nicole Weathers 18:12

So let's talk now about sort of that belief in yourself. So I I use the term self-efficacy, right? That is kind of the belief in myself that I can do hard things, that I have mastery of these things, um, which leads to competence. So, how do you think that develops over time?

Rachel Kelter 18:31

In my experience personally, and then just what I've seen as an NPD and a leader, that I really believe it develops over time through this concept of self-trust. So less about maybe reaching this point of certainty, but again, how do we build continue to build this evidence that we can count on ourselves, that we can do these hard things? And again, back to Brene Brown's research, she talks about trusting really built in these small moments over time. Um, and that's not only trust with other people, but that's trust with ourselves. So I think there's a misconception that trust and confidence can come from this big achievement or promotion or a successful presentation, or maybe, you know, I'm off orientation. But that I think that confidence and then self-trust, it builds more quietly over time. But every time we've build that self-trust in whatever those moments are, like we're keeping a promise to ourselves. And I actually think as soon as I said that, I want to think about some of the research around forming habits. So with habits, there is this concept of what type of person do you want to be? So if you want to build a habit of, I really want to start eating healthier and I want to lose weight, I want, you know, those things. I want to work out more. The first thing within habits is tying some identity around, not to say, no, I what is a healthy person do? I am a healthy person. And when I choose the stairs versus the elevator, if that's available to me, I'm almost giving this vote towards this wanting to be this type of person. So I'm curious if that kind of relates to this was that kind of what made me think of it. But every time we follow through something we said we would do, it kind of gives us that vote to confidence. So um, you know, maybe it's choosing courage over comfort in a situation, having a hard conversation when we'd rather avoid it. Um, maybe acting in alignment with our values or um maybe setting a boundary. Um, I know before we start recording, Nicole, we're talking about these actually saying no to something. And it's it's really hard. And how do we set a boundary and and do the things that are within alignment of our values and ask for help when we need it? Um, so I think each time you can do that, it kind of gives that boat of confidence towards this concept of self-trust, which then I think helps develop this self-belief over time. And okay, I can trust myself in in maybe this situation to act this way or to pull out this skill set that I need, or maybe lean into, I know this is going to be really hard, but I'm gonna really try to choose courage over comfort in this in this situation.

Host Nicole Weathers 21:25

So, one of the things that we have our um nurse residents do in this program, we have like a what we call a transition journal that sort of goes along with the program. So it's kind of just a place to capture things they're doing well, things they want to improve on, that type of thing. And as you're saying this, I'm thinking is this a piece, is this sort of reflection a piece of building that self efficacy or that self belief or that confidence? Because it's a place to capture those little everyday things that you are doing well. And so by taking the time to acknowledge when you are in line with that, right? Or taking the time to identify proof, everyday proof that you are competent, that you do know what you're doing, that you can perform certain skills or complete certain tasks, that that is maybe a tangible tactic or tool or strategy to help new nurses or any nurse for that matter, or any human for that matter, sort of build that self-belief and that confidence.

Rachel Kelter 22:34

Does that make sense? Yes, I love that. And it made me think of some advice I got early on in my um like a leadership career was there will be, especially when I got out of direct bedside care, because in that sense, you can really get some immediate feedback and from the patients or the families to say, oh my gosh, thank you for caring for my loved one and for doing a great job. But as you move away, I think from the bedside, those moments can maybe come fewer and far between. And so someone had recommended, um, because I definitely am one that has the negativity bias and focuses on all the things I'm not doing right, but they had recommended any time that I received an email or uh most of it was an email, but if you get like a physical card, um, to keep that in a specific place in a folder. And I had labeled the folder like like feel good things. So when I'm having a hard day, I can pull that out and show both like what you were saying. I think it's this evidence that, okay, I can, and maybe motivation, like I can do this, I can keep going. I also love that if they like write it down. I know that's evidence-based when we write down our goals and our and even maybe this like evidence of uh beginning to build the self-efficacy and confidence that we will get there, right? And and we will continue to have that in in front of us and putting it maybe in a visible place. And I actually love doing vision boards. I I host the vision board workshop, and it's a lot of that same kind of concepts that when you see it every day and it's right in front of you, that you, you know, you have not only this maybe goal you're maybe want to work towards, but also evidence that, okay, I I can do this. I am seeing this maybe progress I'm making towards it. Vision boards are a little bit more abstract, I know, with pictures, but um, but just kind of a similar kind of concept to what you're talking about with the with the writing all that information down. So great exercise.

Host Nicole Weathers 24:40

Yeah, I love that you bring that up because that's actually something we do encourage our new nurses to do from the very beginning is whether it's a physical file. So when I was still at the hospital, you know, and working with diabetic patients or whoever, and they would give you an actual handwritten note. So I have both. I have the physical file in my file cabinet over there. And then I also have an email folder where anytime somebody, you know, sends a nice note or a complimentary email of some sort, I stick it in there. I do think that that is another version of here is proof that not only am I maybe doing a good job, but that I do have the skills that I maybe sometimes second guess that I have, right? Um, so I think those are both really good examples of ways that you can help develop your self-advocacy or that belief in yourself. So I followed this gal on Instagram. Um, but with your vision board idea, she actually has you, you know, create your vision board. And then throughout the year, you replace the pictures that you found out in the internet world, and you replace them with actual pictures of yourself doing the thing that you said you were gonna do. So if it is to present at a national conference, let's say that's one of the things, goals that you have for the year, then as the year progresses and you actually do that thing, you swap out the picture. And so I think that's just a really kind of cool way to use vision boards as a way to identify, you know, what your goals are, and or, you know, maybe the areas where you need to build confidence, let's say, and um actually reminding yourself or proving to yourself that you've done those things. So, in the framework that we've been talking about over the course of this entire year, actually, um, you know, we talk about some other concepts like belonging and safety, and where they sort of sit in the pyramid has been

Safety Belonging And Feedback Shape Esteem

Host Nicole Weathers 26:40

kind of one of the things that we debated with um the focus group that we met with as we were sort of doing a little bit of research and verification on this model. So when you sort of look at this model and some of these other concepts like competency, safety, belonging, and now esteem, what role do you think some of those other concepts maybe play in building esteem?

Rachel Kelter 27:05

Yeah, I definitely think they're all extremely important in building that. I think it helps create the conditions that allow us to take these risks or maybe make mistakes or grow. If, and I think about from maybe a psychological safety perspective, if I am constantly worried about maybe being a judge or rejected or excluded, you know, I'm less likely to share my idea or, you know, admit I don't know something or try something new. And in those environments, I think people often focus on protecting themselves more and maybe questioning their self-worth. Uh, if we look at worth from an esteeming perspective, but maybe focus on protecting themselves versus developing themselves. We put on this like metaphorical armor because we we may feel vulnerable. And uh maybe for me, I know this is an actual example for me. Uh, when I can feel maybe uncomfortable in a situation, um, instead of leaning into the I'm just not sure, I can easily pull on the armor of evidence, meaning like, oh, well, you know, I think we're taught, give me an example. Like, what do you mean by that? And I want to like have all the examples in the world of something, but it's also okay to say, I'm not really, I'm not really sure in this situation. Um, so I think in environments where we don't have the the safety of from a psychological perspective, we, you know, we can put on that armor more. I I think. I think on the other hand, with psychological safety, we have this permission maybe to learn out loud. You know, again, make those mistakes, give and receive feedback, which is constantly a skill set, I think, if people were struggling with. I know within um the an organization I work for, that's probably one of the number one requests is gaining more education on giving and receiving feedback. And I think a lot of it is we it it feels scary, it feels vulnerable. Um, people put on their armors, they get defensive, right? Um, and I think we can feel like our worst is maybe on the line in those situations. Yeah, it just it can feel it's just really hard. It's just a really hard feel. And um, and most people, I think, shy away from those hard conversations. From a belonging perspective, we know that as people, we are hardwired for connection. So it is really hard to develop from a confidence lens. We don't we can't, I don't think we can do that independently. I think we learn that we are capable of something or we build these this confidence, not only from the evidence of things we're doing, but I think, again, kind of what we talked about earlier from people seeing it in us. So a trusted mentor or friend or a leader, a colleague, um, maybe they can lend us their belief for a bit before we start to develop it a little bit more.

Host Nicole Weathers 30:08

So as we're as you're talking about each of these things, my brain is my brain is like rearranging parts of the model and seeing how all of these connect. And I guess I want to run my thinking, I want to check my thinking with you. So, you know, starting with competency, in my mind, competency relates to self-efficacy, right? So that whole idea of mastery of uh the skills that we need to do. So for a new nurse, that is, you know, starting IVs, inserting folys, all the human skills as well that go along with that. Safety. So you talked about safety and feeling psychologically safe and how that is sort of related to esteem and sort of that inherent self-worth and all of all of that, which is, I think, tied a lot to feedback. Um, and I think that that is a connection there. And then uh belonging. And we talked about belonging uh a couple months ago, but that really does translate, I think, to the value that other people see. And so it's almost as if each of these sort of lower components on the model feed into esteem, and they all sort of, you know, interact with one another. And when there are gaps in one area, it does lead to gaps in the next. And that comes back to connection. So your work focuses heavily on communication, connection, and human skills. How do conversations um with leaders, mentors, colleagues, educators influence the story that we tell ourselves about our capabilities?

Rachel Kelter 31:45

Yeah, definitely have a huge influence. I think conversations and communication are incredibly powerful because they can shape the stories we tell ourselves. It can become maybe this internal voice of who we are, what we're capable of, and whether we belong or not. And on both sides of it, we kind of talked earlier again about the people when we maybe we don't have the confidence but competence, but we other people like mentors and maybe preceptors and our coaches and therapists can help us see that when we we can't all see that. I think in early in our careers, we borrow that maybe perspective a lot from people. Um, I think sometimes it's even if I don't believe it right now, how do I continue to even verbalize? Yes, I believe this, I'm working toward this. I think your own verbalization out is really powerful and you hear it. Um, I always talked about the writing um is very powerful as well. We, you know, with mentors and and preceptors too, again, they see a lot of this potential um in us before we see that, and in our leaders too. And they may challenge us when we don't think we're quite ready, or um, a calling might reflect back a strength. And I think that these conversations, when we maybe don't have the evidence of experience, we have the evidence of the conversations from from these trusted people. But we know the opposite can be true. We have a critical comment, uh, we are talking about feedback, um, a dismissive leader, a culture where speaking up and making mistakes is punished, or we become, we have these repeated messages of, you know, you're not good enough, which we've talked about with worth. Um, and they really can become our internal narrative. I think it's, you know, with us people, our job was to challenge that internal narrative. Like, do we owe Renee Brown talks about owning our story? So, you know, this may be what we were taught at this point, but what are the things we can challenge and get curious about? It's just so it's powerful. The those the things that in everyday interactions, um, and I am such a an advocate for journaling, especially with gratitude journaling. And I bring that up because for me, internal narrative or dialogue, again, going back to the negativity, it can really have an influence of what I believe I'm capable of and my, I think my self-see too. So being able to journal and kind of clear my head and get that out makes room for an opportunity to maybe read back and challenge those thoughts.

Host Nicole Weathers 34:35

You know, sometimes when we talk about new nurses, new nurses coming into the workplace, um, you know, obviously competence is a big thing. Competence is a big thing. And what I hear you saying is that a lot of that is really built from the preceptors, mentors, leaders around them, and their skills when it comes to communication, feedback, some of those human skills with how they are interacting with that individual because they don't have a lot of competence or confidence when they first get started. They're borrow, they do need to borrow that from other people or they need that positive reinforcement. Otherwise, our sort of negativity bias can overtake things, I think. And so uh, you know, I think that's just a really good reminder for all of us who are sort of working in this nurse residency space. Um, sometimes we get really, really focused on our curriculum components of our program or the topics that we're covering, but so much of that new grad experience is really impacted by the other people, the other people on their team, the other people that they're interacting with. Um, and so part of maybe what we need to focus on as um NPDs in this space are not just on what we're teaching our new grads, but what are we teaching our leaders and our preceptors and our mentors about this? So I don't know if you have more you want to say about that.

Leaders Who Model Learning Out Loud

Rachel Kelter 36:04

Oh, 100% agree, 100%. And uh when I do workshops, especially with leaders, that often comes up with, you know, I think we get so focused on like you were saying, maybe the curriculum that there is maybe a bigger conversation around like what am I role modeling as a leader, preceptor, coach, mentor? And am I walking the talk, so to speak? Am I living into my values? Am I am I speaking up for what is right or what I think is right? And am I leaning into those hard conversations when it's really hard? Am I allowing my team to see mistakes and that I am not perfect? There's this like sense of vulnerability that hey, I'm not, I'd think about like, hey, I'm not sure either, but I know we can work on this and get through it together. The leaders that I see have maybe the most engagement with their teams, connection with their teams really are the ones that can foster that connection, not through perfection and having all the answers, but the courage to say, you know, I'm not sure, but you know, how can we do this and figure it out together? Or um what, you know, what do you think? Or what, you know, this was really hard today. I'm I'm still working on how I want to navigate this. Yeah. So I just I think it's a it's a lot of the role modeling and we talk about a lot. And I think we underestimate like, you know, something we learn in elementary school, but actions really speak louder than words. And we can profess all these things, all our like especially around values, but if we're not ribbing into those, then um we people can easily see this mismatch.

Host Nicole Weathers 38:01

Well, and and we see this a lot in residency. And I don't know how connected you are to residency in your organization, but um, you know, we can have leaders that say, yeah, you need to go, you need to go to your residency classes, you need to do the things that your residency coordinator is asking you to do. Um, and then they but but it sort of ends there, right? And they're not checking in, they're not um providing the feedback. I mean, I know a lot of I think everybody likes feedback in a sense. Definitely the generation that's coming into the workplace now really relies heavily on feedback. And so they're looking for that from their leaders, from their preceptors. And when they don't have it, and that preceptor, leader, mentor is just relying on the what's happening in the residency program that to provide that for them, I do think we see a really big sort of disconnect. Um, I think it sends the message to the new nurse that, oh, well, maybe that isn't actually that important for me to attend or engage in because, you know, my leader's not actually following up on anything. They're not, you know, connecting with me throughout the year. It was just kind of something that they mentioned at the beginning.

Rachel Kelter 39:19

Yeah. And it it then it feels like a check the box type of thing, right? And and with residency, we're only seeing these nurses for a short period of time. And but where they're going to navigate a lot of the hard challenges is out with their teams and with these patients. And and that's yeah, where where does that support lie? Like that's where they need it the most, right?

Host Nicole Weathers 39:48

And I feel like that's what reinforces some of these other topics that we've been talking about, right? It's the that communication with their leader, that communication with their preceptor outside of the residency classes per se, that are going to help begin to build that self-efficacy, that competence, that competence. Um, because it requires, I mean, right, self-efficacy, if we talk about mastery, that requires repetitive practice and repetitive proof that I do know what I'm doing. You know, we talked about this earlier. And so all of that is not actually happening in the residency program. Right. It can't.

Rachel Kelter 40:30

It can't. There's this, it's to the repetition. We we talk of a lot about this with I help support um some EDP initiatives. And when I have NPDs specifically come through, it's always how do we get them off orientation faster or how do we grow their confidence faster? We know, I mean, really, we know the answers. Like it takes time and repetition and consistency, I think, too. And it's, I would say, not always uh I don't know if the fun part, but it's the consistency of this repetition can be boring. It's not like, oh, this new innovative thing all the time. It's like, no, do we to get mastery in something and build that self-esthy, like you were saying, we need the representation and time and time and time again. And and yeah, that's gonna happen more out in their environments. There's just no way to do that with just in a in a classroom setting.

Host Nicole Weathers 41:25

In this visual model, you know, we really are seeing esteem at the top of the pyramid. You know, we've talked about how each of these concepts of esteem come through some of the earlier components that we've talked about, like competency, safety, and belonging. But then, you know, as we've talked today about the impact that leaders, preceptors, MPD have on that esteem through feedback, communication, how they do their job influences how the new nurse continues to develop. And it's just interesting to kind of have this conversation with you, I guess, and sort of begin to see how all of these things really come together. So if there's one thing that nurse leaders, educators, or preceptors could do to help someone build confidence, build esteem, build self-efficacy, what would that be?

Rachel Kelter 42:21

I would want, I think what I would want is to kind of understand first where people are coming from. So is it someone who on the outside, I'll say this, naturally is more competent or has higher self-esteem or confident in their worthiness tied to that we know it's inherent versus tied to these external outcomes. I think I would want to know as people are joining our organization and where we're supporting, if we look at it from um a new nurse lens, where where are people starting? And then how do we meet them there and then help them develop these things from there? I think very first is I'm such an advocate for self-awareness, as you mentioned earlier, and then helping them recognize themselves first. And self-awareness has really two components curiosity about yourself and how you show up, meaning, okay, why does this situation bother me every time? Or, you know, why does this person I interact with make my heart rate go up? Or why uh, you know, when I'm in this situation, I feel really energized. And and then the second part of it is that external support that we've been talking about from a trusted leader, coach, mentor, colleague, friend, even. So I think people start there, maybe with some of the self awareness, because as you were talking about, we're building, you know, the self ecstasy, we're building confidence, we we we've got our competence down, but when we're building this confidence through repetition and um, and then something happens and it and it kind of shakes us up. And how do we? It's easy to say, like, you know, oh, you're you're still doing a great job. This happens to everyone, but does that person actually believe that? And if not, what's maybe what's the deeper issue there and challenge? Is it because they're coming in with maybe very high self-epicy and low self-esteem, which we see I think a lot in perfectionists, um, where they're they believe they're I and I feel this in myself, like we believe we're highly capable to do the things, but we don't always have the maybe maybe it's more confidence to to do that. So I I would want to know that. Maybe where where are people starting? Because I think then we can start to maybe individualize support a little bit more, maybe kind of learn the conversations or even the additional support they need. Maybe, maybe this person needs support from um, we have like employee assistance programs within our organization or um other mental health support, coping strategies and resources that we can kind of leverage. And I think I hope for leaders and MPDs too, that doesn't feel like it it's all on them to figure out you know, can we pull on these different resources to support? So I know that was like way more than one thing, but I think it comes down to like starting where they're at, where people are coming in and how do we assess that?

Host Nicole Weathers 45:24

Well, I think you point out two things, right? It's like the individual work. So in our residency program, we talk about building that psychological capital around confidence, dealing with uncertainty, optimism, gratitude, you know, all of those types of skill sets that are necessary, I think, that build the self-efficacy, that build that self-esteem. But then there's also this organizational component to it. So whether that is, you know, recognizing the good work, reinforcing the good work, giving feedback on where we have opportunity for growth. So I do see it like this idea of esteem being a core component to engagement, kind of being equal between the individual doing their own internal work and the organization or leaders recognizing the good work that's happening.

Rachel Kelter 46:14

Yes, it's that both and, which is really hard, I think, for us, at least it is for me. Like we want one answer like, is it the person or is it the organization? But it's it's both. It's it's both that that we I love that

Investing In Human Skills At Work

Rachel Kelter 46:28

you said that.

Host Nicole Weathers 46:28

You know, I have one more question for you. If there was one thing that you saw more organizations doing that could help with the development of new graduate nurses or and maybe their their sense of confidence or esteem, what would that one thing be?

Rachel Kelter 46:46

What would you like to see? The first thing that comes to mind would be recognizing and investing more in those human skills. We do a lot with technical skills. I think nurse residency is a great example of where we pull in a lot of human skill development. And when I say human skill too, I wanted to share that these are skills that it's not whether you have them or not. Like these are things that you can you can build in in practice and you build over time. Like trusts, for example, we were talking about earlier. I think even just from when I was pretty heavily involved with residency as a leader overseeing a group of NPDs, we kind of really blew up the curriculum and started to recognize that when we focused more on those people side of things, not only at work, but how this was impacting people at home as spouses, as parents, as partners, the help will not work too, and vice versa. So there's this misconception that, you know, we can just leave our home. I think it's changing. I think we're getting there, but we can leave all the home stuff and personal stuff at the door when we come in. That's not true. And same for values. There's no such thing as personal and professional values. We are who we are. So I think as organizations can recognize that and know that, and I think we're getting better. As I said, like from leading this group um of NPDs over residency to now, we're starting to see the shift. But I still think it got a ways to go to know that it's not just the the competence, it's not just the the technical skills that we need by it, it's it's it's all of these other parts. And I think because it's harder because people are complex and we're messy, it's harder to lean into that and and recognize that oh, okay, we're gonna, we're gonna, this is gonna be hard work. And it's not always, I don't think, something you're ever gonna necessarily achieve. But if we can get better at all practicing this, right, bettering ourselves and each other, I think that would make a little bit of a difference.

Host Nicole Weathers 48:52

No, I agree. The the clinical, technical, nursing skills are kind of the easy part to teach. It's all the other stuff, it's all the human stuff, the people stuff that's much more difficult. But I do agree that that is really what we could be a little bit more intentional with and really kind of begin to see the the needle move a little bit more.

Rachel Kelter 49:13

And I do think it's I think I see I I do I see it changing, um, at least in my quarter of the world, a little bit with my organization and then others I've been out. Um, and then through conversations like this, so I'm so glad you have podcasts and talk a lot of the about the and even on my own podcast, so because we have those conversations. I think it's we have this acceptability to spread this message and and this um importance of these things. So I do I am hopeful and optimistic that we will continue to see it move forward.

Host Nicole Weathers 49:45

Excellent. Well, Rachel, thank you so much for joining us on this episode of the Beyond Nurse Residency Podcast. I really appreciate you sharing all your wisdom and expertise and insights into this topic. And I just want to thank you for your time.

Rachel Kelter 50:00

Yes, thank you so much. This has been such a fun and awesome conversation, and thanks for having me.

Resources To Support New Nurses

Host Nicole Weathers 50:08

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 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.