EP 29: Building a Safer Workplace: Collaboration and Prevention Strategies

CB_Tracy Gosselin (1).mp3: Audio automatically transcribed by Sonix

CB_Tracy Gosselin (1).mp3: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Renee Thompson:
Plants thrive and grow in a peaceful, nourished environment, right? Well, it's the same with human beings. But what if that environment is not so peaceful? What if it's toxic? Welcome to Coffee Break: Breaking the Cycle of Bullying in Healthcare – One Cup at a Time. In this podcast, you'll get practical, evidence-based strategies to help you cultivate and sustain a healthy and respectful work culture by tackling an age-old problem in healthcare: bullying and incivility. I am your host, Doctor Renee Thompson.

Renee Thompson:
Hi everyone, welcome to the Coffee Break podcast. I hope wherever you're listening to this or watching that you're in a good place and that you're making progress on your journey towards cultivating a healthy work culture. And that's what this podcast is all about. It's about addressing disruptive behaviors so that we can cultivate the good behavior so that we can do the important work that we need to do in health care. And today, I'm excited to welcome Tracy Gosselin to the show. So welcome, Tracy.

Tracy Gosselin:
Thank you Renee, I'm happy to be here.

Renee Thompson:
We're happy that you're here, too. Tracy is the Senior Vice President and Chief Nurse Executive at Memorial Sloan Kettering Cancer Center in New York and New Jersey. Prior to this role, Tracy was the Chief Nursing Officer at Duke University Health System, and this is in the Raleigh, Durham area. And she was there for 28 years! Okay? So really long time! Tracy's also a fellow in the American Academy of Nursing and the New York Academy of Medicine. She's currently the Chair of the Advocacy Committee for Seat. And again, Tracy, thank you so much for carving out a little piece of your time to talk today with our listeners about and what we're going to focus on is workplace violence. But can you start by telling us a little bit more about yourself? And, okay, you got to tell us, how did you go from working at Duke for 28 years to then leaving because you actually didn't move out of North Carolina? You're doing the back-and-forth thing, but now you're in New York City. Can you tell us a little bit about yourself and how that happened?

Tracy Gosselin:
So great question. I grew up in Massachusetts. I did my undergrad in Massachusetts. I knew as a student nurse, I wanted to do oncology. At that time in health care, there were no jobs for nursing, and I again only wanted to do oncology. My dad said, You need a job. So I ended up at Duke as a new graduate, working on the oncology floor, and spent 28 years of my life there, from inpatient to outpatient oncology, a variety of leadership roles. And then the five years before I transitioned to Sloan Kettering, I was the Chief Nursing Officer for Duke University Hospital. And those decisions about when you leave or why you leave, I think are pretty personal in some ways, because it's hard. It's a place, a lot of my identity; I was very familiar; I knew a lot. And yet we all grow up in our specialty or we might move to find the right specialty. So when I was approached about the opportunity at Sloan Kettering, I was like, All oncology? Inpatient, outpatient period, two states, and the amazing work in team; I'd get to work with and lead. I was like, Well, I think, okay, let's do this. Even though it was, I moved to New York right before the Omicron Covid wave. Got to do some compare and contrast. And so I make it back to North Carolina for a few days a month to work and then back up to New York the majority of the month.

Renee Thompson:
Wow, I actually love the Raleigh-Durham area. And I have to say, I love Duke University Health because that's where my grandbabies were born. Okay? But my daughter lives in Oxford, North Carolina, which is about 45 minutes north of Raleigh, and I was there even though I live in Tampa, I was there when she had both kids. Olivia, she went into labor early, and I happened to be in Dallas and hopped on a flight. Then got to the Raleigh airport, somebody picked me up and sped me over to the hospital, and I was there just in time for her to deliver my granddaughter. And then Lucas, who's two years old, he was breech and they opted for C-section. And then we knew why he was breech. He was 11 pounds. Okay? So he was a little chunker. Yes. But she received such great care there. And of course, I'm always checking out the team to make sure they're kind and respectful. And they all were. And I've had the opportunity to do some work at Sloan Kettering. They reached, there were several people reached out to us a couple of years ago because they were committed to addressing workplace violence. And, Tracy, this workplace violence is really an umbrella term. And it's patient family abuse, it's bullying, it's incivility, it's coworker to coworker. It's all of that. And when you stepped in the role of, you know, CNE, that's when you and I met and we said, All right, let's do this. And we've done some really great work together. So can you talk about what you're doing at Sloan Kettering under that sort of umbrella of workplace violence and what are some of the strategies that you're implementing to really keep it a safe environment for your employees?

Tracy Gosselin:
So it's a great question, and I think when I reflect on my experience in two different organizations, it's: what worked well where you worked before may not work well at your new place. Right? And part of that is because you're trying to understand where culture is, where people are in their thinking of what does this mean? We're dealing with a tough diagnosis, tough disease. New York City sometimes can be tough in and of itself with just the traffic, the noise, the volume of people, right, what some people deal with from a day-to-day commute and different things. Yet, at the end of the day, I think there's some key pieces when I reflect on both and I would say specifically more now in my current role, finding your stakeholders. Right? And it's not something that just happens to nursing, although nursing, I think, probably bears the brunt of a lot of incivility from colleagues and from patients and their loved ones. But who are your stakeholders to help you? Right? And so is that your security team, your threat management team, your patient representatives, right? Your other clinical disciplines. So my physician colleagues. Right? So a variety of people. The other piece I think that's really important is knowing your data. Right? Does your data tell you, right? That's very quantitative. You can also read it, get a little narrative. And then also as I like to do, I like to round. … I like to take selfies. And it's really this moment for me of remembering why I do this. And I remember what that was like when it was me. And it's always been there in health care, right? The colleague-to-colleague incivility, the patient family incivility. Yeah, I would say the circumstances of where we are in society are different, maybe, and being able to hear, Oh, that's hard. And then thinking about the workforce of today, nobody wants to be that person. We talk about burnout. We talk about resilience, all these things. So know who your stakeholders are, go after them, right? Surround yourself with them. Use your data in the different ways that you can and build that coalition. And to me, that's probably what's been the most important thing when you need to include your folks from legal because yeah, I think we all know we may not want to talk about it, but as soon as something happens in that environment, whether you're inpatient, wherever someone is practicing, as soon as you feel threatened or scared, you're going to have a quality safety issue. Do I want to go back in that room? What's going to happen the next time we call? When do we bring them back? I think those are critically important pieces of why everybody needs to have the same understanding, and nobody wants to harm a patient. Yet when you're scared, it makes it hard. So I think for me, those have been some of the key things. I would say the other piece, in partnership with you and your team, was let's have a discussion. And knowing as a leader when you can either lead it or you need to be a part of it. Right. And I think in collaboration with you, it was, I can arrange for it and convene the 100 people, but I actually need to be a part of it. Right? Because I don't have all the expertise. I haven't maybe done some of the research, right, in certain areas. So I think being able to bring awareness to people as well as tools. I think tools are so important. And that ongoing work of what we're doing now with you all, with looking at how do we use this in our residency program to help nurses around communication skills?

Renee Thompson:
So I've written a full, I think, half page of notes already. I want to circle back to where you started with your stakeholders because I think you're in a unique situation. Tracy, when you were at Duke, you knew who your stakeholders were. You knew the culture. It was easy. You didn't have to think about it. You knew who the players were. And then you go to a new organization. And I think about the leaders who might be listening, who are new to their organization or who have been there for a while, but they don't always realize the value of first identifying who are the people. If I want to tackle a problem, and this is what we do as a company too, I do this all the time. It's not, How am I going to address this problem? It's, Who can help me address this problem? And that is identifying who your key stakeholders are. And I like the fact that you included legal there. It's not the first thing I think of. But when you're talking about workplace violence and there is that sort of risk and for some type of legal implication, that's the word, it's really taking a look at, Okay, let's involve them. Was that something that you were immediately able to do and establish, or did that take some time?

Tracy Gosselin:
I would say in both cases, both institutions were willing to support, willing to engage. And I think part of it is it's that perspective take: how do you include people? Maybe their lens and purview might be different from mine, but if we turn the table, we know the Joint Commission, they've issued their guidance and the standards that were all held to. What would happen if we didn't have protocols in place and something bad did happen to …? We hear, thank goodness, not every day, but we hear too often about some of the breakdowns that are happening in health care today, where people are getting injured. And so really trying to balance the workforce and the care delivery system. And I think that's the piece for me that's really helpful to talk with them about. They, I know they probably don't want to do what I do. And Renee, I certainly don't want to do what they do.

Renee Thompson:
No, no. And I, to your point, I don't think anybody is coming into work, first of all, nobody's coming into work thinking, who can I bully today? Who can I be mean to today? And I don't think patients and their families are coming into your organization or any organization saying, All right, I'm going to be as mean as I can to the people who are caring for me. I am going to be incredibly disruptive and cursed and screaming. And it's not to make excuses. But this came up when we first started doing work with you, and we really tried to get to know what are the, how do disruptive behaviors show up differently, maybe in your organization? And I'll never forget having this conversation. We talked about the fact that you're a cancer center. And if you look at, yes, the majority of the workforce, they are nurses. And so many times nurses would be treated terribly by their patients and family members and yelled at, screamed at, spat at; everything. But then the nurses will justify and say, They have cancer. They were just diagnosed. I understand it. And we get that. But at the same time, we still need to address it. So how have you been able to really overcome that piece? Nobody is expecting to come in to working and they're not expecting to get attacked. They're not planning to attack. And I'll just use that word attack. And it can be as extreme as you want it to be. But then how to deal with that mindset that we just justify, especially when somebody has cancer?

Tracy Gosselin:
One thing for me, the good part of being at an academic medical center before, some days there is some really bad diagnoses that aren't cancer, right? That we see, that we face, that we try and coach and support families, teams around. And I think it's, it ties back for me to this piece around humanity. And one of the things I do when I ran, I ask, Are people being nice? The staff know. They know exactly what I'm asking for. And, but it's being able to engage, I think, acknowledge that it exists. I think we also acknowledge that sometimes there's some metabolic things that happen with cancer and framing things in the right place and ensuring then that we get the right medical care that people need. This could be either disease-related or subsequent to some type of treatment. So I think that is always critically important. Yet at the end of the day, it's really this piece around we're not going to have a workforce, nobody's going to have a workforce. And I think for patients who are seeking care, remember that, that it makes it really hard for people to want to come back day after day. It may not be the same patient, but it might be the same issues. It might be on the telephone, it might be through all the portals we all have. And you're like, Oh my gosh, because people feel devalued in their role, right? And really just being able to know that it's there. I think the other piece it's just saying, It's not okay. I mean, it's not okay. And because I don't know if we would say, Oh, that's okay in elementary school. Sure, that's great. Or, Sure, you can do that in your religious belief place you go, sure, or spiritual, it's okay. Or do it in a restaurant. Sure. That's okay. The taxi cabs in New York have the fine if you do something. I'm like, This is amazing, right? Look at these taxi drivers. I better be a good person in the back seat.

Renee Thompson:
Yes, or else you're gonna have a hefty fine to pay.

Tracy Gosselin:
So I think part of it is acknowledging it. And then sometimes I think we have to bring others along because you don't want to have turnover. You don't want to have people feeling burned out. You want them to get to that place, like Maslow's hierarchy of needs, right? You want them to have those professional moments where they feel they can self-actualize, know they're contributing, know they did, the work's hard, the work is always hard. But knowing that they made a difference in someone's life, and not everybody gets to say that when they go home from work. So bringing people along, pilots; pilots are very helpful when sometimes people might be resistant to change. You want to go 100%, and they're like, I'm like, Okay, what about a pilot?

Renee Thompson:
I love that term. I pilot everything. Let's do this as a pilot, or you could say experiment because then it's not something where it's concrete and it's like final. It's like, let's try this and see if it works.

Tracy Gosselin:
And we learn, and then we have something right now where we're getting feedback from our leaders. So when I have a meeting on Friday on workplace violence, I'm gonna be like, Look, here's the feedback we got. Here's what went well and here's where we have opportunities. But I definitely think acknowledging it and letting people know that, Yes, it is real. And it's not just nursing.

Renee Thompson:
It's the whole team. And you said this before and you talked about heightening awareness; you have to engage in conversations with people. So you mentioned discussions; talking about it, allowing people to actually verbalize, I've just been ignoring this because again, I feel bad for them, I understand it, they have cancer, they were just given that diagnosis. And then for the leaders to be able to say, It's still not okay for somebody to treat you that way. I always say this, There's no excuse for cruelty, even though you do understand it. What can we do? And I think bringing back that piece that you mentioned earlier about the data, especially in your organization. Very similar to you, Tracy. You were at Duke's for 28 years. We have people who were in their role for a gazillion years. They don't know anything outside of that organization, not as much that way now, we see a lot more movement. But you got some old timers there who have been there for decades. They may not know that this isn't a problem just in their organization, that this is a global issue. And being able to show the data that shows that workplace violence is on the rise, physical violence from patients and families, verbal abuse, bullying and incivility, coworker to coworker that it's not just in their organization and using that as a starting place to engage in conversations with each other can really help, and you've done a great job with that.

Tracy Gosselin:
Thank you. One other piece of data is people depending on how they get their employee data, employee occupational health data is ensuring that your data is segmented out for workplace violence. And when we talk about lost days or no lost days, but maybe a minor injury really, again, getting into that versus just the reports.

Renee Thompson:
Yeah. And it's looking at internal data. That's what you're talking about. And then the external data that I mentioned earlier, it's those collective outcomes or it's showing you what's going on. And as you said, you have to segment up the workforce and workplace violence particular, and then get crystal clear on what does workplace violence mean? All the time people say, I'm being bullied and, This one's bullying me, and that's not bullying. I actually had a conversation yesterday with someone who was talking about patients being bullied by physicians into accepting or approving some type of treatment, some type of surgery, and that these physicians are bullying patients. And my first thought was, I don't know that's bullying. To be considered bullying it must be a target, behavior has to be harmful, it has to be repeated over time. Now that might be there, but I think we first have to get really clear on those terms. And what is workplace violence? What is bullying? What is incivility? And then pulling out the data that reflects a true definition of what that is so that you know what's happening and where it's happening, so that you know where to intervene.

Tracy Gosselin:
I think it's an important piece. It's interesting. I think having that presence and visibility with your front line helps. I can say in the past month, I've had two front-line staff say, Tracy, how would you handle this? Oh, and it takes me back. One, I had someone who helped me figure it out, and it was a little nerve-wracking because you're like, Oh, I can say something? And it was like, Yes, you can, but you have to be respectful, when on the inside you're angry and you're scared and you're sad and you're all that. You're trying to manage the emotion. And I think it's a lot of what you all help teach. And like so I've said to these two different nurses, I said, here's how I do it. But it's how I do it. You have to find the right tool. You have to have done your own kind of rehearsal. I've done my rehearsal enough so I'm pretty clear on it. But it's, Susie, I can't hear you when you're yelling at me. When you're ready for your care, let me know. Or, When you're done yelling, reach out, and I'll provide care. So I think being able to put that in ways that works for people because it's really hard. Like, I need a big script. I'm like, No, you don't really need a big script because the person who is upset about XYZ, they're not going to listen to your big script, but you have to name them. And I think that is the key piece. Like, somebody would be like, Tracy, when you're yelling at me, I can't hear you. When you're ready and you're not yelling, I'll come back to provide you care.

Renee Thompson:
So simple, yet powerful. And it puts the, I'm going to say the word control back into the nurse, the physician, whoever it is, providing that care. It's similar to what we've used many times and what we recommend that you say, I am willing to basically provide your care, answer your questions, whatever you were going to do, as long as you are willing to stop yelling at me or stop cursing or talk to me in a respectful manner. I am willing, when you are willing, or as long as you are willing. And to make it okay, and I think what it is, Tracy, is that you're giving them permission to not just stand there and take it.

Tracy Gosselin:
How do you want to de-escalate it? Yes, we have a fabulous team that will help in our patient experience department, our representatives, advocates are wonderful. Yet we have to first say it because it's not, I granted it. your stomach might be in a knot and your hands might be a little sweaty because it is hard. It's not, we didn't go into this profession to have those conversations. Totally. So it's it goes against the culture in some way. But at the end of the day, you cannot keep allowing it either.

Renee Thompson:
Because I can remember when I was a brand new nurse, I was caring for a patient who had a stroke, flaccid on the one side, he had aphasia, and the only thing that he could say were curse words. Okay. And that's actually not as uncommon as people think. And I was trying to get him on the bedside commode and I was struggling. And he starts like, this man did not talk, but all of a sudden every curse word came out of his mouth in anger I had never been talked to before. And I walked out of the room crying. I was so upset. And I had an older, wiser nurse pull me aside and basically help me through that, to help me to know that it wasn't personally, it wasn't anything wrong, it didn't do anything wrong. It's just his frustration, his inability to communicate that came out that way. But it affected me for a long time. And when you said earlier about when someone's scared, how it affects quality of the care that they're providing, I'm going to tell you, how quickly do you think I wanted to go back in that room again? I did not want to go back in, and it was a distraction to me because that's what it all is, it's a distraction to anyone who overhears it. And it affects the delivery of care that we're providing. And yeah, it's letting people know that it's okay, give them permission to set those boundaries with their patients. And as you said, get the help that they need. There are resources, but sometimes people don't know who to contact. What if, my husband was in law enforcement and he always was trained in those what-if situations? What if we pull somebody over and they have a gun? What if they do this? Well, and it's all, what would you do? Okay, I had to do the same thing with my teenage daughters when they were teenagers. Now they're in their late 30s. But okay, what if this would happen? What would you do? It's the same thing with these patients. What if this would happen? Who are your resources? Who do you contact? And make sure that they know who they are. And you've done I think, a really good job with that at Sloan Kettering.

Tracy Gosselin:
Yeah, we have a good team. We're on our journey. We're trying to make it better and think about our next steps of training, what our tiered approach should look like. So, you know, you pull from some of what you've done before, some about what you learn that's new, and you keep reading and saying, No, this is really good. Okay. Yeah, that might work. And talking with others, I think definitely helps.

Renee Thompson:
Yeah. And you've done what I would say is a really good job in recognizing that addressing workplace violence and keeping a safe environment for your people isn't a check the check box; we're going to do these three things and then you're done. That this is an ongoing, forever commitment and focus. As you just said, you might read something or hear something another organization is doing. And then we're going to go back to that. Let's try this as a pilot in this department or in this area, but that it's just something that you always have to keep your finger on the pulse of. And as we wrap up here, Tracy, I'm going to take it all the way back to the first strategy or comment that you made, making sure that all of your key stakeholders are a part of it, that it's not just nursing, it's not just threat management, it's not just the physicians, but it's the entire team, and making sure that everybody is committed to an ongoing focus and commitment to addressing workplace violence.

Tracy Gosselin:
Everybody's on the journey. That's what I say. Everybody is always working on something. And so I think how we can lend our best self to those processes hopefully create the right environment for our teams, our patients, truly the right one.

Renee Thompson:
Yeah. You're so right. As we wrap up, is there, give any advice for someone who maybe is new to an organization, recognizes that they need to do something about workplace violence, and whether that's establishing who their key stakeholders are or they want to, maybe there's nothing in place right now or barely anything. Do you have any advice for someone who wants to start this journey?

Tracy Gosselin:
So it's a great question. So I think there's a couple things. Understand your data. Ask for the data from different places. Talk to your leaders. What's, what have we done? Where are we? What are we thinking of? Find those other stakeholders that can help and that can lean in. And I think sometimes there are some great tools. So people may not consider it a tool, but some of the Joint Commission work around the standards, just mapping some of the standards around workplace violence and saying, Okay, yes, we have something; Oh, we don't show something. And thinking about. And it's very interesting when, you know, I don't know if people do this to you or anything, but people are like, Oh, hey, I saw this sign at this institution, or this. And I'm always like, Oh, that's great. Like, how do you share with others and ask questions because I think we truly are all in this together to make it.

Renee Thompson:
And if one organization is successful in this one area, I always look at it as they have an ethical responsibility to share that with others. But also, it's really my push-and-pull strategy. As an organization or as an individual, you need to pull information, like you need to gather it, you need to be looking, you need to be, what's happening out there in the place of workplace violence? But then if you're an organization, you're doing well in an area to push that out to people. That could be through publications, that can be through presenting, that can be just by sharing. And you mentioned the Joint Commission. I happen to be on their task force for workplace violence.

Tracy Gosselin:
Oh, that's good. They just had a recent paper come out on a study, I believe it was in Connecticut, and they were measuring some of the events on medicine units, I believe, at a couple different hospitals. I haven't fully ready yet. I've looked at it, that's all.

Renee Thompson:
Well, neither have I. Oops.

Tracy Gosselin:
Just came out. Just came out.

Renee Thompson:
Okay. But because I have a list of articles that I'm supposed to be reading and I'm like, Okay, I'm going to get to that massive list of articles, especially when it comes to the work that I do. That's always moves up to the top of the list. But so it's a, you know, your point, it's really, you basically said: assess. Just like the nursing process, you have to assess first. Talk to your people, look at the data. Because I always say data is just part of the story. You really have to find out what's happening from your people and that's your leadership team, that's your front line, that's. Think about all the different roles in your organizations. Work with your, identify your key stakeholders and then just start, okay? Awesome. Oh my gosh, this has been so incredibly helpful. I just so appreciate the work that you're doing. And again, just your, I would say that you get it that this isn't a one-and-done. This isn't a fix this, but this is a journey. And I appreciate that, Tracy.

Tracy Gosselin:
Thank you so much for having me. And if people have questions, you can find me on LinkedIn, and happy to share thoughts, share ideas. And I know where to find you. So that's good.

Renee Thompson:
Yes, this is true. And you know, if you're listening, we'll have Tracy's LinkedIn profile in the show notes. You'll be able to click on that and connect with her directly. And we'll also put a few things that Tracy mentioned in the show notes too, for you, some links and resources. We've done a little bit of work, we've written a few articles about dealing with patient and family abuse that I think you'll find very helpful at least. Tracy, I want to thank you for being a guest on my show, and just keep up the great work that you're doing to address workplace violence.

Tracy Gosselin:
Thank you so much for having me.

Renee Thompson:
And for all of you who are listening, thank you for doing your part to cultivate a healthy work culture. And if you're enjoying this podcast, don't forget to share it with your colleagues, rate, review, and make sure that you come back and listen to future episodes. Thanks everybody for being here. Take care.

Renee Thompson:
Thank you for listening to Coffee Break: Breaking the Cycle of Bullying in Healthcare – One Cup at a Time. If you found these practical strategies helpful, we invite you to click the subscribe button and tune in every other week. For more information about our show and how we work with healthcare organizations to cultivate and sustain a healthy work culture free from bullying and incivility, visit HealthyWorkforceInstitute.com. Until our next cup of coffee. be kind, take care, and stay connected.

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