EP 35: Building Strong Nurse Leaders: Strategies for Support and Development

Coffee Break-Dr. Cole Edmonson: Audio automatically transcribed by Sonix

Coffee Break-Dr. Cole Edmonson: 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, Dr. Renee Thompson.

Renee Thompson:
Hi everyone! Welcome back to the Coffee Break podcast. Wherever you are, whether you're listening or you're watching, I hope you're having a great week. And you know, a magical thing, magical thing happens when you find another kindred spirit who shares your passion, and today we get to have a coffee chat with Dr. Cole Edmondson. He's like my soul brother. Okay, when it comes to, we're both so passionate about preventing and addressing bullying and incivility in healthcare. So Cole, welcome to the show.

Dr. Cole Edmonson:
Thank you, Dr. Thompson. Renee, my dear friend, I am so glad to be here with you.

Renee Thompson:
Yeah, really excited to have this conversation with the world because you and I talk all the time about what can we do to address bullying and incivility in healthcare, because you and I both know we have important work to do, and as I always say, no time for shenanigans. And to tell you a little bit more about Cole, first of all, Cole and I met for the first time, I think it was 10, 11 years ago when I was exhibiting at a conference. And I had known about Cole; I had read his work on bullying and incivility and really saw him as this expert who's out there, you know, as a nurse leader doing great things in this space. And he walked up to me, and he says, hi, I'm, you know, Cole Edmondson. I'm like, what? The Dr. Cole Edmondson? And he hugged me right away, and he basically said, I so respect your work. I've been a fan. And my first thought was, oh my God, he knows who I am, like he knows me. And just from then, from that moment, we just became colleagues and friends, and I don't know if you remember that, Cole.

Dr. Cole Edmonson:
I do. I remember it really clearly, and I think we actually took a picture together. And I had that picture that I just looked at this last week while I was preparing for the podcast. So it's so fun to look back at us in our first time that we had the opportunity to really meet and talk about our passion.

Renee Thompson:
Yes. That's one, okay, we are definitely on the same path. And to tell you a little bit more about Cole, he is such a well-respected nurse leader in the world, and he has served on the board of AONL and currently serves on the board at AMCC. He is an RWJF Executive Nurse Fellow and a fellow in the American Academy of Nursing, and most recently, he joined our team at the Healthy Workforce Institute as a consultant and is already making a huge difference in the good work that we're already doing. And so, again, welcome to the show, Cole. I'd like to start by because I thought, oh my gosh, I have Cole on the podcast. How can I pick one thing to talk about? Because you and I can talk about so many different aspects of leadership and culture, and I remember you talking about some of the community practice work that was based on Dr. Mackoff's nurse manager engagement theory and the good work that you've done in that space, really helping nurse managers. And I wanted to talk to you about this today because nurse leaders, especially that front-line manager, they're really struggling, and you've done such a great job really creating a safe place for them. So maybe you can talk to us a little bit about that work that you've done.

Dr. Cole Edmonson:
Well, thank you. And first of all, I am thrilled to be a part of HWI. I mean, you and the team just do such phenomenal work and are making such a difference and having the impacts on many, many lives. And so I truly appreciate being able to have this opportunity to work alongside you and learn from you who you happen to be like my superhero, who I love and adore and have just followed for years. So, it's an honor to be here with you today and to be able to work alongside HWI.

Renee Thompson:
Thank you.

Dr. Cole Edmonson:
So thank you for asking, you know, about kind of the nurse manager's community of practice work of Dr. Mackoff. And I guess I'll start kind of first by saying the question that I always put out there is: why is it so important for nurse managers to have a community of their own? And I think it's so deeply connected to the professional governance models. We have, the nursing leadership structures we have, and as we know, they are the most influential role in how their unit will perform on all measures, especially culture. They are unique in that they are accountable and responsible, and yet they have some of the lowest levels of actual authority in the organization. Like you and I know, they said at the greatest pressure point for the organization's performance, they're implementing the strategies of the organization, and they are role models for clinical nurses and other professionals on the unit, and now we know the turnover is often greater than 30% of nurse managers. So this is the question that I sought out to try to figure out an answer to, and came across Dr. Barbara Mackoff's work that she was doing with AONL in the nurse manager and director fellowship programs, and really became fascinated when she published her book on nurse manager engagement theory. So Dr. Mackoff agreed to come and help myself and the team at the facility to really implement this work and to translate her theory into practice. And you and I, being translational …, know how important it is to move things from theory to practice and then return those results to the theorist to be able to understand how the theory holds up, where it doesn't, where we need to make changes or create other alignment. So, to counter this, I grabbed Dr. Barbara Mackoff's hand and said, come on this journey with me, and let's talk about what we could do to actually implement this community of practice work at a hospital or health system. And what we ended up creating was a co-led community by nurse managers that created a community of practice, and it was primarily, Renee, in three areas. We really needed to address the span of control and support of the nurse managers and what was happening with their role and their engagement. We also needed to really use a curriculum-based theory of their lived experiences, and provide a safe space for nurse managers in this community of practice, which was peer-led and peer-driven. And that's where Dr. Mackoff came in, was really to be our coach to help us implement this and to teach us the way forward, to use lived experiences, to be able to drive outcomes. And it was such an incredible experience when our outcomes moved from the 55th percentile from nurse manager engagement to the 93rd percentile. We had no nurse manager turnover except for promotions for almost three years, and we had employee engagement scores that went to the 99th percentile as well during that time, and we saw a dramatic decrease in incivility and bullying occurrences. So, that area, this just really spoke to me of how important it is for nurse managers to have their own space and place, and to be in control of their own lives, and to be able to have a community of support, as I know you do as well.

Renee Thompson:
Yes, and there were a few things that you said that I want to reinforce, circle back to. You are so right. That frontline manager, they're like at the pressure point. Everything is right there. They're responsible for their entire department, and as you know, they're responsible for their culture, good, bad, or ugly. But yet, they don't always have the decision-making power. They don't always have the tools. They're not always developed. And that's a whole other conversation about how we put people into leadership roles. And when we look at that frontline manager or, you know, that nurse leader, especially without giving them a safe space in place. So a safe space and place to talk about their challenges in doing so in a way that they don't feel judged, admit that they're struggling. Because what we have seen too, with the leaders we work with, let's say, you know, I present something they want to engage in a conversation about what they're learning after in a way that's safe for them. And we do a lot of we'll do webinars or I'll come out and do a presentation, but then we always follow it up with a coffee chat. And it's just, you know, I love my coffee. So I bring my coffee cup, and people hop on, and we give them that space because that's what's going to help them to actually, first of all, admit that they don't know something or to be vulnerable without being judged. So that's just in general saying that. But what you've done and based on Dr. Mackoff's work is actually, there's curriculum for this, okay, and you first talk about span of control, the curriculum, their lived experiences, and you saw that the outcomes the positive outcomes from this. But I am curious: when you brought these leaders together initially, were they on board right away and kind of laid themselves open and talked about everything, or were they guarded? And if so, how did you move them past that initial? Oh, I don't know, this is really a safe place.

Dr. Cole Edmonson:
Yeah, it's a great question and one that, when I think about it, we had so many what I would call early adopters in the culture in our facility, and they immediately were attracted to this work, and they saw all the potential for what it could do for their role, their joy, their engagement, their team, and their ability to actually have. And I'm going to say, more control over their practice. So, several folks approached me immediately about it. And then, of course, we have others that are kind of wondering what this is and how this is going to play out, and I'm going to wait and kind of see what the results are. I'll participate on it. So we didn't really have anybody that was a detractor. We had most folks that were on board with it because it was going to be a new experience, and we were a magnet organization which also, you know, builds in a lot of innovation and trying new things and not having as high of a fear of failure. So utilizing kind of those early adopters as well as those that kind of were a little bit skeptical about it, to be able to help move them through kind of conversations, through connections, through community, and to help kind of paint that vision of where we're going with this and that. Ultimately, they would be the community of practice that was going to be deciding on things that they had the ability, and the authority, and the resources to decide on. So they were going to be integral to being able to recreate the nurse manager role in how they thought it could best be deployed in the organization.

Renee Thompson:
Wow, okay. I just want to clarify, getting together, and I love this concept of community, it reminds me of, we do a live culture call every single month with folks that we're working with. You know, there's 130, 140 leaders who show up. It's not just to hear me talk, you know, for 20 minutes because then we open it up for Q&A. I think it's the community. It's there with other leaders, just like them all over the country, who are struggling with the exact same issues. Now, those culture calls are just that. They're about culture. But what your community, it wasn't Just Culture, it was performance. It was quality. Can you talk to us a little bit about just some of the areas that your leaders were able to come together, and have meaningful conversations, and then actually take a look at improving practice?

Dr. Cole Edmonson:
This was just such an incredible experiment for us and an innovation in our culture. And as you mentioned, you know, it really was about the community coming together to problem solve, you know, and I'm a big believer in calling the circle to be able to actually continue to problem solve together where there is, you know, a circle has like no beginning and no ending. There's no power structure within the circle, and yet it's one of the most strong and powerful structures you can actually create where we're all equal, and we're all having that conversation, and we all have input. So to be able to create this community of practice, we used a lot of the circle work to be able to pull people in and to make sure that they were represented and had a voice. A couple of things that they did immediately was they said, we don't really like how nurse manager orientation is done. We think we can improve that. And so that group actually took on how do we orient new nurse managers into our organization. And they innovated it and they met all of the requirements you needed for orientation. And they expanded on that, then, to be able to make sure that people had mentors and buddies and that they had a really great opportunity to be able to share their strengths individually, to know who to go to for what. Essentially, they became such a community of practice that they were answering one another's questions. And very rarely, you needed to elevate questions or concerns or problems because they had experience from one year as a nurse manager to 30 years as a nurse manager in that group. So they built on that experience level and that wisdom and knowledge in a very authentic way, in that safe space, to be able to take on some of the challenges and the things that they wanted to correct in the organization. They helped us a lot with looking at span of control and what is a reasonable span of control for a leader. And they also helped us tremendously in looking at what kind of support do you need as a nurse manager? Administrative support, payroll support, staffing support, those things that they really felt were super important to their role, their engagement, and for them to be able to continue to have great joy in their jobs every single day. We know these are some of the highest pressure, toughest jobs in healthcare today, and we have been reimagining this role with AONL at the current time through all the workforce compendiums, as well as the reimagining the nurse manager role. That makes me so happy because I've always said when you find a great nurse manager, you hold on to them, you support them, you hug them, you love them, you give them the recognition that they deserve and need, and make sure that, number one, they feel appreciated for what they do every day.

Renee Thompson:
Wow, I'm so glad you brought up the whole AONL span of control at the 2024 AONL conference. Rose Sherman, our mutual friend, and colleague, she actually talked about this. Her whole talk was about the nurse manager role and the span of control, and how organizations need to take a look at how many direct reports and what's reasonable because I have seen anywhere from one manager has 180 employees versus someone who only has 40 or someone who has 90, but they have four assistant nurse managers. So, it's taking a look at the span of control, but then you can't just look at the numbers. It's looking at what support do they need. And you're asking the question, what support do you need? Because I often find that there's a disconnect. I'll never forget this time I was working with a healthcare organization, and I met with all of the front-line managers, and they basically said, we don't feel supported by our directors. And then I met with the directors and like, oh, we absolutely support our managers. So we had the second conversation and I said to the managers, what does support look like to you? It's so easy for people to say, I don't feel supported. I don't feel appreciated. Well, what does that mean? What does support look like to you? And then, if you're a director, you need to say to your managers, I want you to feel that I'm supporting you. What does support look like to you? So that I know, and it sounds like in your community of practice, those were conversations that your managers were having with each other to say, this is the type of support that we need. Can you talk a little bit more about that?

Dr. Cole Edmonson:
You're exactly right, and those conversations are so important to remove any kind of assumptions so that people can really get what they need as a nurse manager, as a nurse leader, and be very clear about it. I think that's one of the most powerful things that can happen, is a really clear, focused conversation that's intentional around, what do you need from me as your support? As a servant leader, I have always believed that we are there to support the team members that we work with and have the privilege of leading so that they can support their team members, and those team members can take care of patients in the absolute best way possible to get the greatest outcomes for everyone. So this is really a servant leader approach to this, which is how can I support you? What do you need from me as a leader? And then, really, sometimes even documenting that and kind of codifying that so that we go back during meetings and say, am I doing this? And then giving people permission to hold you accountable to what we just talked about as a leader. And that can sometimes be difficult for leaders to be held accountable by the team members they lead and are responsible for and support. But I've always welcomed that because I think it keeps us very focused on why we're there, who we're supporting, and ultimately, how do we get best outcomes for patients, for our team members, for our organization, and for the communities that we serve? Yeah, and without that, I think there is a lot of dissonance. There's a lot of gaps that are there and a lot of misunderstandings that start to occur as well. And then you have people that are very dissatisfied with their leader, with their role, with their organization. So communication is involved in what, 97% of all kinds of errors that occur in healthcare. So let's correct that in this. In saying, as a nurse leader, what do you need from me, and what do I need from you? And let's get a clear agreement on it. And then let's check in with one another to make sure that we're doing that along the way, not just leave it to a once-a-year evaluation time.

Renee Thompson:
Right, that is the missing piece. You may have that conversation. First of all, that's step one is to have that conversation. What do you need from me, and be crystal clear on what that is, and this is what I need from you, same thing. But the second step is to make sure you're circling back and checking and not waiting for the end of the year before you realize that you are so far off track and you haven't. Maybe if you wait for a year, you may have forgotten the entire conversation ever happened. And circling back, when you talked about being a servant leader, it reminds me of something that I learned in business. Okay, as I've been growing a business, I always say I'm a nurse, I'm a good nurse, and I'm still learning how to run a business. You know, it's very different, very much like a nurse manager who was maybe a good bedside nurse and now has to manage the department or an executive leader who now is responsible for an entire hospital. It's a different skill set. You have to learn. And I remember this message, and it really rang true for me and it resonated with me so well. So, from the work that we do here at the Healthy Workforce Institute, we're not the heroes here, not at all. We're not coming in to save the day. And I don't want all the accolades for the work that we do. The leaders who we work with are our heroes. We are just their guide, so we guide. I always think it's making that leader, that nurse manager, the superstar, not me. And if you're that nurse manager, you're not the hero your team is. And if you're a director, you're not the hero your managers are. So, look at the hierarchy. You're always the guide to the person who is right below you. And I just thought if you approach your work that way and your conversations that way, it becomes more about them, not about you. And something else that has come up, Cole, that I think really relates to this is this whole concept of having moral courage and looking at also the role of the nurse leader. And I know you've done some work, and there's been some research. Can you help us tie that into the conversation we're having?

Dr. Cole Edmonson:
It's really an incredible opportunity to kind of bring these things together and to think about how they are actually going to be multipliers for one another. And if you think about building a community of practice for people, you really need to think about, you know, the level of moral courage in the nurse leaders that you have the privilege of leading. And in the original work that I was doing around this, I started thinking about all the times when people don't speak up, when nurses don't speak up, when therapists don't speak up, when nurse managers don't speak up. And what it led me to in the literature was really the idea of moral distress and moral courage and really moral distress just simply being when you know the right thing to do, but you can't do it because of some barrier that is moral distress, and what's the pathway out of moral distress, and it oftentimes comes in the form of moral courage. So when I started researching this, the literature was really silent, Renee, on how nurse leaders experience. Sure, the literature was really replete, though, with how clinical nurses experienced it, you know, especially moral distress at the end of life, futile care in the ICUs, and the ER, and pediatric nursing was probably the most researched. So, as I started researching this phenomenon, I began to kind of understand what might be both the causes of moral distress and nurse leaders and what the interventions that might assist in improving their level of moral courage. And really, six areas emerge, but I know we don't have time to go all over all of them. So I'm just going to give you two of them, okay? We can do another podcast two here and go on and do the next one. But so a couple of things that really stood out in that work. And as I started to kind of fill that gap in the literature and try to understand it, two things that emerged out of the six that are really important. One was the lack of ethics training for nurses. At the time of the research, only about 21% of nurses reported that they had any formal ethics training. This was really interesting to me and they also didn't have a safe space, so here we go. This is the tie-in back to the Safe Space piece is really thinking about creating a safe space for discussion of ethical issues and thinking about having a framework that they could utilize to evaluate. Is this an ethical issue, or is it not an ethical issue? Is it a legal issue or is it not a legal issue? Where does it set in terms of that? Because there are legal issues that can be answered by the legal system, but then there are ethical issues that can't be answered by legality and the law that we really have to take on a deeper process with. So those were two areas that emerged really quickly. So, the interventions that I chose to try and put in place to be able to correct for that was teaching an ethical framework. And it wasn't just teaching it, but making sure that people had practice sessions and then were able to demonstrate an understanding of that actual framework. And for that, I chose what the one I loved the most, which is value ethics. And value ethics frameworks is just simply do the right thing. And then the second part was creating and that safe space for discussion of those ethical issues. So the model that I chose was really followed the idea of Schwartz rounds that are the rounds that are focused on caregivers, closed to only caregivers, created a safe space from an initial event that you could do formal debriefings with the nurse leaders and to really listen and understand and help to kind of move forward with any kind of additional education or support that someone would need that, and oddly enough, the outcome were not surprising to me. But I will tell you, just by simply using your voice and speaking up from an ethical framework perspective was the number one way to decrease moral distress and also to increase moral courage in nurse leaders. So that simple act of speaking up relieves that moral distress. The outcome may not be what you want it to be, but you have in fact, done what you could do to be able to influence the situation and the outcome, and then you can have feelings of positivity around your role in it. And you don't have to create what we call moral residue when you're just not speaking up, and you just put it in the bag, and you put it in the bag, and you put it in the bag, and it builds up over time to create moral injury, which is where we are today with so much of the burnout and … and the issues that people are experiencing, especially through the pandemic, these were not just legal issues or practice issues, these were ethical issues. And so, having this framework and that safe space made a huge difference to nurse managers in being able to speak up in the ways that they were experiencing moral distress.

Renee Thompson:
And just listening to everything you just said about when our leaders don't feel safe to speak up, it might be because they don't think anything they say will make a difference. They might not have the knowledge and understanding you're talking about lack of ethical training, that just builds up like a pressure cooker. And what ends up happening, unfortunately, is they get to the point where they can no longer handle it, and they leave us. And, you know, we already talked the nurse leader turnover rate is increasing. But to give them again that safe place, it's almost because it's not really a venting session. It's not, hey, everybody, come bring your coffee, and we're just going to complain and vent. And it's not that there's a framework and it's structured, but you give them the opportunity to actually then engage in conversations about some of their challenges. And I love that you mentioned Schwartz rounds we had as a guest on our show, Dr. Jennifer Bickel. She's the chief wellness officer at Moffitt Cancer Center. And she talked about how wellness isn't just referring somebody to EAP, and she talked about a lot of different strategies, Schwartz rounds were one of them. And that's what I would encourage all of you who are listening to is to absorb everything that we're talking about and realize, though, it's not just one thing, it's this. And I love your circle analogy. It's a lot of different things under this circle or umbrella of community of practice with your nurse managers, and to give them that space where they can engage in dialogue with each other about really important topics and challenges that were not openly talking about and how it leads to moral distress, and then eventually, again, if not addressed, moral injury, and then they leave and they just don't leave. They carry that with them potentially for the rest of their lives, and we don't want that. And, you know, I love, Cole, that you always tend to circle back, and I'll keep saying circle because it's actually my favorite shape. But we want them to feel joy about their work. We want them to feel really good about the work that they're doing because it's important work. And so everything that you're talking about, it does ultimately impact. That nurse leader is a human being. It affects their culture because if you're not in a good place mentally, physically, emotionally, it's hard to lead your team and help them to be in a good place. And so as we start to wrap up, let's say somebody's listening to this, and they realize that, you know what? I'm a nurse manager, and there's no safe place for me, or I'm a CNO, and we don't have anything like this in our organization, or maybe you're a director. What would you recommend as a starting place? Talk about a lot of things, but what would you recommend as a first step?

Dr. Cole Edmonson:
When I think about some of the first steps that could be really, really impactful for an individual or even an organization is to do the research and to really go and look and see what's out there and really looking for partners that can help you with this, because this is hard work. This is complex work. Culture change isn't easy, and we know that. And so the opportunity then to bring in the right partners to bring in the right resources to be able to do a really deep dive on your culture and who you are and who you are and who you want to be is so important. And there are a number of organizations out there that do this, and it's depending upon what you find after you do this really intense introspection, but certainly for incivility and bullying, of course, HWI, perfect place to start. It is the most comprehensive program I've ever seen in all of my wanderings over 35 years as a nurse. I also love, for the Just Culture piece, is JustCulture.org where, which is …'s organization, who really started this work and pulled it into healthcare, and I was benefited from a lot of their tools, a lot of their consulting, a lot of their wisdom along the way to be able to implement these things. And then, of course, I have to like give a shout-out to Dr. Barbara Mackoff, who now has a new book out on learning Labs for Nurse Leaders, which I can highly recommend you look for. And certainly, AONL is a great place to look for some of these resources as well in the compendium, in the nurse leader work that we're doing, they have fellowships as well that you can access and be a part of. And, you know, there are also resources that ANA to be able to access these pieces of it. But I think the first step is really kind of understanding where you are, because change always starts with us. And then, looking to see if you can understand where your organization is and what the opportunities are, and then go and look for what potential solutions are out there, and these are just a few of them. Schwartz round. If you go to the Schwartz Center is phenomenal in this. And many of these programs, they have ways to help fund them on a sliding scale for organizations to work with you, and they can help innovate around that. And if you're interested, sometimes they'll even co-create with you. These partnerships and the ways in which you can put these into your organization, because it has to be in you. And I talk about this all the time. It has to be sustainable, has to be scalable, and ultimately, it has to be impactful, and really have that opportunity to improve the lives of clinicians, team members, patients, and communities. And just really thinking more broadly around what is our impact in doing this and ultimately asking the question, why wouldn't we do this, is a really powerful place to start.

Renee Thompson:
Right, it can't just be a one-and-done. You can't bring your leaders together and do a two-hour workshop on fill-in-the-blank. It has to be beyond that. It has to be sustainable. And all of the recommendations you just provided reminded me of what I'm working on as a leader, as a business owner, when I have something that I want to do, okay, something needs to be done. And we've already talked, okay, now you know your nurse managers need a community of practice. They need a safe place. They need to address their moral distress. We tend to start thinking in terms of how can we do this? Oh my gosh, how can we do this? But instead, asking ourselves the question, who can help us do this? As you say, there are so many resources out there, so we're going to put all of the ones that Cole mentioned in the show notes. So, number one, I'm going to link the episode with Dr. Jennifer Bickel, where she talks about Schwartz rounds, and she talks about wellness, okay, as a system. I'm going to put Dr. Mackoff's book Learning Lab that's out now, right, Cole? Is that available now? Okay. We'll make sure we put the link. Of course, AONL, okay, I'm a huge fan. We're going to put the link to AONL, ANA, and Just Culture. We'll put that in the show notes so that if you're interested, yeah, just start assessing. It's the nursing process we always have to assess first. And I really appreciated that you said, it really needs to start with us. What do I know? What do I need? And then I can take a look at my organization. But we'll have all those resources in there for all of you. And oh my gosh, Cole, we, you know, you and I can talk for a very long time. We have a lot of these, you know, similar passions, but I always learn something new when I'm with you, and for that, I am grateful. If people want to connect with you, what would be the best way?

Dr. Cole Edmonson:
Easiest way to find me is on LinkedIn, and I would love to connect with you or follow you. So please reach out to me on LinkedIn.

Renee Thompson:
That's great. Yes, I have been connected with Cole, and this is what I always do when I meet somebody at a conference. I make a list, and I go to LinkedIn, and I ask to connect with them, and then we can continue the conversations that we started. And so, I highly encourage you to reach out and ask to connect with Cole. I also want to just mention, if you're listening to this, you won't see this, but if you're watching this, Cole and I both have our Be Kind buttons on, okay, just to remind people that, you know, working in healthcare right now is not easy. It never was easy. Okay, let's just face it. It was like, oh, it was easy before, and it's not now. It's always been challenging. However, we can make it better and sometimes it just starts by, first of all, being kind to ourselves. I know a lot of nurse managers beat themselves up because they're not perfect, and so just give yourself some grace. Be kind to yourself first, and then just be kind to each other. And Cole, thank you so much for being a guest on my show and for doing this work for as long as you have, and for just being a great friend. And now you're a member of our team. I can't wait for our continued work together. Thank you for being here.

Dr. Cole Edmonson:
Thank you, Renee. It's been a pleasure. And I'm just going to end by saying, I always tell people, if you like the culture you find in the organization, help keep it. If you don't help change it, you can be the one that helps to change the culture as you and the team at Healthy Workforce Institute have helped to for so many organizations. So thank you for the work you do. Thank you for being who you are, and super grateful to be on the team at HWI. Look forward to working with everyone.

Renee Thompson:
Oh my gosh, yeah, I always say we have such important work to do, and it's always easier to do that work when you're working with really great people. So thanks, Cole. And I wanted to thank you all for listening and for watching and doing your part to stop the cycle of bullying in healthcare. If you like this episode, please rate it. Give me a review. I'm always looking for reviews and then make sure you share it with a colleague. So, I just want to end by reminding you all that together, we can absolutely make healthcare a better place. Thanks 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 this podcast helpful, we invite you to click the Subscribe button and tune in every 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 us at HealthyWorkforceInstitute.com. Until our next cup of coffee, be kind, take care, and stay connected.

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