EP 42: Cultivating a Positive Work Culture

Cofee Break_Dr Helene Burns: Audio automatically transcribed by Sonix

Cofee Break_Dr Helene Burns: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Intro/Outro:
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.

Dr. Renee Thompson:
Hi everyone! Welcome back to the Coffee Break podcast. Wherever you are, whether you're listening or you're watching, I just really hope you're having a great week. And I will tell you, I'm having a great week and a great day today because not only do I get to interview and have a coffee chat with Dr. Helene Burns, the chief nurse executive at AtlantiCare, but Helene happens to be a friend of mine, and we've been colleagues for a long time. I guess we started out as colleagues, and then we became friends. So, Helene, welcome to the show. Thank you so much for being here.

Dr. Helene Burns:
Well, first of all, thank you for inviting me. I'm so excited to do this with you. And yes, we've been colleagues, but more importantly, we've been friends for a long time.

Dr. Renee Thompson:
Yes, and it really started because I used to host my own events in Atlantic City because I'm from Pittsburgh. Helene's in New Jersey, so Atlantic City. We would host these events and I would have nurses from these are bedside nurses. They would come to my events. And we had a couple of nurses at the time you were working at Kennedy, which then became Jefferson, and now you're at AtlantiCare. But these nurses went back, and they told you about me, and you were having an event. And I was invited to, I think it was a keynote at your event, and that's when I first met you and I. My first conversation with you was so comfortable, so fun, and I said, oh my gosh, I love this woman. Like, we're gonna be friends. I could tell, like, I am so into those people that make you feel so comfortable, even though you've got this executive role, you didn't act like it. You were just so down to earth. And then, of course, Helene, our conversations turned into conversations about grandbabies. And so I have my grandbabies first. And then excited.

Dr. Helene Burns:
And I was jealous of you. You were first.

Dr. Renee Thompson:
I was, but then Helene had the most beautiful little grandson absolutely adorable. So, in addition to all of the amazing things Helene does, she's also a grandmother. Well, let me tell you, though, about some of those amazing things. Helene, as I mentioned, is the chief nurse executive at AtlantiCare. She went from Kennedy to Jefferson, and now she moved over to AtlantiCare. She is also a fellow with the American Academy of Nursing, and she's also recently been inducted as a fellow at AONL. And this happened at their conference in 2024, and I was in the audience, and I watched Helene walk on that stage and receive her award, and I was proud of her because Helene's done amazing work as an executive leader.

Dr. Helene Burns:
Thank you, thank you, thank you. It was a very special day, and so was for the Academy of Nursing. You have to pinch yourself when you get that opportunity to have that level of accolades and to have your whole family there. It's just all so exciting.

Dr. Renee Thompson:
It is exciting. It's really cool. And there's an element of, oh my gosh, I am standing among all these other amazing nurse leaders and a little bit of, am I worthy? Because I knew myself when I was inducted as a fellow into the Academy, I'm just standing there in awe of all these amazing leaders who have done such amazing work for our profession. And then there's a recognition that, you know what? They're probably saying the same thing about me and everybody else. And it's just, I don't know, I guess it's how we are. And Helene, I thought about how I want our conversation to go today. Because, again, you and I have known each other for a long time. One of the things that I love about you and your work, and I've seen this consistently over your career, is that you understand what it takes to be a leader who can cultivate a healthy work environment. You might even say that these are great leaders who can do this. Can we maybe start with that conversation? Can you give us some examples of leaders who have been able to do this and do this well?

Dr. Helene Burns:
I think I've had such an opportunity here in New Jersey. I've been very involved over the years with the organization of Nurse Leaders in New Jersey and AONL New Jersey, which is an affiliate of AONL – American Organization Nurse Leaders. I've been on the board for a number of years now, probably almost ten altogether. I was the past president of that. Back in 2006, that core group started to talk about, actually our conversation was about pending staffing ratios, and we started to talk about what it takes to have a healthy work environment. That evolved into the fact that we have councils here in New Jersey and many hospitals. Actually, I think about 60% of the hospitals now have councils for a healthy work environment, and they are co-chaired by a clinical nurse and a nurse leader, the CNO. And it is, I learned so much from the evolution of that, not only at my organization but also in how we've all evolved. That and what is emerging are some great leaders. When I think about my board members who are CNOs, I think of marriage Dr. Mary Jo McLaughlin. She is from Huntington Medical Center. She just embraced the concept with her staff. And while none of our work environments are perfect, nobody's is healthy. The work environment is so important, and understanding what the barriers are to getting there and how we, as leaders, help to get rid of those barriers is important. Another one of the leaders here in New Jersey is Brandy Kennedy, and she's the CNO at Morris. Morris Town Center is part of Atlantic Health. Once again, I see CNOs who don't just talk the talk; they walk the walk. You've got to do both. You can't just talk about a healthy work environment. You've got to get in there with the staff and figure out how to make that happen, whatever that means. When it really could mean relationships among nursing staff, physicians, and any of the providers. How do you cultivate that so that people can speak up do the right thing, and be in an environment that they're happy about?

Dr. Renee Thompson:
Okay. You said a few things that I want to explore a little further. You did something really powerful. And I think every, I don't know, problem-solving begins here. By asking the questions, you ask the questions. What does a healthy work environment mean? How do we know when we're in a healthy work environment? So, you always start by asking a question. And what you did was you didn't ask all the leaders. You said CNOs and those nurses who were delivering the care because it can't just be a group of leaders sitting around a conference room saying, how are we going to make it better here? And how are we going to improve the environment? You have to involve the people at all levels, really. We call it our top-down, bottom-up, everything-in-between approach. You have to get their buy-in, and you mentioned two relationships, especially, I think, right now. That's the key to tackling some of these challenges that we're experiencing in healthcare. It's that collaborative problem-solving. And that's where getting together with your physicians and your providers and other members of the interprofessional team to take a look at a problem, an issue, and how you solve that problem together under that umbrella of a healthy work environment. So, can you talk a little bit more? I know you've done this while you and I had a conversation at AOL about these partnerships with your physicians as part of this healthy work environment.

Dr. Helene Burns:
Yeah, I remember that conversation, and here's how I feel about it. I think that it is a dyad relationship. The physician and the nurse, whether at the bedside with that individual patient or at an executive level. I've always said that it's very important that the CNO have a collaborative relationship with the chief physician because, as we act many times, that's how the organization acts. They watch us, how we treat each other, how we stand together on issues. And sometimes, behind the scenes, we may disagree, but out in front, we have to be an equal partner. And I love it when medical staff treat nurses as a partner, not as a subordinate, but truly as a partner. I remember when I was with Jefferson and I first got my DNP, and in public, every doctor would call me Dr. Burns, and that led to so much. That meant, and it's not a medical degree; it's a doctorate in nursing practice. But I quickly realized that they were as proud of me for having that degree as I was. And it sets the tone for we are on the same page. We are equal, and when we treat each other as equal, then the expectation is everybody treats each other as equal no matter what their role is, and that could be clinical or even non-clinical. However, treating each other with that respect creates a healthy work environment. In a nutshell, it is.

Dr. Renee Thompson:
People might argue that we're not equal; I have this responsibility, and you don't. People will nitpick that, and they'll push back. But I think, again, under the umbrella of a healthy work environment, every single person on the team, when you look at the entire interprofessional team, recognizes that everybody has a different role. We all have a different role to play. Physicians have their role; nurses have their role. Respiratory has its role. The administrators have the role. Facilities and manager have their role. Everybody has a role to play, and every role is valued. When you have that, where every role is valued, you can break down that hierarchy. And where some people perceive that their role is more important than another role because it shows up, it shows up on how they treat people. And I love that you said that as soon as you got your DNP, they started calling you Dr. Burns. That is so cool because I don't always hear that, or they don't always hear that they're recognizing you for the fact that you do have a doctoral degree. You may not be a medical doctor, but it indicates respect for your role. And even myself, you know, when I meet someone, Dr. Helene Burns, like, if I'm meeting you for the first time and I wait for you to tell me to call you Helene, you know, and somebody will keep calling me Dr. Thompson, and I'll say, and I'll never forget this happened recently, where somebody, a leader we've been working with, I've said to him probably 27 times, Ken, please call me Renee. And he said, out of respect for you and your degree and your hard work. Basically, nope, I'm going to keep calling you Dr. Thompson. Like, okay, you, but getting back to that, building relationships and creating these dyads, you and another physician executive, you can have your debates behind the scenes, but you need to show up as a united force that you're in this together. Because what does not help creating a healthy work environment is when we demonize any one role because I see that all the time it's the physicians or, oh, it's the nurses, or oh, it's fill in the blank, but that you guys aren't talking badly about each other behind your backs, that you're coming together. And if you have an issue, you're talking through it and doing that well. And so you mentioned Brandy, you mentioned Mary Jo. Can you tell us? I don't know, Helene, in your experience, what makes a leader great? What makes a leader? What are some of the skills or characteristics of someone in a leadership role that truly help them to be a great leader, one who's respected and cultivating a healthy work culture?

Dr. Helene Burns:
You know, when I think about it, I always think it's listen first, don't talk, listen first, and develop that relationship so that you develop that respect, the mutual respect. It's not that they respect me, it's that we respect each other, and then value one another. When people understand or people know that you value them, you respect what they have to say. You listen. And sometimes you have to clarify. Sometimes, the best question I ask is, what did Lane say about that? And they'll tell me, and it was like, I never said that. Oh, here, let me clarify that for you. And it's the people who need to understand the why. Why are we doing this? Why is this so important? Understanding the why is just like getting to really helps you clarify and develop that relationship. When you're a CNO, sometimes people will say, we don't see what; we don't see enough of you, and, of course, you get the guilt with that. But when they know that they can touch you, call you, get clarification from you, and when they see you, they feel comfortable. One of the best things that happens is if I walk down the hall and people are coming towards me and not trying to run away; if they're running away from me, then you're not developing a relationship. If they're running towards you and they look and they smile, that is always, you know, because I'm new to AtlantiCare, have only been here about six months, so we don't know everybody and everybody doesn't know me yet still. But when I walk down the hall, and someone looks up and smiles at me, I know that I'm making a good connection, and that opens the door for me to say, hey, how are you? How are you doing? What do you need for me? That type of thing. Because that's when you start to hear what the issues are. It opens the door.

Dr. Renee Thompson:
You just blew my mind. I had never really thought of it that way. But how? This is all about self-awareness, too. Okay, you have to turn the mirror back on yourself. It's essential to be a good leader. But I never thought of it in this way. As you're walking down the hallway, I'm even thinking, like, in the lobby or anywhere in your organization, if people run towards you, that's a good sign. If people run away and turn and go the other way, that might indicate that there are some issues, and then it's up to you to figure out why people are turning away from you. Helene, when I was a brand new nurse. I was scared of my manager. So this is even just the manager. When she came out to the nurses' station, I would find a reason to step away from the nurses' station. I was just intimidated by her. The only time I ever really talked to her was if there was an issue or my annual performance review, and I would have like heart palpitations before I'd go and meet with her. I don't think she knew anything about me. I was one of the many nurses she hired that year. And so it's not to say, you know, that's the opposite, leader. Well, maybe I am saying that, but I never thought of it in the way you described it when you walk down the hallway. Are they moving towards you, or are they moving away from you? And I love that simple sort of assessment. So pay attention if you're listening to this. Pay attention to what people do when you're walking down the hallway.

Dr. Helene Burns:
You can see this in the nurse managers. When a nurse manager is truly connected with their staff, the staff are complaining about the nurse manager all the time. They empathized with the nurse manager's job and their role, and it's the same time type of thing. They're willing to help each other out. I think that leader, that unit-based leader is so critical for the development of a healthy work environment. If your staff, trusts you, you trust them, you have an open relationship. What's happening? If there are issues internally with staff members who don't cooperate well or don't work well together. You, would you address that? That's when you build that healthy work environment. It takes everybody. It's a village to get to really that environment, which is really very positive, and I think a unit leader in that manager is key to that. And you have to have insight. You have to be out there and see what's happening.

Dr. Renee Thompson:
So, I'm curious. All right. You were at Kennedy and then Jefferson for a long time, and now you're at AtlantiCare, and you're new there. You know the importance of building relationships, but you're also new in your role there. Usually, when you bring in a new executive, there may be problems that have been piling up that they're waiting for you to come in and all of a sudden magically solved. So, how do you prioritize doing the work of CNE simultaneously? Doing the people's work that we've just been talking about is equally as important. And build that relationship with your key stakeholders, physicians, and some of the other people in your organization. How do you prioritize that? Because I can only imagine what your days are like.

Dr. Helene Burns:
I think just having the experience of being a CNO for over ten years helped me to just really hit the ground running and get started. I knew what the issues were or what I anticipated some of the issues would be. My biggest concern was I wanted to know what the staffing was like, what it was. Did we have enough staff or cone, or are we still coming off of the pandemic? So do we have enough staff? We've been heavily relying on agencies, which we had at the time when I started. We have been waiting down the agency because I need every single week with the recruiters and the directors myself. We talk about where we are in positions, how what about the hard-to-fill positions, and what we can do about them. I said right at the front, I want same-day hires. And when we do it open house, I want to hire that person right there on the spot. And so, I just pivot and do things quickly sometimes. And sometimes, in an organization, when you're new, you can do that. You have to be careful not to always say, well, well, we always did so great over there. And sometimes you bring your best practices with you. But we also learned very quickly, I will tell you, that my number one priority is staffing to make sure that we have adequate staffing, appropriate staffing. Where were the barriers, and where did we have to focus our time? I quickly met with, and I'm luckily surrounded by great universities. I quickly met with all the deans and each dean told me that they didn't think they were the priority for our organization, which was funny because I thought you all said that's not true. Each one is truly a priority to help us get new nurses into the organizations. I just think the experience I've had over the years helped me to prioritize very quickly. For us, nurse managers had some of our nurse managers had too large of a span of control, one nurse manager, 120 employees. How does that work? Not well, and let's do all the payroll early on. There were very early conversations with nurse managers telling me that somebody's payroll means I don't have Sunday off because I'm doing payroll for all those employees quickly. I did so in a budget-neutral way because I know how to do that. But we were able to give the nurse managers associate nurse managers, and if they had more than 40 or 50 employees, they had another associate nurse manager, anywhere from 1 to 2 associate managers. And the one thing I said is I don't want everybody on the same shift. You know, at the same time. And I want you to be visible to the staff. That's the purpose of it. And then, we elevated some of our unit secretaries to coordinators who are now doing payroll.

Dr. Renee Thompson:
What? Yes. That's awesome.

Dr. Helene Burns:
So, take that administrative burden off the nurse manager. Because really, the most important thing for the nurse manager to do is to be on the units. We also had a problem with them going to meetings all day long. So we had to categorize all the meetings, and we cut many of them out because the most important thing for the nurse manager is to be on that unit with their staff. So they were the very early things we did to make an impact. And when you do that, people notice, your staff notice it.

Dr. Renee Thompson:
They see that you're doing something. And what I've learned about you over the years, Helene, is you're not paralyzed by perfection. You're not waiting until you have every piece of information. Like, you're right. You've been an experienced chief nurse executive for a long time. You've been in healthcare for a long time. You're doctorally prepared. You're coming to this position with experience and knowledge already, and you can apply immediately. Like you said, the same-day hires focusing on staffing, working with your deans, because that's a role that I had before I started my company was I was the director of academic Service Partnerships, so I worked with all the schools of nursing that would bring their students to our organization and really worked with them. I had to chuckle a little bit because when they say, oh, none of them think that they're the priority in our situation, we had one that everybody thought had the priority over everybody else, and there were some conflicts with that and getting into that role. I had no idea that these things were happening. And then how do you navigate those waters when you've got some long-standing? That's the way it's been done here for years, and then you just come into it with fresh eyes. And I think having an open mind and maybe an innovative mindset to just try something to see if it works and it sounds like you've really done that. And I so appreciate the work that you're doing with your nurse managers and really looking at the span of control, the scope of their work. Yeah, I was a nurse manager. It was me, and I had 75 employees, and I can remember coming in on Sundays to start payroll before Payroll Monday hit. And that's not a good place. And I burned out very quickly. But you're doing a great job with that. All right. The last thing I want to ask you is if you have your finger on the pulse of what's happening across the country. And I know the work that you've done with the New Jersey Organization of Nurse Leaders Group has just been fantastic. And it gives you that opportunity to, you know, not only see what's happening in New Jersey, but your work with AONL and the Academy really gives you a sense of what's happening around the country. Are we making progress? Are things getting better out there when it comes to a healthy work environment, or do you think we're at a standstill? Yeah.

Dr. Helene Burns:
To answer the question, are we making progress? The answer is yes and no. And I think that there are great and best practices out there that others need to just find out about and grab. I think that there are still organizations that are struggling. I think there CNOs and nursing staff who are struggling. It's not a, and we've not gone over the rainbow. I think we're on the trail. I think many more understand that our role as leaders is to develop a healthy work environment. If we pay attention to that, then our clinical staff can do all the right stuff that they need to do. They can care for the patient if we can care for them enough. That really sounds so simple and it's so hard to do, but it's so essential for the work that needs to get done. I think that we're making progress. I love that we're talking about healthy work environments. I love that we're talking about behaviors and what's appropriate and what's not. Because for many years, and you and I have been in nursing a long time, we didn't even talk about that stuff. That was, nurses ate their young and did it. I remember myself being a young nurse and people being mean to me because I didn't know when you don't know what you don't know and you have to learn. And that's why we've all been in that space. So, I think we've come a long way, but we still have a long journey. The more we talk about it, the more we do things, and the more we find out who's doing it well and how they are doing it. Going to a national conference and this being a topic, I love that focus of AONL was really one of the large focuses this past year. Now, in the spring, it was about the nurse manager and the role of the nurse manager. Such a crucial role for a healthy work environment, and we have to take care of the nurse managers so they can take care of us, which, just to me, it was like they were spot on to talk about that one.

Dr. Renee Thompson:
Oh my gosh, I could not agree with you more on many levels here. Okay, first of all, you're absolutely right because what I've seen is we are making progress, and there are pockets of amazing transformations in some organizations, even if it's the organization and some service lines or departments where the organizational executives get it. The culture and the environment are just as important as the services that they're providing. So, if you have an executive team that gets it, it's much easier. But we also have pockets and organizations where they're still sticking their head in the sand, saying, we don't have a problem here. Everything is just fine, and that's a whole other conversation. But knowing that the frontline manager is really if you're going to start somewhere, start there, because one of the things that we've noticed as we've been surveying our clients and our community, and when we do webinars, we're always asking questions, a lot of our lot of the organizations out there, when you take a look at their frontline nurse managers, 50% of them have less than two years of experience, And a lot of them learned how to be leaders during a pandemic when everything was in crisis mode. To your point, we need to focus on those nurse managers, and I love what you're doing at AtlantiCare, where you're looking at their span of control and you're giving them the support that they need. And thank you so much for, like, yeah, you're going to be the manager, you're going to have two assistant nurse managers, but you all can't work Monday through Friday daylight. You need to have some coverage whether you decide on weekends, evenings, nights, or whatever makes sense for you. But there's got to be the fact that you have to spread the wealth, as they say. But we are making progress. The bottom line is that we still have a ways to go. Helene, if someone. Let's just say they're a new chief executive, and they're starting at a hospital that they've never worked at before. They're brand new. So that was you six months ago, and they're listening to this episode. What advice would you give them, being brand new to an organization as a chief nurse exec?

Dr. Helene Burns:
I'll go back to the listen first. Listen, first, you don't have all the answers. Find out what their issues are. You can help. That helps you to prioritize and find out what the issues are. Listen, hear what they have to say. You get a sense of the culture by doing that, you start to understand what the priorities are. We don't have all the answers. Oftentimes, we know how to find the solutions and just listen and prioritize from there. After all these years of being a nurse 40 plus, I still love it. I still love what I do, I love coming to work every day, and we all have stuff we're working on, and things are not perfect, and that's life. But nursing is such a wonderful profession. No matter what level you are or how you pick in our profession, it's just a great place to be, and we just need to find the jewels, go find the best practices, and implement them. People are doing great things with nurse manager roles today, and just pay attention and do the right stuff. Ultimately, you have clinical staff who love coming to work and caring for patients because you've provided that free, healthy work environment.

Dr. Renee Thompson:
Yeah, so wise, and I love how you started by saying, just listen. Because if you listen, they will tell you what they need. But sometimes we feel like we have to go in there and just start doing things, fixing things. We're a bunch of fixers, especially if you're in a leadership role or a bunch of fixers. But it starts by making sure you're fixing the right problem, and that is by truly listening. Oh my gosh, thank you so much for being a guest on this show, for all the great work that you're doing now at AtlantiCare and the work, and the amazing work that you've been doing at AONL New Jersey. Thanks for being my friend. I so appreciate just the years that we've been doing good work together and sharing pictures of our grandchildren via text messages and on Facebook. I think you're an amazing human being, and very honored to call you a friend. So thank you for everything that you're doing, Helene. And if people want to connect with you, what's the best way?

Dr. Helene Burns:
[email protected] and I am on LinkedIn, so come find me on LinkedIn. And it's always a pleasure when someone reaches out. You know, I remember one time I had a very bold nurse manager who worked in another organization, and she sent me an email and said, would you be my mentor? And I remember this was several years ago, my secretary, and she's like, you're busy. You don't have time. Just like you don't have time for this. I'm like, oh, I need time for this. And here I've met somebody; she's now in a director role, she's doing a phenomenal job, and she wants to be a CNO someday, and someday, she's going to be a great CNO. And it's like giving people that time to be there for them and to mentor them. It's part of our job. Yeah, it's always a pleasure. Always so much fun talking to you.

Dr. Renee Thompson:
I know we always have a good time together, and I look forward to continued conversations with you, Helene. And again, thank you for being a guest on the show. And I know how busy you are, but you're always there for the people who need you, and have always appreciated that about you. Like this mentor or person who reached out to you to ask you to be a mentor? Yeah, it's just kind of who you are. And circling back to the beginning, we talked about what makes a great leader. Well, there you go. You just explained what makes somebody a great leader, so thank you. And thank you, listeners, if you're listening or you're watching, thank you for being here. We know there's a lot of noise out there right now, and you have choices on how you spend your time. So, if you're listening or you're watching, thank you for spending your time with us. And if you like this episode, if you could please rate it, post a review. I'd be so incredibly grateful, and make sure you share it with others. We have important work to do in healthcare. There's nothing more important right now than the culture of a healthy work environment. So, hopefully, you learned a few things that are going to help you to make yours just a little better. Thanks, everyone. See you next time.

Intro/Outro:
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 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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