EP 61: Empowering Nurses in Healthcare’s Hierarchy

CB_61 – Dr. Katie Boston-Leary: Audio automatically transcribed by Sonix

CB_61 – Dr. Katie Boston-Leary: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Dr. 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.

Dr. Renee Thompson:
Hi everyone! Welcome back to another episode of the Coffee Break podcast. Wherever or whenever you are, I hope you're having a really great week! Okay, I bet we could all agree that burnout and well-being are still major issues in healthcare. But the question is, what are we doing about it? So today we get to talk to my friend, Dr. Katie Boston-Leary, who is doing something about it. Katie is the Senior Vice President of the American Nurses Association for their equity and engagement platform and has just done incredible work on this. So, Katie, thank you so much for being on the show.

Dr. Katie Boston-Leary:
Thank you for having me. I'm really excited to be with you, Renee. You know, we go way back. So this is really awesome that I'm here with you on your show.

Dr. Renee Thompson:
Well, you said we go way back. We do. And we swim in similar lanes because people, when they say, oh, wellness and burnout and all of those things, it's not specifically what we address at the Healthy Workforce Institute, but there's an alignment If you have people who are working and unhealthy work cultures, they're going to be burned out. It does affect their wellbeing, and that's really your specialty. So, for everybody who's listening or watching right now, I want to tell you a few more things about Katie. First of all, I already told you that she is the senior vice president of equity and engagement at the American Nurses Association, and she's just done phenomenal work there. She was also inducted as a distinguished fellow at the Academy of Diversity Leaders in Nursing with the National Black Nurses Association. She's also involved in the National Academy of Medicine and the Healthy Nurse, Healthy Nation campaign. And Katie, I swear every time I go on LinkedIn, anytime I see anything in the nursing world, news. There you are. So you've been published. You're on podcasts. You're partnering with amazing human beings. So it's like, oh my gosh, I could probably have spent an hour just going over your bio. And so I just want to thank you, before we get into our conversation, for the amazing work that you're doing to really advance the profession of nursing.

Dr. Katie Boston-Leary:
Thank you. I do want to say, and I do sleep, even though it may not seem that way, but and I spend time with family, and I do all those other things. So, some things just they seem like they're all happening at the same time. But it's really around time of when they hit social media. But I do find space to take care of myself because I want to practice what I preach, right? But can I take this time to commend you?

Dr. Renee Thompson:
Me?

Dr. Renee Thompson:
Yes, because the work that you're doing with incivility and bullying and creating healthy work environments, you've been in this space for so long, you're such a known voice. Sometimes, we're crisscrossing each other where I'll be at a conference and you were just there. And, you know, we've never met at one, but it's going to happen. I guarantee you. And because, as you said, our work is aligned, and there's enough for everybody in this space. So I just want to really commend you and the reason why your work is so important. Just recently, our membership team relaunched, and I shared it with you. Our membership team relaunched a video that they did, a webinar that they did a few years ago on bullying, particularly for new nurses to practice. And it had high uptake then, and they just pushed it out there today, years later. A few weeks ago, and I was concerned about some of the wording and everything because I know that you're an expert in this space. And I reached out to you, and you gave me great feedback, and the importance of that feedback is this: unfortunately, some emails have gone out with the old title that made it seem as if bullying is bullying. Let's just figure out how to navigate it. That's the way it came.

Dr. Renee Thompson:
Right, right? It is what it is. It's just the way it is. Yeah.

Dr. Katie Boston-Leary:
And we were like, no, this is not going to work. I gave the feedback, and they changed it. But unfortunately, the email promoting the webinar had already gone out after I connected with you, and we made the change. A nurse who watched the video reached out to us at ANA and talked about how she wishes ANA considered changing the title because she saw the old title, and she told her story about how she was bullied, where she also had some suicidal ideation, and really talked about how it's plagued her career for a long time in various places, which was very sad to read. So, thank goodness I have a colleague like you to validate my concern, and we were able to say we did change the title. We just said, you know, we didn't change it before it went out fully, and we had a subtitle, a text in there that we don't tolerate bullying. And here are some resources if you have considerations, ideations for suicide. So we were able to say, yeah, we got it. We did it. But I thank you for being such a peer and colleague that I could rely on. So because sometimes, no matter where you are, you need that. So, I thank you for responding.

Dr. Renee Thompson:
You're welcome. And yeah, I know some emails already went out with the title, but as they say, the best time to plant a tree was 20 years ago. The second best time is today. And so you made the correction, even though you had some of that language that's out there and you decided to not just, well, let it go, people. You know, there's too much effort to try to change it. You reached out, I gave you my expert opinion. I'm like, oh, change that title. And you all did. And now you're seeing that. Also, that change in title is resonating with people because you're right. It's not the way it's supposed to be. You know, we learn about bullying in nursing school and, you know, there are lots of reasons for that. Which actually brings me to something I want to share with our listeners and viewers. Katie, myself, Dr. Roberts, Susan Roberts, and somebody on my team, Cheryl Fletcher, we wrote an article for publication. And Katie, maybe you can tell everyone what that article is about. So we just got excited. We're all excited.

Dr. Katie Boston-Leary:
I know we are because it's been a long time coming, right? So we wrote an article about, and I'm going to fumble the title because I don't have it handy, so hopefully, neither. But it's really about how nurses are functioning in oppressive environments in general. And part of it is because of the hierarchical nature of healthcare institutions where we practice and work, and how when I did my dissertation on the lived experiences of nurses in terms of power and influence in the acute care setting, and every nurse that I interviewed said, we're the lowest on the totem pole. Highest is it would have been physicians, but it wasn't physicians because they felt that administrators gave them the power. So, administrators were at the top. And then you see some of the bullying and incivility that we see that we've witnessed for years. And part of that has to do with the fact that that is a cycle of oppression. And if you can't punch up, you're going to punch sideways and down. So it's been this thing where it doesn't make sense that nurses are mean to each other. And there's this old folklore and adage about how, you know, nurses eat their young and things like that. Why are we here? They know. We know we need them, these new folks; why are we being mean to them? But it's really because of all the dynamics and the social dynamics and the social fabric in healthcare institutions that impacts us acting out and harming each other. That's what makes it make sense.

Dr. Renee Thompson:
Yes, and you're right. If we take a look at why we see more bullying and incivility in healthcare, you know, we can go through a laundry list of reasons, and we understand it. But you and I are of the same sort of mental fabric that okay, even though we understand it, what are we doing about it? And when I look back at your career, and I look at your involvement in so many different aspects of healthcare, especially nursing, under that umbrella of how it affects our well-being, you can't do all of this work, Katie, if you're not passionate about well-being. So, can you talk to us a little bit about where does this come from? Where does this drive and passion come from for you to just do as much as you're doing right now?

Dr. Katie Boston-Leary:
Sure, I'm going to start with how I got here organically, and then I'll move towards how I got here intellectually, organically. I practice as a nurse. You have, Renee. We know what it's like. We know that we were it was ingrained in us for years that part of being a nurse is there's a suffering component that we have to just suck it up and deal with, and the suffering can come from any direction. But that's just the nature of the beast, and we got to deal with it. And then as a leader, and I bought into that, and then as a leader, I started to see that I can impact that. And it didn't have to be that way, especially when during the time when I was a chief nursing officer and the millennials were starting to enter the nursing workforce at that time, and they were pushing back on a number of things that we'd expected for years, for decades. And there was this tension between these generations that this is the way it is. Millennials deal with it. And millennials were like, no, I don't have to. And then we started having all these webinars on how to deal and meetings and how to deal with this group, these millennials that are asking for all this stuff, like who do they think they are? They just got here. They need to work their nights. They need to suffer through.

Dr. Renee Thompson:
They need to suffer.

Dr. Katie Boston-Leary:
Yeah, they need to suffer. Absolutely. That's the rites of passage, right? So this is what's required of you. And they were pushing back. And then it hit me also that it wasn't just the millennials who gave us the signals that this was not going to work. There was also the millennial effect, where there were people that were not millennials, that were saying, I think this can be different because they were seeing this demand that we never really dealt with in a large sense, for us to be different. And then, at that time, I'm working at this community hospital where I'm sandwiched between two giant systems that had a wider portfolio of services. And I'm working in this small community hospital of 120 beds that were limited in terms of what we can offer. And I found that I was a training ground for these larger hospitals. But then I'll always get not always. For the most part, I'll get some of the team after they attain those skills back, right? And that's what they'll say. It's time to give us some clues about how. Yeah, I went over there, and I learned these skills, and I was just a number. When I come here, people know my name. Like if you want to get loved on you, come to this community hospital. But if you want to just learn about how to expand your portfolio in terms of, you know, being higher specialties, more acute, more technology, go over there. But once you get it, so that was the thing. And that's when I said, oh, I think I have something special here. Like we need to love on these nurses and care for them holistically and really get to know them as much as we can about them, for them to understand that we don't want to just want their talents; we want their whole selves. So that's where I started to do that, because that was my retention strategy, honestly, and it was my market differentiator. That's all I had. So that's where we did a lot of great things. I developed this love affair for this group. It was so different. And what's so interesting about this time and this group and this community? Unbeknownst to me, this was a hospital that was not too far. It was in Maryland, in rural Maryland, and it wasn't too far from Ku Klux Klan headquarters in Maryland. And talk about lack of diversity. It was in a very farm part of Maryland. Not a lot of diversity at all. I was their first black CNO. I felt that I had to really prove myself. That's where I got my first CNO job. And so I'm working with this group and I'm like, what can I do to make them listen to me because I'm sure they don't want to. They've never seen me before. Yeah, but that issue was in my head, and I worked myself out of that and said, everyone wants the same thing. Everyone wants to be cared for. Everyone wants to be seen, supported, and kept safe. That's what I'm going to focus on, and that's where it came from organically. So I did that, worked there, left there, was recruited to another facility, be a system CNO. And then I finished my doctorate, I did my study on power and influence, and then I felt then that something just triggered in me that I need to do something broader in the in the space of social change. And then the pandemic hit. I started to do some LLC-type of work. I started my own LLC, and then the pandemic hit, and I was like, what am I going to do? So, I took this clinical professional trauma course to help clinical professionals deal with trauma. And there was so much in there that resonated with me. So, that's how I gained some knowledge in this space. And then I joined ANA, we found each other at the right time, and then I was gifted this amazing program to lead, which is Healthy Nurse, Healthy Nation. The rest is history.

Dr. Renee Thompson:
Oh my gosh. Okay. I have to ask you a few things because you're talking and I'm like, that's a checkbox that's like it's really resonating with me. And I'm sure it's resonating with the people who are watching or listening. I keep going back to that suffering component. You know, where it's still happening today. We do a lot of work in maternal child health. So like the NICU, we see a lot of experienced nurses incredibly competent. And then you have these brand new nurses. And one of the primary issues that we see pretty consistently in the NICU is this divide between the newer and the older. We've heard it. They haven't suffered enough. You know, they need to earn the right to take care of these really sick babies, and God forbid a new nurse makes a mistake. You're done. And you're only going to get the growers and feeders, you know, at that point. And instead, why can't we look at that and says, oh my gosh, you're brand new here. Okay, look, I've been a nurse for a really long time. I'm going to help you. I'm going to do everything I can for you to take so that you can learn how to take the very best care of these babies to the point where, like I always say this, my goal is to help you to be a better nurse than me. Could you imagine if we had these expert nurses who said that to our new people? My goal is to help you to become a better nurse than me because I remember, you know, these new nurses, as you were saying, like the millennials will say, hey, when do we get a break? And the more experienced break. What do you mean break? Like I haven't taken a break, eat, or gone to the bathroom in 25 years. And I'm like, come on, we're our own worst enemy. But the fact that you were in this community hospital, as their first black CNO, I can only imagine. Did you feel that you had this added pressure to be like, fantastic. Did you feel that people were testing you, or kind of taking a step back and waiting to see what you would do?

Dr. Katie Boston-Leary:
All the time, and there were some dynamics there. You know, that I had to deal with. But, you know, I think it's part of my upbringing. You just got to keep rolling with the punches and moving. But I will say, even though there was pressure, don't get me wrong. And I remember I had to do a lot to prove myself to the CEO that, you know, I'm well qualified to be here even though. So I was promoted, I think, by pressure and by looking at the canvas and saying, who's the best person to be an interim? Who's the most educated? Which I was, because I've always felt that I had to get all lined up, all the degrees and staff, right? So, based on that, I think that's how I got into the interim role. And I don't believe it's my understanding that the goal was to eventually recruit. But I started to execute and I'm starting to get some good feedback where I was promoted. But there was some dynamics that I had to deal with from the CEO and from some of my peers, not so much from nurses. It was really more with some of my peers in the C-suite and the CEO. Eventually, that all dissipated, I think, because I remember we had an employee recognition event. I was supposed to give some written statements about my team that was being recognized, and I had sent it to his secretary, but his secretary forgot to send it to him, and he chose to embarrass me at the event where he said my name, and he said, could you stand up? And I stood up, and I'm like, what's going on? And my colleagues and my staff were like, my team was like, are you being recognized? We didn't know that you hit a milestone. And I said, I'm not. I don't know why he's asking me to stand up. And I stood up, and he said, Katie, I need you to tell me, share all the narratives about your team. And I said, I can pull it up on my phone. And I was clumsily trying to find it. And he said, well, actually, I did that because you never sent me the narratives that I asked you for. So next time I ask you for something, make sure you give it to me. This was just kidding. Yeah, this was a major event. Oh my gosh, for our organization. And he embarrassed me like that. And I was incensed. I was angry, I was getting text messages from a number of people, including my peers in the room, that he should not have done that to you. And then, lo and behold, just so happens we had a meeting, a C-suite meeting right afterwards, and the entire meeting went by and I said nothing to him, I was fuming. So right before the meeting concluded, I said to him in front of the other members of my colleagues in the C-suite, and I said, don't you ever do that to me again?

Dr. Renee Thompson:
Good for you.

Dr. Katie Boston-Leary:
I said, of all the things I said, did you know? I said, I saw, I made sure he knew that, you know, his admin didn't get it to him. I said, but regardless, let's say I forgot to get that to you. You have no right to embarrass me like that. But you know, what was interesting about that incident was my colleagues who had texted me, who said he shouldn't have done that to you when we were at this place now, where I was holding him to account. They were silent. None of them supported me in that room, so I. Yeah. So that's the allyship piece, right? Including the chief medical officer, who was black. The key thing for me, though, from that experience was bullying happens at every level. I saw it in my research and incivility. I saw it in my research because I think there's a perception that the higher up you go, the more we know better, and you don't. No, no, no. It happens at all levels. And in my research, I even had a story from a CNO who was being bullied by the CEO so much that she was losing her hair.

Dr. Renee Thompson:
Oh my gosh.

Dr. Katie Boston-Leary:
And they wouldn't act on it, right? Until he did something really egregious. And they finally removed him because of they couldn't hide him anymore. Yeah, where she was at the point she was losing her hair, her family told her she was under psychiatric care she would avoid. She would not sign up for projects because that he was involved in, because she knew that he was going to bully her. So, it happens in every level, and it happens in a number of different forms. Because going back to my time practicing, because you just hit the nail on the head, and I remember you made me think about my time, my entry into nursing. I started in a step-down NICU.

Dr. Renee Thompson:
Oh.

Dr. Katie Boston-Leary:
And yeah, and I wanted to be with the big girls and the big boys. And I wanted to be in the main NICU, and I could never get there. And I kept wondering, what would it take for me to get into where the incubators are, right? And with the little tiny ones, I want to be in there. And I couldn't get there to the point where I got frustrated and I knew I wanted to be a nurse anyway. So I said, well, I'll go to the OR. So that was that type of bullying where you're othered, and you're kept out of certain services. But in the OR, I was being bullied in a different way. It was, in some cases, physical, and in some cases, it was also from withholding information and withholding resources for you to do your job.

Dr. Renee Thompson:
Yeah, you got gatekeepers, you know, who control information and control other resources?

Dr. Katie Boston-Leary:
Absolutely.

Dr. Renee Thompson:
So, Katie, I don't know that I ever shared this with you, but we do a lot of consulting. We go into organizations. We're hip to hip with the leaders of physicians, the whole team. Our two most popular, I don't know that I would use that word, though, common service lines that we work with is maternal child health and surgical services. Oh, and that's what we see, like we do some work in emergency departments and occasionally an ICU or a med surg, but maternal child health and surgical services. And there are lots of reasons why those two service lines we see interesting, more disruptive behaviors. Maybe we could write an article about that next, Katie.

Dr. Katie Boston-Leary:
You know, you're onto something. No. So, I didn't know about that, with maternal and infant health. I did a short stint there because it would float us to that department if we had low volume in the step-down NICU, but OR for sure. And I would always I actually would say maybe it's because of all these walls that are up where people can hide.

Dr. Renee Thompson:
You in a room, no windows, and you're standing there for 8 to 10 hours with the same people. Yeah. Okay. So that's one of the dynamics. You do have this, and we talk about oppression, this hierarchy, and hierarchy. Yes, especially in surgical services. And then you've got these battles between anesthesia and this you know, surgical service, that one. But then what we find sometimes it's the text, the search text. Yes, depending on a variety of factors. But if they've been there for a long time, they rule the roost, and that conflict between them and the nurses. And so it's just a whole other world and surgical services. You're isolated from the rest of the hospital in many ways. And so however, just like maternal child health and surgical services, I've seen amazing teams, team members who it doesn't matter what role they have, they got each other's backs and they work really well together. It's important for me to remind myself too, because I deal with bad behavior every day of my life that there's still goodness out there. Yes. Yeah. However, we need to tackle the badness because of its impact on wellbeing. So, can you tell us a little bit about what the American Nurses Association is doing? Like what are some of the solutions that are out there right now to tackle this enormous problem that we're all facing in healthcare?

Dr. Katie Boston-Leary:
Yeah, so let me start with the most recent program that was launched by our credentialing entity, NCC. We have a well-being credential for institutions that just got launched, where you can understand just holistically, how an organization is fairing, similar to Magnet and Pathway to Excellence. This is another designation that's available to institutions to make sure that where you're working or where you're considering as an employer really is doing the work to care for you fully and wholly. So that's one big thing, and that's going to launch early next year. We're in the midst of piloting it, but we've done the press release and there was a recent webinar on it on LinkedIn, and we'll share the resources with everyone.

Dr. Renee Thompson:
Yeah, no, that's great. And actually, I attended the magnet conference and somebody actually mentioned it, but I haven't. I remember writing it down that I wanted to check it out because, again, anything that we can do to really hardwire a culture where people feel cared for. And that's one of the things that you said you love on your people and they feel cared for is critically important right now. So, I can't wait to learn more about this accreditation.

Dr. Katie Boston-Leary:
Yeah, yeah, I'm excited about it. And Healthy Nurse, Healthy Nation was a part of working on it with an NCC team, particularly the Pathway to Excellence Dean Christine Pacheco. So that's one that we're really excited about. And then we do have some focus on workplace violence with work that we do there. And we have a group that we've assembled from around the country. And I'm so proud to say this one member of our group, because we're trying to not be so insular as Is nurses and is a nursing organization. We have a retired FBI agent that's involved in this.

Dr. Renee Thompson:
No kidding.

Dr. Katie Boston-Leary:
Yes, that I used to work with. So a position statement is coming out relatively soon on workplace violence. But I'll admit that we're not focused heavily or enough on worker-to-worker violence. Yeah. So that's an opportunity for us. And years ago, we decided to pull it all under one. We used to have them separate, where we have workplace violence from outside in, and the bullying and incivility sitting somewhere else. And there was a collapsing, but with the collapsing, one took precedence over the other. So we're not focusing heavily on the bullying and incivility. So we're going to do that now.

Dr. Renee Thompson:
You know, I'm glad you brought that up because, you know, my lane where I focus is bullying and incivility coworker to coworker. Okay. Whether you've got a hierarchy in there, it doesn't matter if you work in healthcare. You know, you're our people. That's what we focus on. You know, bullying and incivility, but it does relate to patient and family abuse. Okay. And it really is under that umbrella. I always say now, workplace violence is an umbrella term that includes patient and family abuse, coworker to coworker bullying and incivility. All that verbal abuse that we know usually precedes, you know, physical and non-physical.

Dr. Katie Boston-Leary:
Yes, definitely sexual advance.

Dr. Renee Thompson:
All of that, all of that. It's all under that umbrella to the point where I was actually grateful. A couple of years ago, the Joint Commission reached out to ask me if I'd be on their Workplace Violence Task Force, specifically because of my focus on bullying and incivility. But the other people that were on this task force, they were FBI people. They were security. They were really focused on physical violence. And at least they recognized that. It's not all physical violence. It's the verbal, it's the bullying, it's the incivility. And so you're right, we've separated them in the past. But I think people are recognizing that they're still under the same umbrella of workplace violence, whether it's physical or some other, you know, verbal or sexual violence. So, yeah, I'm glad to hear that you're working on this.

Dr. Katie Boston-Leary:
Yeah, we are. So, a position statement is going to be presented to the board at the upcoming meeting. Not to say that we'll be ready after that because it may come back with some revisions. But we're proud of what this team has assembled. And we asked initially, like, how do we move the dial? Because we've been talking about this forever, and we're still here. And I know we have our data with one out of four nurses' experience, but we had data that showed that nurses are abused every two minutes or something like that. And and it's underreported. We all know that. Absolutely. So that's why we have to really make sure we and, of course, there's policy work involved too. And we know that there's the, again, the Save Act and a number of different bills that are being passed, but again, not enough focus on the harm within and the systems. And that's why I think it's so good that we have this article coming out in December in nursing management because it really illuminates kind of like that charity begins at home kind of thinking, let's start here, right? Let's take care of each other because that's the one. That's the harm we don't talk about and how it sets up some of the careers of nurses where they've never recovered because it just continues to happen. You leave one hospital, you go to another one, and when you go to another one and you experience the same thing and then you go, you know, where else is there for me? And some nurses leave healthcare, some we have, like the example I just gave you, there's some folks that give up completely because of what it does to them psychologically. So we have to fix this.

Dr. Renee Thompson:
We do. And you know, it's interesting. I had a conversation not too long ago with someone from a healthcare organization, and they were talking about really wanting to address workplace bullying and incivility. They were losing a lot of people because of it. And I always ask, well, what strategies have you tried or what strategies have you implemented so far? And she shared some things with me and then she said, we're really focused right now on policy and creating policies and making sure we have a policy about this. And I'm like, okay, policies are important, but policies don't solve problems. Yeah, people solve problems. So, how are we making sure that our people are equipped with the knowledge, skills, and tools that they need at 2:00 in the morning, when facing these issues, or when you have a brand new manager who's 25 years old and one of their most experienced, clinically excellent nurses, the physicians love is nasty to people? Like, how are we helping that brand new manager address those issues? Policies are great. They're a good start, but they're not the solution.

Dr. Katie Boston-Leary:
Oh, absolutely. And I also believe that as a leader goes, a team goes. I think that as nurse leaders, maybe, and again, this is, I'm not, hopefully, this is not taken as me generalizing. But I do think because of the culture, some of the cultural passages and what's been told to us over the years about how we got here is still setting up the rationalization of some of the behaviors that we see today, where they're being minimized or not being addressed really fully for sustained change. So I do think that there's work to do there to see where the leader is, to make sure that because, you know, we don't take care of patients, right? Leaders take care of people, take care of patients. So, but at the same time, there should be a focus on span of control, so leaders can be more involved and aware of what's going on and nip things on the bud before they happen. And there's some departments that are relatively easier than others. But I do think if you set the culture and make sure that people are held accountable when things happen and you know, I know there's this concept that what's zero tolerance mean? It means there's no room for you to say this behavior that I, this what an act that I did is not as bad as the other. Like we're not any level of it. Yeah. We're not going to have. And I think if we start to really think about that differently and also address the oppressive nature of how we that we operate within, and that's very important because this hierarchy, where it's this cultural haves and have nots, where nurses will see how certain things they're held accountable for, it doesn't happen on the physician side or in other departments. That disrupts and impacts what you may be trying to do with your team. There needs to be consistency. And I remember this is my, for example, and I have so many, but you would have a situation in the OR where the entire team probably acted out, right? It was a sewage tech. It was a nurse. It was a physician. It was a surgeon. It was the anesthesiologist. And then, when it comes to the investigation, everything else, you're probably going to suspend or discipline your staff. But the physician gets an arm over the shoulder, not even a slap on the wrist just to cut it out, kind of talk and nothing happens to them, right? That is disruptive stuff. And that doesn't help with what you're trying to maintain with this zero-tolerance mentality. And then sometimes when you're trying to intervene here with your team, to your point, with someone that probably acted inappropriately because of the relationships that that person has with a surgeon or someone that has some influence in the organization, your hands are tied. So these are all the things that we have to contend with, because this is why I believe we're still in this space, in this place where it's accepted behavior.

Dr. Renee Thompson:
It is, and you said it. It depends on, sometimes, who the person is. I always say, if we tolerate someone's justify somebody's bad behavior, sometimes based on the role that they have, the revenue that they're bringing in, how long they've been there, how competent they are. And when we go into organizations, and we are working with the nurses, they always say, what about the physicians? What about the providers? And so all the work that we do, it's the whole team. And those physicians are right there. And we actually won't do work in an organization, the consulting work that we do, unless we have the chief medical officer on board and whoever that medical director is for that service line. Because you're right, there's got to be some consistency when it comes to any type of disruptive behavior in the workplace.

Dr. Katie Boston-Leary:
Absolutely, and there was this thinking that we had that, you know, because a lot of organizations are going through this physician employment model. Yes. Where the physicians, then they'll be held accountable, and everything will fix itself. No, it gets worse in some cases.

Dr. Renee Thompson:
Yeah, it's a problem.

Dr. Katie Boston-Leary:
Yeah, exactly. So that's a fallacy. It's still, the problem is still the problem so because the hierarchical piece is still there about the power and influence.

Dr. Renee Thompson:
You're right. It is.

Dr. Katie Boston-Leary:
And it also feeds into the value of nursing discussions that we always have. Who brings more to the bottom line tangibly to organizations? And that's why one group gets this treatment, and the other one gets the other. And I do think that from top down, there has to be this understanding that this will not be tolerated, period. By anybody, by anyone.

Dr. Renee Thompson:
It doesn't matter who you are, how long you've been here, how much revenue you bring into the organization, how needed you are. That's right. Even if you're the most you know, I'm going back to nursing. Most clinically competent nurse in that department. Yeah. We need to be held, you know, responsible for your behavior. So, Katie, as we wrap up, if you have a nurse leader, because most of the people who listen to this are in a leadership role, healthcare leaders, and they recognize that there are issues in their department and their organization with well-being, and there's a lot of burnout. What would you recommend as sort of like a first step for them? What could they do?

Dr. Katie Boston-Leary:
The first thing is that I always say when it comes to, you know, because we have a word salad when it comes to wellbeing. And the other side of it, you know, burnout, stress injury, compassion fatigue, moral distress, it's a continuum. And I start with this. Let's start with the individual. We have to reckon with ourselves, the fact that we're not martyrs and we don't have to do it all. We need to put down the belief that we are rescuers of everything. And there's this video that I share about the top ten signs you're a rescuer. And one of them is even when there's a problem, you may find one because you need something to fix.

Dr. Renee Thompson:
I love it.

Dr. Katie Boston-Leary:
We need to put that aside, right? That's one thing that we need to recommend. And the importance of that is if you don't, it leaves you very little to take home and pour into other people because you can't pour from an empty cup and also receive love. So that's one. From a community perspective, I believe that well-being is a team sport, and sometimes, when you're starting to get back to that place because it's very easy for you to slip, right? You may have come up with a routine where you take care of yourself, and all of a sudden, you're back where you were. Yep, you need to have someone close to you, a loving critic that's going to tell you, right? Like, kind of like our mothers that would tell us when we're gaining weight. When our husband tells us that we look great. We need a colleague that's going to also tell us to tell you the truth that you need to just stop, right? There's a saying about how when you're in the bottle, you can't read your own label.

Dr. Renee Thompson:
Oh my gosh my business coach, he helped me through something that I was really struggling with. And he helped me to see things from a completely different perspective. And I was like, oh my God, you're so amazing. And he showed me this bottle of soda. He said, you can't read the label from the inside. That's why you need that outside perspective.

Dr. Katie Boston-Leary:
Absolutely.

Dr. Renee Thompson:
I love that.

Dr. Katie Boston-Leary:
Yeah, so you need someone to tell you you need to surround yourself with people that will be honest with you about when you're slipping because we all have a tendency to do that. And then, third, we have to have systems take this off, right? And take this on, not from a sampling of having just having different events, Walkathons, and Pedometers, and all the other stuff for wellbeing, but also look at how the setup in these institutions where we work are creating burnout as well. Yeah, where we need to do everything in our power to reduce workload cognitively, physically, psychologically, right? And mentally. We also need to do everything we can to make sure that we take off unnecessary tasks from nurses that tend to burden them because we need to be relentless in our pursuit to reverse course because we have unintentionally designed an environment where nurses spend less time with their patients.

Dr. Renee Thompson:
Yeah. And it's not sustainable. It's not.

Dr. Katie Boston-Leary:
And the less time you spend with your patients, the less joy you're going to have with what you do. The joy is in that human connection time.

Dr. Renee Thompson:
You are so right. Katie, I can't thank you enough for being a guest on this show and for all of the work that you've done and all of the work that you will continue to do to really create a loving, caring environment for not only nurses but for everybody who's working in healthcare. I'm so grateful to know you as a colleague, as a friend. I just, I'm so grateful for your work. And so. All right. If somebody wants to connect with you, what's the best way?

Dr. Katie Boston-Leary:
LinkedIn is the best way. That's the main connector. So please look me up on LinkedIn. I think it's going to be in the show notes. We'd love to connect and hear what everybody's doing so because we do policy work, especially with the National Academy of Medicine and all of that, so that is the main place to reach me. We also have some great programs HNHN.org, which is for Healthy Nurse, Healthy Nation. It's a free program, and this is where we establish a community where nurses educate each other and feed into each other on how to be well, how are you eating on night shifts, stuff like that, right? And then, of course, I work for the American Nurses Association. You can find me there as well on NursingWorld.org or ANA.org.

Dr. Renee Thompson:
We will put all of those links in the show notes. So, any of you who are listening or watching right now, just check out the show notes and you'll be able to connect with Katie and some of the other resources that she recommended. So I want to thank you, Katie, again for being a guest on the show, and thank you for your great work.

Dr. Katie Boston-Leary:
Thank you so much, and I appreciate you, Renee, and thank you so much. I'm really this was great. I appreciate you having me on your show.

Dr. Renee Thompson:
I appreciate you. So thank you for listening. Thank you for those of you who are watching right now and for all the great work that you're doing out there to create a loving and caring environment. And if you like this podcast, please make sure you rate it, review it, and share it with others. Thanks so much for being here. Take care.

Dr. 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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