This episode of Friends of Flo is brought to you by NCLEX mastery. If you're a nursing student and you're about to take your NCLEX, you need to go to the app store right now and download NCLEX mastery.
Tess:All right, so welcome back to another episode of Friends of Flo my name is Tess Judge-Ellis and I'm surrounded by my colleagues and friends and we have a guest today a special guest
Rebecca:Our special guest, oh I'm Rebecca Porter, and our special guest today is BJ Hannon.
Andrew:Hi, BJ.
BJ:Hi
Andrew:I'm Andrew Whitters by the way. Good to see you here.
Tess:And if you haven't listened to Friends of Flow, we are a podcast we are designed to empower nurses to be leaders and encourage them to be leaders in healthcare as we move towards true healthcare reform. Nurses are going to be the leaders and so having a voice is important
Rebecca:and we've been friends for, Tess and I have been friends for
Tess:20 plus years since we were baby nurse practitioners in the last century. And then of course Andrew and I have known each other for quite awhile.
Rebecca:And BJ and I have known each other for five or six years.
Tess:So what's the topic today, guys?
Rebecca:I think we're going to talk about intergenerational issues at work and BJ is our expert in this. So we were able to reach out to folks and ask questions about what they wanted to listen to and we found a lot of chatter online, didn't we? About, kind of nurses being mean or you know, maybe the issues related to intergenerational issues in nursing, you know. So you're a baby boomer, let's say you are born before 1965 and now all these millennials who were born in, let's see, 1995 are entering the workforce.
BJ:1980
Tess:Okay. Yeah, they were born in 80. And so BJ, you've done a lot of work on that.
Rebecca:What are generation x, I'm getting all confused. Define all the generations
BJ:I can do that for you. First of all, I just wanted to share why I am interested in this subject.
Rebecca:Yeah, start there.
BJ:It was fairly accidental actually, and about, I'd say 12, 13 years ago with our chief nursing officer we were looking at the demographics in our department of nursing and like a lot of institutions, we noticed that we had a large number of nurses who were in their early fifties and we were very concerned that if these older expert nurses suddenly decided to take early retirement and walk out of this hospital, we would have some issues with a lack of expertise and leadership. My job was to put together some focus groups with older nurses, 50 and older, bring them into these groups and basically asked them what can we do as an institution to keep you working longer
Andrew:And in what year was this? I mean just for context
BJ:That was about 12 years ago, I believe it was about 2003 or four that we were doing this and we were not unusual. There was just a large cohort of nurses and back then you know, people took early retirement.
Andrew:Right
BJ:57. We don't see that very much anymore, but anyway, I was fairly inexperienced with doing focus groups and I brought these older nurses in and ask them what we could do for them to keep them working longer and it took these nurses who I had for about 60 minutes. Let me tell ya, it took them about five minutes to tell me we do not want those high bar stools it's hard on our knees. We need more bathroom breaks in the OR because a lot of us are on hydrochlorothiazide, you know, we want larger fonts on the computer. All of those things. We do not want carpet because it's really hard to push carts across carpet. Well anyway, and I said, great anything else. Now understand I had them for 55 minutes. These nurses were in their fifties and they began to unload on a lot of new nurses saying, I'll tell you what's going to make me leave. Not the font and the computer, but all of these new young nurses
Rebecca:And what part of it?
Andrew:So yeah, what specifically?
BJ:A lot of it had to do with concerns about the art of nursing, meaning these were older nurses who felt that a lot of these young nurses we're only sort of technically oriented. They really did not understand much about comfort and how you really physically care for patients. That was one.
Rebecca:The hands on
BJ:Exactly
Tess:You know, they do nursing 101, but it's not stressed.
BJ:I remember one quote from a nurse, one of our older nurses who said, if I have two days off, I know when I come back, one of my patients that I had two days ago, nobody would've ever shaved them or cleaned their dentures
Tess:Or even like organized their bedside, right?
BJ:Exactly.
Tess:So Andrew, you're younger. I mean quite a bit younger than we are. Did you learn how to make an occupied bed?
Andrew:Oh yeah, that was part of the didactics. That was part of the didactics in the nursing program
Rebecca:Did you have a lab, like we had nursing labs
Andrew:Yes, indeed
Tess:But it's so high tech now
Andrew:I was just going to say, I think that, I do think that once I got into as a professional once I got licensed, I think as a new person, uh, there is this pressure that you feel to just update yourself with all of the technology that surrounds the care of a patient, there is sort of a hyperfocus on that perhaps versus doing some of the more remedial bedside routine stuff, which is obviously still important
BJ:Right, but the word remedial I think is
Rebecca:It's not remedial
Anrew:And it's not remedial you're right and I'm not defending any new nurses for a lack of shaving a patient or doing denture care or anything. But what I'm saying is I think that there is a pressure that young people might feel coming in, who are brand new nurses, coming into the profession that there's sort of an undue balanced between doing what a patient needs, which is the hands on care. And don't get me wrong. I think that patients do need hands on care, but there is this pressure
Tess:I hear you defending the nurses and I don't mind that at all, but it's honoring the intimate space
Andrew:Oh, absolutely
Tess:You know the relationship that goes into like the basic needs and I think it has to do with the expertise of the 50-somethings.
BJ:If I can comment here
Andrew:Please comment and I'm not defending it by the way
BJ:I think that we know that there is a very big body of evidence out there right now in the literature about something called missed nursing care. And one of the researchers who has researched this subject indicates that in modern nursing today we have some cares that are disappearing and missed. Number one in that is the bath. Number two is ambulation. Number three is nutrition. Number four is like oral care. Number five is night care. Remember when you put people to bed at night
Rebecca:We had a cart that we walked around with at night and we would backrub and foot care.
Tess:I don't think they teach back rubs anymore.
BJ:It's not just backrub it's make sure that they have their sleeping pill, that their room is...you soften the lighting. It's something that we used to call night cares, but the point of this is it's that this is something older nurses did because there was no one else to do this. There is among a lot of our new younger nurses an idea that this is not their job. This is the job because they are assessing and managing the patient care. The research is telling us that a lot of new young millennial nurses see these issues as the job of the nursing assistant. You know, we don't ambulate patients because that's the job of physical therapy.
Andrew:It's very laborious too
Tess:What you're talking about is the actions are laborious, but it's the...
Rebecca:It's that space of getting in with the patient and I can tell you from the times of the hundreds of bed baths that I gave patients over the years, the intimacy of that care of that time. The things I learned.
Tess:The assessment
Rebecca:The assessment, but it's also the time of having hands on, your wet hands on somebody's body and you're washing them and the intimacy of that and the things that patients will tell you
Tess:I was talking to my mom about this and she said, remember the days when...I mean I almost invited her to come here because she was just in town, but she taught nursing. She said remember the days you didn't have a stethoscope. You didn't have like the ability to take a blood pressure because she's, you know, an age. She's in her seventies and she said you walked in and you looked at the patient to see how they we're doing and that was it. You didn't go by the monitor, you didn't go by the blood pressure and the temperature. You say, how is the person doing? And some of that is learning their patterns on an intimate basis by walking with them. By looking at them. I mean anyway.
BJ:Well, I will say that there was, you might might believe this too Rebecca, there was a certain sense of pride as a nurse that my patient was sparkling clean and up in a chair and you know, their family was coming, right but you knew their family was coming in at 10, you know, in those days, in the ICU, Andrew, people, you know, we opened the ICU every two hours for 10 minutes for family and we would, you know, really buff and puff these patients, you know. But I think from a millennial standpoint, these are things that a lot of our young nurses feel are not
Rebecca:Are below them
BJ:I don't even know if it's below them. I think they prioritize...and the bath and things like that keep getting pushed down the list.
Andrew:Sure
BJ:One thing that concerns me because I do quality work and concerned about falls is you know it used to be if a physician ordered ambulating, TID, you ambulated that patient three TID. If you got busy and it was time to go home, you still ambulated that patient. That was an order. Today there is a lot of younger nurses who may not see the value in ambulating and if physical therapy is not there to ambulate their patient, it gets missed. It gets missed and not understanding that's the number one cause of deconditioning...
Rebecca:And pneumonia
BJ:And it may not seem like this big huge treatment. It's just walking your patient in the same way, turning, you know, turning your patient
Tess:Positioning's huge
BJ:Positioning. We don't do range of motion anymore.
Rebecca:Really? Oh my gosh
Andrew:So what you're speaking about is some degree of the hierarchy of needs of a patient that are arguably being missed. And so I just want to expand on that thought because I think you're right. I think there is a culture of missed cares and missed priorities. I see it outside of the hospital setting. Even in nursing homes where you have a geriatric population that is susceptible to bone demineralization, muscle weakness, pneumonia because of what you had just mentioned. Ambulation. Range of motion.
Rebecca:Socialization.
Andrew:Yeah, socialization
BJ:And to add to that Andrew
Andrew:Yes, please
BJ:Malnutrition, there's a lot of younger nurses that if there's not a nursing assistant or a family member around to feed this patient, you know in our world where you do all of this a la carte food, you may have these patients don't get fed.
Andrew:We're chewing on a big global subject here on terms of like what is being witnessed in nursing. So as someone who has been in the profession, as you previously mentioned, for decades, what is a solution that you might give to some new nurses, especially the new nurses that are coming in who might be a little timid, they might be shy and perhaps they might be concentrating too much on monitoring, you know, like on terms of like actual looking at the monitors, looking at, you know, just the numbers, lab work. What would you tell, what would you advise to a new nurse and then to also help mitigate that behavior while also catering to the needs of the...
Rebecca:That tension
Andy:Yeah, because I think there is an obvious tension.
BJ:Oh, I know there is a tension out there and I think one of the things that we have done in nursing is this compartmentalized care and there are on our units at our hospital are big med surge units. Clearly bathing patients is the job of a nursing assistant. It is in their job description. So if you do not have enough nursing assistance, the bath does not get done.
Rebecca:So I have to tell you the number of times I've been on units walking through. I frequently see RN's sitting at the desk and the nursing assistants are scurrying around like headless chickens and looking haggard and tired and worn. And it's not that these RN"s are busy doing data collection and checking data on a computer and looking at things. They're sitting there doing their nails, they're sitting there gossiping. They're on their cell phones looking at pictures of one another on facebook and instagram. And I just kind of seen it because I see this attitude that that's not my job, I don't do that
BJ:I have a little different viewpoint on that and that is having been a nurse for a long time and seeing computerized charting into our world and computerized documentation, it was going to save the nurse time. It was going to save the nurse a lot of times so that they could spend more time at the bedside. I will say that one of the biggest complaints from a lot of our nurses is the absolute time it takes to do computerized charting
Rebecca:Oh it's for everybody
BJ:It takes a long time. You know, when I was first a nurse, everything was on paper and we used to carry around little clipboards, right? And then you'd sit down and you would narrative chart and from your notes all day. But these nurses are documenting constantly in multiple sources. We know as someone who works with error and quality issues, we know that a huge amount of our errors come from failure to document or incorrect documentation. Here's a really unique example is that we had a patient who came into our emergency room and had what looked like a PICC line in their?...in there right brachial?. It had little pigtails on it, looked like a PICC line smelled like a PICC line. It was not a PICC line. It was a midline and somewhere along the way the ER nurse knew that, but she failed to document it in the record, so everybody lives off the documentation of the record. That's patient was transferred multiple units and everybody...
Andrew:With no confirmation
BJ:No and it was just. You read in the record it says it's a PICC and then the patient was ordered to be given Vancomycin through a central line. It was given through a midline because it was a failure to document correctly. People are so overburdened with documenting that we do a lot of this copy and paste forward.
Andrew:Yeah, absolutely
Speaker 3:If someone makes an error in copy and paste forward, it just gets continued and continued. So one of the problems is is that because of the burden of documentation, it is easier these days to copy and paste and assessment from someone else rather than do your own
Tess:Yeah, we do
BJ:And what happens is that in the original assessment, there's an error,
Tess:You're just saying this, and then reassessments not done
BJ:Exactly
Rebecca:So in my language in my storytelling way of doing things, I call that Chart Lore
Tess:Chart Lore. We're gonna hold off on that and re-pick up the chart lore.
Narrator:Here at NCLEX Mastery we love nurses and especially nursing students, but we need your feedback about this podcast. If you have ideas on topics or questions you want us to answer, shoot us a message, leave a comment, go to our Facebook page and just tell us what you think because we want to help you in the most specific way that you need that help. Thank you so much.
Tess:So now we're back again with and I'm Tess Judge-Ellis
Rebecca:And I'm Rebecca Porter
Andrew:And I'm Andrew Whitters
Tess:And you're joining us for Friends of Flo
Rebecca:With our guest
Tess:And we do have a guest
Andrew:With our wonderful guest
BJ:So I wanted to go back to the original thought was I brought in all these older nurses and this was their complaint was this lack of art of nursing. So I listened and there were lots of other concerns. One of them had to do with younger nurses and scheduling work life balance kind of this, what do you mean I have to work these hours? What do you mean? Oh, I don't think I want to do this. And then there is these older nurses also. I'm pulling off the themes here. So it bothered them that they appeared not to be willing to do, you know, schedules that they used to have to do. And I do know from generation to generation, there is this passing on of suffering in nursing, right? I worked 10 years of straight nights you have to work 10. So there was that complaint and another complaint was this desire to not be a bedside nurse? Well, I really don't need to learn that because I'm not going to be, I'm going to be a nurse practitioner, I'm going to be a nurse anesthetist, so I really don't need to learn this. So these were kind of the big three themes from older nurses, you know, lack of flexibility in scheduling, complaints, work-life balance. My home life is way more important than, you know, the schedule I'm working, which of course to baby boomers was not. It was unheard of and the other was this, I really don't want to be at the bedside very long so I'm not going to really invest a lot of time. So when I did a theme analysis of this and got leadership together, we immediately understood that we needed to talk to younger nurses. So I put together five focus groups of nurses between the ages of 22 and 25 to ask them, you know, how they perceive the workplace. What I got from a lot of the younger nurses was we feel bullied, harassment. They meaning the old, they're not nice. They won't help me. They don't understand that I need, that I'm not ready to come off of orientation that I need a few more weeks or months. They give me jobs that I'm clearly not ready to take on. All of this, and from my standpoint, having conducted these focus groups, I looked at all this talk to our chief nursing officer and said, there is something going on here. Definitely, not that I thought that we all come to work every day holding hands, singing Kumbaya together, right? However, I think I was unprepared and our chief nursing officer was unprepared for the level of this little bubbling turmoil under the surface that was clearly generationally based. That was the source of it. It was a very different viewpoint about nursing coming from a very different perspective and I struggled and struggled with the profession of nursing, trying to find webinars, information, conferences on intergenerational conflict, specifically in nursing. Now, I will tell you, I have learned oodles and oodles of information from the business world and in fact most of the conferences and webinars that I have listened to come out of business and industry not nursing.
Tess:So what have we got out of all this then, and how do you think we ought to move forward?
Andrew:Yeah, how do we mitigate all this tension?
BJ:Well, one thing that people in my opinion have to do is understand that we are all the products of the times in which we grow up
Rebecca:And the places that were from
BJ:And come to maturity. Different times, different influences, all kinds of things make us very different.
Tess:So talk about the influences from like the older gen or you can finish your thought....
BJ:Well my thought really is that this blame has got to be removed. You know baby boomers tend to blame millennials and say they have no work ethic. That is not true. You know, when I look at our young millennials, they are bright, they are well educated, they are energetic, visionary, they are massively IT able. They are great workers.
Rebecca:And I see them as caring people, too.
BJ:They are. However, in looking at the literature and the research out there and the work that I have been involved in, there's a little bit of a caveat here with millennials that there is a little bit of need that this needs to work for me. As long as this is a job that works for me, that you know, it's going to bring me what I need, you know, they're very willing to work, but models from business and industry tell us that this is a generation that needs a lot of reward and recognition. They need to...they are the trophy generation. You know, it is interesting when you look at millennials, they are the children of the hardest working generation in history. The baby boomers, workaholic, workaholic, work, work, work,
Rebecca:Everything for work
Tess:Well I can do anything, I can raise a family
BJ:Exactly
Tess:I can be this way and...
BJ:The best nurse ever. But they did not raise their millennial children with the same values. And it's problematic because baby boomers who get very upset at some of the behavior of millennials, which is pretty much, why I don't think I want to do that. Well, I'll just quit and try something else now. Yeah, I'll go to grad, oh, I'll just do a different.
Rebecca:I'll go to a different place to work
BJ:A lot of this"quit" behavior. You know, baby boomers never quit. Why didn't we quit, you guys?
Rebecca:Why are we at the same place for decades
BJ:Because the whole baby boomer system of seniority, if you quit, you lost your place in line. And besides the fact, I think a lot of baby boomers were brought up in an environment where there was a stigma about quitting, but we have a lot of millennials who, a lot of their behavior, I am sorry to say, is from their baby boomer parents.
Rebecca:So what do we do, what advice do we give...to the millenials who are listening to us and the boomers that are listening.
BJ:For boomers my message is at some point baby boomers, you need to stop helicopter, helicopter, hover, hover fixing, you know, making things all work, you know, for your young millennials, this is a habit of baby boomers, is that we tended to get in there for our children and there is nothing wrong with parents who want a better life for their children. I am going to do everything for my child. I'm going to make sure that they have all the advantages and resources and positive reinforcement everything I can do. So the boomers really have to stop interfering.
Tess:How does that work in the workplace?
Andrew:And especially in a culture where it has to be patient centered? And at times it might be even rescuing a patient in clinical situations, so, that's a...
Tess:Even just getting along so there's not so much of that, you know, because you can't rescue a patient if your team is not effective.
Andrew:Exactly. Yeah, sure. Absolutely.
Tess:And if you've got this kind of tension
BJ:And harassment and bullying and prove yourself and show me...our suggestion at our hospital we had no idea that there on some of our units you guys, there was a culture of bullying and harassment. Proving yourself. When we created our Grad nurse residency program was our first chance to really talk to these new young nurses and say, how's it going on the floor? I think we had an idea when we started seeing lots of contract transfers. Why do all these new young nurses want off this floor. We went in there and did a lot of work and looked at their culture. It was nursing leadership and we really, I will say that we offered early retirement to some of the older nurses who were doing this"nurses eat their young" kind of stuff. That has to be rooted out and number one...and you need to stay on top of, you know, the days of of ignoring stuff on the floor. We realize that conflict among nurses impacts patients and we did a lot of work, me personally with lots and lots of group dynamics on the unit.
Tess:It sounds like you also had your CNO onboard.
BJ:Absolutely, absolutely
Tess:Managers had to call it what it was.
BJ:Absolutely
Tess:And recognize how it was impacting...
BJ:I will tell you we needed the cno because absolutely some of our very old baby boomer nurse managers had to go.
Rebecca:They had to go
BJ:They had to go and it is difficult for baby boomers who grew up in this seniority tenured system to tell this nurse who's been working 34 years and as the manager that we can't let you do this anymore. So from a millennial standpoint, this is difficult. First of all, I just want to touch again on this blame idea. You know that boomers blame millennials for what they consider a poor work ethic. You, which is not a poor work ethic, but if you google poor work ethic and millennials, you will look at article and article that they don't want to work, you know, they see this, um, complaint about scheduling or there is a phenomenon in nursing, which I'm sure Rebecca and Tess don't ever remember. People worked full time. Maybe you knew somebody who worked half time, but this.6,.7,.9,.95,.4 and they change all the time. You know, I'm going to work for a while and...
Tess:I can't imagine being a manager nowadays
BJ:.9 and two months later I'm going to go back to school and they need to go.7. Well anyway, this millennials I think need to understand that this is a team. This is not just you out there and when I work with young millennials in the Grad nurse residency program, they tend to want to say, this doesn't work for me and you need to really redirect the millennials back to this is for the patients here.
Rebecca:It's called continuity of care
BJ:This is, if you are going to do this job, we're asking you to focus on this job. I get that you're on the five year plan to get your DNP, you know, but right now you need to really focus.
Tess:Socialize them, back to the team
BJ:One of the things that we see in new young nurses is they are afraid to admit that they may not know something. We are trying to create a culture which you need to do, that it's okay to say, I don't know how to do this you know, you do. But you know, coming from a culture where nurses continually had to prove themselves, prove themselves, prove themselves, nurses eat your young to figure out how to do it. We need to make sure that baby boomers understand
Rebecca:Well we were all new once.
BJ:Exactly. And the complexity of nursing care today is of course different than it was for me in 1973. In 1973 I had to learn five antibiotics. There's a gazillion you know, we have to understand that they are not us, that we cannot...here was kinda this thing with baby boomers, how do you get a good nurse? How do you get a good nurse, put em' on the night shift with 30 patients and one nursing assistant. Golly, they'll be a nurse.
Rebecca:That's what I did.
BJ:Nurses eat their...we cannot do that.
:So I'm just going to circle back and just say that, you know, it sounds like you guys have recognized the issue through the focus groups and listening. Right? And then you've created some, you've had to acknowledge it from a manager's standpoint, call it what it is, weed out the bullying people and the leaders that were bullied. You needed support from your CNO and then you've addressed the culture and the team environment and changed the young millennials kind of perspective.
BJ:Right? I would add to that we, it's not all about the millennials. We do understand, totally, that one thing that creates another bit of conflict on the floor are the older nurses who you guys kind of did the baby boomer mantra, which was stay the course, pay your dues. Eventually you will be rewarded. What's happened is that there are a lot of nurse managers out there who are fearful that these young millennials, they're going to quit. So they....
Rebecca:Overcompensate
BJ:Tend to overcompensate and give them the hours they want. And who loses out here, Rebecca? Who loses out?
Rebecca:The boomers
BJ:The boomers who are saying, wait a minute.
Rebecca:I've been doing during my time here...
BJ:Right and there needs to be a balance and nurse managers or whoever's doing the scheduling needs to understand that millennials can't have it all. That we really need to support our older baby boomer nurses who are feeling a bit left out in this fear that we're gonna lose the millennials...
Tess:It's also like...what I've noticed because they aren't more of a gen x person and so it's a...what I've noticed is that everybody gets an opportunity to shine and if you're going to ignore the gen xers and the younger baby boomers who are still in the workforce, then you have to recognize the merits of everybody and the strengths of everybody. And find a way for everyone to shine on the team and then like of course the millennials are very important and also so is the other folks on the team and getting that really takes your strongest nurse managers...
BJ:It does
Rebecca:To create that atmosphere of inclusion and respect and taking the time to acknowledge, like you said, Tess of everybody has someting to offer.
Tess:Everybody gets a trophy
BJ:(laughs) That's a good point
Tess:Like sometimes it's a self-determined trophy. What do you want your trophy to be right now? Do you want your trophy to be the fact that I can count on you every time? And so, you know what I'm saying? Like that work ethic I can count on you. And so how are we going to reward that either monetarily or with scheduling or is it going to be the like, I'm on this committee thing and, or is it recognizing that, you know, what I noticed that you always have done this with a patient, you know, that kind of...that's a great. Like, that's almost like doing rounds, right? You know what I'm saying? And being onstage with patient care, right.
Andrew:I think you're bringing up some really reasonable social expectations from both the millennial and the baby boomer generations and I'm using those labels generally. But on a positive note in your experience, BjJ could you tell us what a more experienced older nurse might learn from a younger nurse and vice versa. What a younger nurse can learn from an older nurse, just on a positive note...
BJ:On a positive note, I just will tell you from my own experience is that most baby boomers like me are self taught for IT for instance. And I, as a quality person, I managed some pretty big databases, access, things like that I had to learn. I absolutely just crave help from some of our younger quality people. On the other hand, and they helped me and I am not embarrassed to ask or anything like that
Andrew:Well none of us should be as nurses
BJ:And I think the value of learning from them. We have, this is very, very interesting. We have these bright young millennial nurses who are all about creating apps, you know, all of our nurses carry neutered iphones, the volt phones, they are neutered iphones, but they have the ability to put, well you can't get on the net on them, but they have the ability to be loaded with apps and we have such tremendous ideas from our young millennial nurses on doing an app. Then we have older nurses who are anti-app, but then they see the value and are like...
Rebecca:Show me that.
BJ:And then all of a sudden our older nurses are like, way, this is really cool.
Tess:So you can observe that
BJ:Oh, I see that a lot and we celebrate that and one of the things that we do is we do a lot of recognition. We encourage poster presentations. Here's my app, here's what I want to do. We have a lot of, um, we have a nursing quality forum which is once a month and every single unit in our hospital has to present a quality project twice a year. And we are encouraging our young millennial nurses to get involved and do these projects and when it seems to me, when we have a bright new young nurse doing a project, they're phenomenal. I mean, how do we count those sponges in the OR you know, I've got a way to figure this out, how we can do this. And a lot of it involves technology, so that is what baby boomers need to help. Baby boomer nurses who struggle with epic documentation, you know, just ask one of the new young nurses.
Rebecca:One of the native users
BJ:Exactly. However, on the other hand, you know, especially when I work with the new young Grad residents, you need to really help them understand the wealth of expertise of the older nurses. The older nurses, you know and creating. Now that we have weeded out a lot of older nurses who kind of weren't into that, I'm going to help you. The stories, we do stories all the time. We do in our grand rounds, we do nursing stories and the kinds of things...
Tess:We need to tell our stories
BJ:That older nurses can do. What I hear from younger nurses a lot is, oh my gosh, you know, I work with Loretta. She's unbelievable.
Rebecca:All that she knows
BJ:She knows. Here's what she knows. She knows how to get what she wants. She knows how to go around, under, over, behind all of this stuff and get what we need. So if you can create, it takes a remarkable nurse manager, assistant nurse manager who can really bring your generations together. The worst thing in my opinion, a nurse manager could do is do clicks scheduling. By that I mean letting all of your older nurses work weekend option nights, right?
Andrew:I see.
BJ:Or letting all the new young millennial nurses work seven to seven or three to...you have to be really careful and you need to really make sure that you are mixing nurses. No matter how much all of the generation x nurses want to work weekend option nights together. That creates already from the get-go, it creates an us them. And then when a new young nurse gets put on that weekend there, the conflict, you can just see it. The clique stuff begins. So I believe we, yes, we let people do self scheduling. How's that for a baby boomer? What do you think Rebecca?
Rebecca:I wouldn't know where to start
Andrew:Have you found teambuilding...
Tess:We're at a good spot to take a break here because we just started. We're talking really into the intergenerational and going into solutions. So we'll take a quick break and we'll be back
Narrator:Here at NCLEX Mastery we love nurses and especially nursing students, but we need your feedback about this podcast. If you have ideas on topics or questions you want us to answer, shoot us a message, leave a comment, go to our Facebook page and just tell us what you think because we want to help you in the most specific way that you need that help. Thank you so much.
Tess:And we're back now. Friends of Flo. This is Tess Judge-Ellis
Rebecca:And I'm Rebecca Porter.
Andrew:This is Andrew Whitters
Rebecca:And we have our friend, BJ Hannon as our guest today
Tess:We've been having a good time talking about intergenerational related issues and conflicts, socializing nurses. And so we had just asked BJ to, and we were talking about teams and really the qualities and characteristics of what she's seen in really successful teams
Rebecca:Or a unit
Tess:Or units that are really successful in the and even like, you know, literature that supports this kind of stuff, you know, outcomes and those sorts of things. So take it from here.
BJ:So I was going to detail one of our units that has been very, very successful in team building. I would say when I look at their nursing satisfaction data, it's a very high functioning unit. High satisfaction, fairly low turnover. Oh yes, we survey every year. It's a massive survey.
Rebecca:What makes their unit, what's their leadership like?
BJ:This is interesting, the manager of this unit is a generation x. These are workers in their forties. So this manager is neither a millennial and not a baby boomer, which is helpful. She does have two young millennial assistant nurse managers. But the culture on this unit was when she took over, fairly uncomfortable, high turnover rate, and she did a lot of team building from a multigenerational nurse force, older nurses.
Rebecca:What did she do?
BJ:What she did is first of all did a lot of interaction, meaning every, not just huddles, but a one hour every week, let's talk about our issues. And she was very willing to put every issue on the table.
Tess:Very confident
BJ:Very confident. And she was, I think because she was generation x, she was not there. A lot of the younger nurses thought, they're older. The nurse that was their nurse manager before was a boomer, of course, and always sided with the boomer nurses. So from the get go she was determined to stop this, you know, sides and cliques and all this. And she let the older nurses talk about their experiences. I was asked to come up and do this little talk and it started the conversation and there were a lot of young millennial nurses who did not understand that older nurse that they didn't really pay much attention to had been working for 35 years. You know, had worked 20 out of the last...
Rebecca:Which is more than their lifetime
BJ:You know, 30 Christmases who really had worked hard and they never really stopped thinking about themselves long enough to think about it was Clark and how long he had been there and suddenly the nurse manager, the nurse manager instead of doing the hours herself or having an A&M do the hours. They created a staffing committee to do the hours and the scheduling and they had people who work nights, people from each generation who had to work together to do nights and actually this committee which had a lot of younger millennial nurses thought, and this is unbelievable, that some of these older nurses who had been there for 30 years maybe should only have to work every third weekend.
Tess:So they came up with solutions.
BJ:They came up with solutions. The older nurses were so grateful that the younger nurses really cared that they had had given so much to this. Then turned around and said things like, you know what? If you do need a day off, I will do it for...
Tess:Of course
BJ:It was an instead of being....
Rebecca:An us and them
BJ:So they also, this nurse manager is extremely good at critical conversations. Her ability to not let anything go and to bring everybody together to talk about it. They all have on this unit, they all share bathing. This is really interesting because they have a volt phone and so what they do at 2:00 in the afternoon as they volt everybody and say, are all the baths done? If you need help, they put together every day a little bath team, which is a nurse, a RN, and a nursing assistant. If you can't get, Andrew, your patient bathed because you're so busy doing other things, they come in and bathe your patient.
Rebecca:No kidding
BJ:No kidding. That is this kind of a unit and they have high satisfaction and it is simply because they talk. Now I will say that if you talk to the nurse manager, it was very difficult for her to get a lot of her new millennial nurses to talk face to face. They would rather text everything you know, but they are learning and learning and you can go up onto this particular unit and you just feel. You just feel this team work, you know, and with their patient population, they need to get everybody up and they just sort of all do it together.
Andrew:So the skill that, if we could label that as a skill perhaps for especially the new nurses that are listening that takes a degree of emotional maturity to talk about.
Rebecca:Investment
Andrew:Yeah. To talk about issues that might make you feel sad, angry. Especially in the context of a unit where you feel like you might be treated unfairly, to open that up and discuss.
Tess:They have to feel safe
Andrew:Yeah
Tess:And the manager has to feel safe from the aboves, from the physicians for that. They're protected too because if you're going to try something different than you have to have some of that authority too.
BJ:If you talk to this nurse manager, it was very difficult getting it going. And she said we would have, you know, everybody would be sitting around this table and nobody would say anything. And she said, now people are very willing. They also have a system of recognition up there. And they have these little cards with smiley faces on them and they hand them out to each other. You did a great job...
Tess:I noticed you, I noticed that you did that
BJ:And they're really cool and they say one of the things that their cards is saw you do that. Caught you doing it, caught you doing a good thing caught you caring. And it's taken a while. but it really takes an extraordinary nurse manager for sure. And one of the things about nurse managers is that, you know, an assistant nurse managers is that we do not train them. All of a sudden there a staff nurse and the next day, hey we need to be an A&M and we don't train them.
Tess:And I think nurse managers in my opinion, are the most important person on the team because they take the crappola that...
Rebecca:From above and below
Tess:And the crappola from below, they translate the mandates from the head shed down to the team. They translate the crap that's from the rabble. The staff up to the head shed. And they stick up for people and they take stuff that they're never...
Rebecca:Their demands for datakeeping and you've got to do this and you've gotta do this and Jayco is coming...other spy agencues coming and the data that they have to keep it is just...
Tess:It's crazy. What I see that the nurse manager has done is said is empowered her staff empowered by saying, you know, you guys have within you the solutions. And so consequently, probably she's, she's set the culture.
Rebecca:So I have a question for new nurses. How do you interview for a job? What do you ask?
Tess:That's a good question, to assess the culture and assess the leadership? Yeah.
Rebecca:Well what were you going to ask of your nurse manager? They are going to ask you lots of questions, but what could, what could we need to advise new nurses to ask about their ethical climate at work? How do you address that?
BJ:Well, I would flat out say help them say that. And I would get to...I will say that at our hospital, nurse managers interview new nurses always with one or two staff nurses. This is the new pattern. It's a term and one of the things that I don't talk to the recruitees, but one of the things that I know a lot of our nurse managers always ask is, you know, give me your definition of team. What is team? Lot of millennials have difficulty articulating that. So one of the things that millennials should ask is, tell me about the team up here.
Andrew:That's a great way to phrase it
BJ:I would, if I was coming onto a unit, I would want to know who does the scheduling. That gives me an idea whether it's very maternalistic, one person does it or whether this is a team and a group and you know, that kind of thing.
Rebecca:I would ask questions like how a conflict, how do you, how are conflicts held? How do you handle that?
BJ:That's a really good question
Rebecca:How do you handle that here? And the other one would be who are you looking for? What are the characteristics of your best nurses here? Just to make sure that I have attributes too that this is a good fit for me. Not that I'm just a good fit for you, but I'm not just a warm body on your shift.
BJ:I, as a new nurse, I would want to know how they did orientation, how they choose preceptors,
Rebecca:Oh, that's a big one
BJ:You know, all that kind of stuff. Because we fail to really understand how fearful new millennial nurses are, how inadequate they feel from there. We need to really support them. And this old baby boomer thing of, you know, it's up to you to learn the job. You know, we really need to work with our new millennial nurses and we have this yearlong Grad residency program in one thing that they're really focused on is help me, you know, I'm scared and we fail to understand how scary this is for a new nurse.
Rebecca:Well I was pretty scared in my first job in 1977,
BJ:But nobody really supported you, did they? No, and one of the reasons, another thing that we do in the hospitals, you really, really need HR to really drill down and find out why people are leaving.
Tess:Yeah. And it's interesting because we started on that, what was it, the missed cares and the basics. And so that seems like it might be a good place to end this time on and how you see that in a exemplary unit in the way you described how there was a bath team who said that's important and ambulation team that said that was important. So getting back to those basic nursing cares
BJ:And it is a team approach. They use their phone, they use this as very high tech. They use this phone...
Tess:It goes around their neck or something, right?
BJ:No, it looks just like an iphone. It's an iphone and they use it for all kinds of things. There's an assistant nurse manager on one of the units who is presenting a nursing quality forum and they are very concerned about this deconditioning of their patients. And he sends, he's a really bright, young, I hope he stays kind of nurse and he sent out these mass texts that say things like move it, move it. And what that means is, did you move your patient, get them, turned them, you know,
Tess:Range of motion
BJ:You know all of a sudden they get a little ding on their phone. It says move it, move it.
Tess:So that's the leadership that we're getting from millennials, you know, and it's good and you can only do that when you have a good team.
BJ:Right. And move it, move it. They, you know, make sure that maybe you're not getting your patient up and ambulating then because you can't by yourself and you're scared to ask that nursing assistant because that nursing assistant, as Rebecca said, is harried and frayed and you know, you have to be able to quickly text on your phone, help room 2120 or whatever, you know, need help. If we can help millennials understand it is better to bug people for help, then do it because you can't do it by yourself.
Rebecca:And tell the boomer it's okay to be asked for help. And it's not a judgmental thing
BJ:Most baby boomer nurses to want to help you know, but feel you know, this strange dynamic of millennials that I don't want her to see that I need help. No, it's all about the patient. Right?
Tess:I love that. And then what a great way to kind of end our time. It is all about the patient, you know, and building teams and that's where nursing leadership gets into the mix. And then you guys have any closing things to say or just our usual send off.
Rebecca:I just think it's really important to remember why we're all there. One of the favorite things you don't have to do is when I'm with a group is say, why are you a nurse? And so that's what I would end with, so why are you a nurse?
Tess:And keep your eye on the patient
Andrew:Andrew Whitters here telling you to innovate, agitate, and educate.
BJ:Backing up what Andrew said, I think it is very, very exciting to me as an old baby boomer nurse that these millennials are going to come in here and I think change nursing
Tess:Change healthcare
BJ:We may not recognize bedside patient care in a few years, but it has to be the millennials and hang in there. Don't give up. Please don't quit
Tess:And don't just all go in to be a nurse practitioner.
Rebecca:Stay at the bedside we need you. We need you.
Tess:All right. This is Friends of Flo signing off.
Rebecca:Take care everyone.
Narrator:Friends of Flo is brought to you by NCLEX Mastery go to the app store right now, download NCLEX mastery. And before you leave, if you could just share this with your nursing friends, tell them about us. Leave us feedback, go to our facebook page, tell us what you liked, tell us what you didn't love so much, be nice; but thank you so much. We really appreciate you.