Nurse Leader, Educator, and Advocate, Randy Morris

Today’s guest, Randy Morris, is a dynamic leader in the world of nursing, education, and patient advocacy. You may know him on social media as @Dr. Nurse Randy, but behind the title is a highly accomplished clinician and strategist with a bold mission.

He is the CEO of Prism Care Advocates, a board-certified healthcare leader, nurse manager, professional development educator, and nursing practice expert. His mentoring and coaching empower nurses to work at the top of their license and lead their own practice.

His expertise in policy writing, quality assurance, and education has improved outcomes and transformed care delivery in real, measurable ways. And through his private consulting practice—as a board-certified patient advocate, legal nurse consultant, and nursing practice consultant—he helps patients navigate complex systems, supports clinicians in growing professionally, and partners with organizations to meet compliance and quality goals.

Randy is proof that when nurses step into their power, systems change, outcomes improve, and leadership gets redefined. Whether he’s mentoring professionals, writing policies, or speaking truth online, he’s raising the bar for what nursing can and should be. 

In the five-minute snippet: Let’s just give thanks for kindergarten teachers everywhere. For Randy's bio, visit my website (link below).

Contact The Conversing Nurse podcast
Instagram: https://www.instagram.com/theconversingnursepodcast/
Website: https://theconversingnursepodcast.com
Your review is so important to this Indie podcaster! You can leave one here! https://theconversingnursepodcast.com/leave-me-a-review
Would you like to be a guest on my podcast? Pitch me! https://theconversingnursepodcast.com/intake-form
Check out my guests' book recommendations! https://bookshop.org/shop/theconversingnursepodcast

I've partnered with RNegade.pro! You can earn CE's just by listening to my podcast episodes! Check out my CE library here: https://rnegade.thinkific.com/collections/conversing-nurse-podcast

Thanks for listening!

Transcript

[00:00] Michelle: Today's guest, Randy Morris is a dynamic leader in the world of nursing education and patient advocacy.

[00:09] You may know him on social media as Dr. Nurse Randy, but behind the title is a highly accomplished clinician and strategist with a bold mission.

[00:19] Randy is the CEO of Prism Care Advocates and Consulting,

[00:25] a board certified healthcare leader,

[00:27] nurse manager, professional development educator, and nursing practice expert.

[00:33] His mentoring and coaching empower nurses to work at the top of their license and lead their own practice.

[00:40] His expertise in policy writing,

[00:43] quality assurance and education has improved outcomes and transformed care delivery in real, measurable ways. And you'll love hearing how he did this. Through his private consulting practice, as a board certified patient advocate, legal nurse consultant, and nursing practice consultant,

[01:02] he helps patients navigate complex systems,

[01:06] supports clinicians in growing professionally,

[01:09] and partners with organizations to meet compliance and quality goals.

[01:14] Randy is proof that when nurses step into their power,

[01:19] systems change,

[01:20] outcomes improve, and leadership gets redefined.

[01:25] Whether he's mentoring professionals, writing policies, or speaking truth online,

[01:31] he's raising the bar for what nursing can and should be.

[01:36] In the five minute snippet:

[01:38] let's just give thanks for kindergarten teachers everywhere.

[01:42] Here is Randy Morris.

[01:58] Well, good morning, Randy. Welcome to the podcast.

[02:01] Randy: Good morning. Thank you for having me. Good to be here.

[02:04] Michelle: You know, I'm so happy you're here too.

[02:06] I met you on Instagram.

[02:08] Your feed came across mine and I was like, oh, my goodness, who is this?

[02:14] He's very interesting. He's very intelligent,

[02:17] he's very well spoken,

[02:20] and he speaks to nurses.

[02:22] Randy: Wow, let me Venmo you now. I'm Venmo you now.

[02:28] Michelle: Anybody who speaks to nurses is like number one in my book. So I watched you for a while and then I reached out and. And you said yes, and I appreciate it.

[02:39] Randy: Oh, well, thank you.

[02:40] Michelle: So we're just gonna.

[02:41] Yeah, we're just gonna launch right into it.

[02:44] So I'd love to start with your journey.

[02:46] How did you evolve from bedside nurse to thought leader,

[02:52] CEO and digital educator?

[02:55] How'd that come about?

[02:56] Randy: Wow. Yeah.

[02:58] Well, thanks for asking and thanks for the compliments. I appreciate that.

[03:01] You know, my journey into healthcare and into nursing was

[03:05] I don't know if it's unique,

[03:06] but I'll tell you my story.

[03:09] I definitely,

[03:10] when I was a younger person, I didn't really have aspirations to enter into healthcare. It wasn't really anything on my radar,

[03:18] but I had some very poignant experiences when I was in college and I was with a work group going down to Central America doing,

[03:31] doing trips with medical teams. And we were also rebuilding villages in the jungles where the Mayan Indians were having problems,

[03:42] from the hurricanes.

[03:45] So we went down there with a team to help kind of rebuild and then we would take a medical team with us that would help deliver aid.

[03:52] And while I was there,

[03:54] God, I was probably just a little young, 18, 19 year old buck.

[03:58] I ended up becoming very inspired by seeing the real humanitarian work that the caregivers were delivering to these Mayan Indians living in the jungle.

[04:10] And it was really one person in particular,

[04:15] she was a nurse practitioner and she was really helping this family that had, you know, her, this little daughter had dysentery and her husband, who was the income earner of their family,

[04:28] he would bring crops home from their fields on the side of this mountain.

[04:34] And he had recently fallen off this camel of sorts, this donkey or whatever it was,

[04:40] injured himself and was not able to work and make money.

[04:43] So he was at home injured and he had a wound on his hand and he couldn't work. And she had a sick daughter and they had no means and you know, I couldn't do anything for them.

[04:55] And so I saw this medical team,

[04:59] particularly this nurse practitioner and they were able to give this like, care and really connect with them in a real human way.

[05:08] And I knew then in that moment that I was going into healthcare, that I wanted to be a nurse.

[05:15] So I came back to the States and I went right back into my local, you know, first community college to take my AMP courses and then segued right into a BSN program.

[05:28] And then, yeah, got into the nursing profession and tried to find my bearings.

[05:34] Got into,

[05:35] I primarily went into the perioperative perianesthesia specialty. That's where I landed.

[05:41] And it wasn't very long before I actually was in leadership. I think I got promoted to a nurse manager position probably a little prematurely, but maybe it's a testament to, to my clinical acumen and my astute leadership skills.

[05:57] I don't know,

[05:59] but probably. But I ended up getting promoted only after maybe two or three years of actual like bedside care.

[06:08] But don't get me wrong, when I got actually promoted into a nurse manager position, I was also in one of these smaller facilities.

[06:14] So I still had to work as a staff nurse. I was the,

[06:19] I was the,

[06:20] the gap, I filled in the staff call outs and stuff. So I was working nurse manager I should say.

[06:27] And that was at a surgery center. And you know, over my era I ended up just working in about every kind of organization you can. I did some home health,

[06:37] I went back and work at a rural hospital. I've worked at different academic medical universities,

[06:43] urban centers.

[06:45] I have,

[06:46] I love teaching. What I did find along the way was that I really do love teaching and I started taking these adjunct positions and I would do clinical rotations with staff just kind of on as a side hustle.

[07:05] And I kind of went on from there and started doing more theoretical teachings in some of these programs.

[07:11] I mostly did initially the RN to BSN programs at a couple different schools. And then I got my own Master's and went into graduate level teaching, got my own Doctorate, started doing graduate teaching.

[07:26] And I just, I really like teaching but I never wanted to leave healthcare because there's, if I'm honest, there's no money in education.

[07:35] There was no money.

[07:36] Michelle: That's what I found.

[07:37] Randy: Yeah, there's no money in it. And it's so sad because it's what I actually genuinely love.

[07:42] One of my reasons for just wanting a terminal degree in general in my own discipline and profession was that I wanted to get into academia full time as a professor.

[07:54] And it's not that I can't and still wouldn't do that, but at the moment it just,

[07:59] it pays a quarter on the dollar of what I can make in healthcare. So I tend to stay in these sort of like education leadership roles on the healthcare side of things more so than like full time faculty at an academic side.

[08:17] Michelle: Well, thank you for that. I really love hearing how nurses get into the profession and each story is so unique and interesting and so thank you so much for indulging me.

[08:29] And your love of teaching is evident through your Instagram account, it's just,

[08:36] you can tell that you really have a passion for it.

[08:39] Randy: That's. I wanna, that's really sweet. I appreciate that.

[08:42] I feel like I get caught in these leadership roles and within systems and oftentimes I don't have an outlet to teach. And so my foray sort of into the Dr. Nurse Randy, social media was really just to kind of expand my sphere of influence, connect with people that I wouldn't otherwise and just share nuggets of knowledge that are edifying and informative.

[09:08] Michelle: Yeah, I love it.

[09:10] So let's talk about Prism Care Advocates and Consulting. That is your business.

[09:17] And I love your website.

[09:20] Very nice, very well put together.

[09:22] But tell me about the work that you do there and how you created it and just what is your passion there?

[09:31] Randy: Oh yeah, appreciate that.

[09:33] So Prism Care Advocates and Consulting is really sort of honestly,

[09:40] in my own,

[09:42] like working at an employer, I started to network and meet people and being I had gone and become a legal nurse consultant somewhere along the way. I was infatuated by that and I became a certified legal nurse consultant and I started working with a couple mentors.

[10:04] And at the same time I had a personal tragedy happen where I lost my own father who succumbed to medical error and neglect within the healthcare system.

[10:17] And this was pretty traumatic, but it moved me and I wanted to go into action rather than just stay in a space of grief about it. And I was incredibly motivated to advocate for the people I cared about.

[10:34] And the people I cared about were patients and the people I cared about were my peer nurses.

[10:38] And so those two things. So really what Prism Care Advocates is it's sort of an intersection of me supporting patients through my patient consultation and patient education roles and also supporting nurses who are, you know, struggling to navigate themselves professionally.

[10:56] And so I was trained and mentored at my current academic medical center by a dear friend of mine and mentor. Her name is Dr. Barbara Bonis.

[11:06] And she is one who really kind of developed me into what is called a professional practice leader,

[11:11] we call ourselves a PPL.

[11:13] And she really helped infuse into me really an enlightenment of all things around, what does it really mean to be a professional nurse?

[11:24] And that also dovetailed very nicely into my learnings about the legal world as well as my learnings about becoming a board certified patient advocate.

[11:37] Because when my father had passed, I said, well, I was going to help other patients. You know, one of the things you're moved to doing when you've experienced something pretty traumatic in a healthcare system is you don't want what happened to you to happen to other people.

[11:53] And I was just kind of motivated for like I'm going to spend,

[11:57] you know, if I can share my knowledge, if I can share my skills, if I can use my insight to help others,

[12:04] you know, become better at their role as a nurse or patients understand how to navigate safely and avoid risks, then that's what I wanted to do. And so Prism Care Advocates is sort of this kind of, it's a kind of a more well rounded, it has a arm of it that's strictly just patient focused where I do consultations and educations.

[12:28] I also offer private duty nursing and some specialty kind of concierge nursing type things,

[12:33] but then also for nurses who just need somebody, they need a nurse practice expert to, you know, consult with.

[12:42] Here's what's going on in my world. What do I do?

[12:45] And so I love doing that kind of work as well.

[12:49] Michelle: Yeah. Well, first, I want to say that thank you for sharing the story of losing your father. And,

[12:56] I'm so sorry for your loss.

[12:59] And I,

[13:01] I think it's. I don't know if this is something that's in a nurse,

[13:05] but I do see it in a lot of nurses that when they suffer a tragedy, a loss,

[13:11] they seem to just jump into action.

[13:16] Instead of kind of going down that rabbit hole and internalizing things and, you know, getting depressed, they're like, what can I do?

[13:26] And that action seems to bring us out of all the things that we're feeling and exactly as you verbalize, like,

[13:38] to prevent someone else from going through this tragedy.

[13:42] And I just think that's amazing.

[13:46] And to be an advocate for a patient is, it's amazing. The healthcare world is so complex and so convoluted,

[14:00] and even I will say that I recently have had a health crisis.

[14:05] And, you know, I'm still a licensed registered nurse. I still have, you know, all those years of experience,

[14:13] and I really appreciated my sister, who is also a nurse,

[14:19] coming with me to appointments,

[14:22] asking things that weren't on my radar.

[14:26] So, so valuable to me as a person,

[14:31] because I think of myself, you know, as a person first,

[14:34] and then I'm a nurse second.

[14:37] And I think when nurses enter into the healthcare system as patients,

[14:43] sometimes providers can think that we know everything that's going on. Right. Because, well, you're a nurse.

[14:52] Randy: Yeah, but we're human first and we are human first.

[14:57] Absolutely. Yeah. You know, healthcare is dangerous. I mean, it's just dangerous. People don't. I mean, I go back to that landmark publication in 2016,

[15:08] that was a collaborative study from the NIH and Johns Hopkins around how preventable medical errors are the third leading cause of death and that is literally something that's so scary.

[15:25] And we who work in the sort of the inner workings of the system,

[15:30] we take for granted how much we really know,

[15:34] how workflows play out,

[15:36] how timelines really pace.

[15:39] And the average layman doesn't know that if we really think about it from the, from the average layman in the community when they are, you know, newly diagnosed or they're coming in for a procedure or now they're starting,

[15:53] you know, a care journey. Like maybe they have something chronic, maybe they have cancer.

[15:58] They're overwhelmed and they really don't know what they don't know and they don't know who to ask. They don't know if what they're being told is correct. They don't know what resources exist.

[16:10] In a way, they have to almost blindly trust whatever, you know, front desk person, doctor or nurse just tells them.

[16:18] And we don't check their literacy level. Health literacy is very important and people being

[16:25] able to comply and appropriately understand what they're agreeing to. And so there's just so many risks, so many risks for harm, so many risks for danger,

[16:36] for poor outcomes. And this is really my passion because I saw my father fall through every crack in the system, fall over and over again.

[16:46] And you know, it's at every level. It's at the individual, clinician and employee level.

[16:53] It's at the the micro, the Mezno and the macro system.

[16:59] It's just a very fragmented. Because the way that I say it and teach about it, healthcare is really a human endeavor. It is an imperfect system made up of imperfect people.

[17:10] And there's no way you're going to get a perfect outcome. And so the only way to really be successful is to actually be proactive and learn how to self advocate.

[17:20] And so this is why my doctorate work was focused on the concept of patient activation.

[17:25] And that is a term in the literature that really talks about how engaged and informed and empowered are patients to actively participate in their healthcare and to participate in the decisions about their healthcare.

[17:41] Michelle: Yeah, just a fantastic work that you're doing there. I'm so glad that's something that people can access.

[17:50] So a big part of your platform, Randy, is about helping nurses lead their own practice.

[17:55] Randy: Yes.

[17:56] Michelle: Yeah. Tell me, what does working at the top of your license, what does that really mean? And how do you help others get there?

[18:04] Randy: I love that question.

[18:05] And I don't know that there's one simple answer. You know,

[18:08] working at the top of the license, I actually think that's a phrase that we've often heard in the nursing world. Right.

[18:16] But I try to shift the language and talk about professional practice and I, you often hear me say, I drop this kind of comment about how nurses have been deprofessionalized and they often just work as task based shift workers rather than role based professionals.

[18:37] And we have nurses. It saddens me that we have,

[18:42] you know, we go to these Nursing schools, we're totally, I mean, everything is just simply about passing the NCLEX and getting a job. And we only ever have been taught to think of ourselves as a nurse by an employer who gives us a nursing job.

[18:59] And you know, and for compliance sake,

[19:03] we are taught to follow these rigid rules. And it's just this kind of like role of just, well, I have these tasks and here's the checklist and here's the physician orders and I carry these out and then I clock out and I go home, right?

[19:15] And that is how we organize our work. But if,

[19:19] if we aren't careful as nurses,

[19:23] The erosion that begins to happen over time is we lose this identity of owning our practice,

[19:28] being the ones who are, that were actually professionals. We're licensed practicing professionals and we have been imbued with the authority, with an independent scope of practice.

[19:40] We can practice in the domains of safety, comfort, hygiene, restorative care and health promotion.

[19:46] I don't need a doctor's order, I don't need permission from a manager,

[19:50] an employer, I, by extension of having my license.

[19:55] I've already been imbued with the authority to deliver nursing care to the American public.

[20:00] You know, I always remind nurses,

[20:02] you don't work for the hospital,

[20:04] you work at the hospital, right? You work for the public.

[20:10] That is who we are beholden to. That is who our license is a social contract.

[20:14] And so that means if I've taken a license, I've entered into a covenant with the American public,

[20:21] and that is really who I'm beholden to and who I have professional liabilities and duties to.

[20:26] And I never, ever give up that ownership and that liability and that duty to an employer because I choose to take my practice to an organization. So I always tell nurses, you work for the public, but you work at the hospital.

[20:40] And because we take our practice there,

[20:42] they're going to give us a paycheck, we're going to get benefits, and they help us organize our work.

[20:47] And it is one way, in the most conventional way,

[20:50] nurses make their education and their license lucrative to generate benefits.

[20:55] But I don't need the employer and I don't need their permission to do nursing and to give nursing care to the American public.

[21:05] And so when I think about working at the top of your license, it's really understanding my professional role and really leaning into those things that are in my independent scope of practice.

[21:17] I mean, anybody, any nurse, any licensed nurse can be a private duty nurse. I mean, we are all generalists.

[21:24] And so if I want to learn specialty knowledge and go into a specialty. Sure. I want to find the means in which I can acquire that body of knowledge and those specialty skills.

[21:36] But generally speaking,

[21:38] I am never outsourcing the ownership to regulate my practice. I am always responsible for regulating my practice.

[21:46] So working at the top of your license is a first, knowing your role,

[21:49] knowing your scope of practice. And really if I want to have an evidence based practice,

[21:55] I can't wait for somebody else to tell me it. I need to be able to evaluate my practice against the standards of the profession and within the scope. And I need to make sure that I am being self directed to acquire the knowledge and skills to fill any knowledge deficits or skill gaps that I have in my practice.

[22:16] It's me, just what we call self regulating. I'm governing my practice to the standards of my role.

[22:22] Michelle: I really love that you are talking about professionalism in nursing and that,

[22:29] you know, I think a lot of nurses would be really surprised to hear what you just said.

[22:38] And I think it would be very empowering to many nurses because I do think that nurses think,

[22:47] many nurses think that they work, you know,

[22:51] for the institution and exactly as you said, they're very task-based.

[22:59] They just follow orders. They don't see themselves as independent professionals. And I think for so many nurses who came to realize that maybe during the COVID pandemic and then left the institutions to become entrepreneurs,

[23:21] they realized,

[23:23] you know, I'm a professional nurse,

[23:25] I can own my own practice,

[23:29] I can,

[23:30] you know, do all of these things that you just laid out.

[23:34] And I've talked to many of those through this platform and it's very empowering.

[23:39] Randy: It really is empowering. When we,

[23:41] you know, systems see, you know, I always talk about like a nurse provider versus a medical provider, our system, the systems we often work in,

[23:51] they're very provider centric, they're very physician dominant.

[23:56] And there was an interesting thing that happened back in the 1900s. There was sort of a reformation that happened.

[24:04] And you know, in the early 1900s,

[24:06] nurses were regarded as professionals. We were nurse providers and our nursing services were regarded as a professional service. And we got to bill for that directly. We were another line item on the bill.

[24:22] And so we could easily quantify the value that we contributed to healthcare delivery and outcomes.

[24:31] And then in sort of the mid-20th century, there was this sort of reformation and the hospital and the healthcare industry wanted to reform insurance. And one of the things they did was they looked to the hospitality industry and they saw that the hospitality and the service industry was creating this new sort of billing model where they rolled all of the perks and the bed and the food and all the everything into one flat,

[24:58] room and board and.

[25:00] Michelle: And then threw the nurses in there too.

[25:02] Randy: And what they did, they did exactly. We got rolled into that and that's what healthcare adopted. And so when that happened,

[25:10] we sort of became incredibly devalued.

[25:14] And this is why we are no longer a line item on a bill.

[25:19] You can't just go into an organization like with my team that I work with at my academic medical center,

[25:25] I have a, It's challenging. You have to be really thoughtful and think critically around how do you begin to showcase the value of the nurse provider in fulfilling the mission of this healthcare agency of delivering the outcomes right, like safe,

[25:43] high quality care.

[25:45] And good outcomes aren't achieved without the nurse provider and their professional skills and their professional body of knowledge doing the care that they do.

[25:53] And yet we don't get recognized for it. And we can't quantify it like you can a medical provider. Medical providers create and manage the medical plan of care. They're really managing the pathology.

[26:05] Nurse providers are managing the human and the human response to their medical care.

[26:10] And you really need both a medical provider and a nurse provider to deliver comprehensive care.

[26:17] And yet that is not the cultures in which we work in.

[26:21] The cultures we work in tend to see medical providers as an area of say, investment because the revenue they generate is,

[26:31] you know, very visible,

[26:33] it's very quantifiable.

[26:35] Whereas the professional services that nurses now deliver isn't seen any different than somebody, you know, than a bottle of water being brought to the room,

[26:46] you know, or something like that. It's like we're just a part of the flat fee.

[26:52] So I think this is part of the issue of the larger, like sort of nursing shortage that exists within systems.

[26:59] But generally speaking, the nurse role is a licensed, practicing professional role and it delivers professional services. And it's really unfortunate that we have been deprofessionalized. And it's really hard to change that culture if at the individual level nurses only also see themselves just as task based shift workers.

[27:20] We really need to think that we're doing the nursing process,

[27:23] which is a critical care model.

[27:25] That's what the nursing process is. When I am assessing, diagnosing, planning, implementing and evaluating,

[27:32] that is critical thinking.

[27:35] That is a professional,

[27:37] highly developed, trained, skilled model of performing

[27:42] That is not often attributed to the nursing work that we do.

[27:47] Michelle: Well, that's why your work in particular,

[27:50] and also the work of Rebecca Love is so important in changing that whole narrative. And you know, Rebecca's been working on the nursing is STEM movement and removing the nurse from that whole room charge and having that be an independent charge and bringing those things into the light so that we can address them and change them.

[28:19] And so, yeah, very good work.

[28:22] Randy: It's such important work. And if we're ever going to be honored as the professionals that we are, I think it's going to have to the systems, unfortunately, the powers that be, they're going to need,

[28:33] when it gets down to the nuts and bolts, they just need to see money,

[28:36] and you can wield influence. And so this is why I do love shared governance models. It is a way the nursing voice can begin to influence policy change.

[28:48] But that's hard. And not all cultures embrace it.

[28:50] Not all systems have unions per se, but even the union process is a way to legally,

[28:59] allow us to bargain for benefits and to prevent us from being exploited as labor.

[29:06] I don't think it's the ultimate solution in the sense of changing the whole paradigm that we work within to begin to be honored as professionals. I think I would love for us one day to be able to bill directly, you know, to have actual, like be another line item on the bill.

[29:24] And they will see that when I recruit a nurse,

[29:27] the nurse is actually.

[29:29] I don't know what 

[29:31] the staffing model would necessarily look like, but I think that there would be, it would go a long way to showing executives and system leaders the real contribution that we're making right now.

[29:42] We're just,

[29:44] we fall into the fray of all these like ancillary expenses.

[29:49] So when we're the most expensive thing in this little rolled up bundle,

[29:54] you can see where we're easy to cut. Because they've saved a lot of money by not hiring that nurse.

[30:00] Michelle: Exactly. Yeah.

[30:02] Well, you spoke about nursing policy and health policy and you have had a major influence on writing nursing policy and leading quality assurance.

[30:13] Can you share an example of how that work has directly changed patient care or even organizational culture?

[30:22] Randy: Yeah, that's a great question.

[30:25] You know, sometimes that kind of work,

[30:29] culture change actually is not spontaneous. It's not even a short term thing. Right. I think that culture change,

[30:36] the literature tells us it can take years to do that, but you can begin to influence culture.

[30:42] So one of the things I would say I might be in a unit who there's practice drift happening. Right. I'm doing a culture assessment of nursing practice. I pick a standard,

[30:56] and let's say it's the feedback standard.

[30:59] You know, the nursing performance standards, by the way. I mean, like, oftentimes the nursing process is just the first six. There's actually 18 standards published that we're legally and professionally responsible for.

[31:12] You know, the first six is the nursing process. But it doesn't stop there. It goes on. And we have 18 now. There was only 17 up until the re the new edition that just came out a couple of years ago where they added advocacy as a new professional standard.

[31:27] But we pick a standard and we go into a care area, a unit, a team, a service line, a cluster,

[31:33] and we begin to do a culture assessment, and we pick the standard and we take a sampling of the staff that work in that area,

[31:41] and we begin to engage them and talk about the standard and how, A, do they know it?

[31:48] B,

[31:49] do they own it? Have they internalized it and see do they perform it?

[31:57] So know, own, perform.

[31:59] And you round robin on a sample size of a representative sample of that unit, and you begin to kind of evaluate what you've gathered and see where,

[32:12] where does the unit fall, Right. You get enough of a sample that you can ascribe it to the general, like, population,

[32:18] and maybe the unit's small enough, you can actually do everybody.

[32:21] It's very different. I've kind of done different culture assessments,

[32:24] but, you know, there's one that we did around medication practices in one of our units at the academic medical center that I work at.

[32:32] And we saw that the way that people were doing medication management was not to a standard. They were actually deviating from a standard. So I don't know if you've heard of the term practice drift, but this is a term that is now in the literature.

[32:46] It was initially actually, I think, surfaced with the North Carolina Board of Nursing. They kind of wrote it into their practice act, but it's been now kind of widely adopted and used across the profession.

[32:56] Practice drift is a phenomenon that occurs that where the practice culture,

[33:05] the customary practice of the clinical team does something that they believe is the right way to do it,

[33:13] but it's really a deviation from the actual standard. And so it may have started by maybe one person, one time creating a workaround to make something they're doing more efficient.

[33:25] And then they get away with it. And so they do it again and again. And then a peer nurse sees it, they copy it, Then they do it.

[33:34] More nurses see it and they copy it. Then it becomes so pervasive that we not only do it and get away with it,

[33:40] we now teach it to new nurses. And it's become the expectation when if you really evaluate it against the actual standard, it is actually something that is a deviation from the standard.

[33:51] And so that is what we call practice drift.

[33:54] And you don't always recognize it,

[33:56] but whole systems, whole units, whole clinical teams can actually be caught up in this. And so when we do culture assessments, we come in with of like, we're outside the bubble, we're neutral eyes, we're just objectively evaluating the standard.

[34:13] And I have identified where nurses practices with their medication management aren't to the standard, but yet everybody does it.

[34:21] And so you really have to create an action plan that how are we going to steer us back to it? And let me tell you, that is easier said than done because 

[34:32] some of these places,

[34:35] they are, this is so well established that it is. I mean, you get your veteran nurses and they are the guards of this and they are not open to doing it another way.

[34:47] And sometimes, you know, this is classic change management theory where you have your early adopters, you have your late adopters and blah, blah, blah.

[34:56] But there are people that say, I'm not adopting any other way of doing it. Not because it's better,

[35:00] not because it's efficient, just simply because it's different.

[35:04] They're that resistant and that settled into the way they do things. That's how adapted they are.

[35:11] So you kind of have to, it takes a little bit of a customized approach to evaluate because you know, if you're going to begin to correct it, you're going to create disruption.

[35:21] And along with disruption, you can have a lot of fallout if you don't handle it well, if it's not communicated well, if it's not done in a supporting way,

[35:28] you don't want to do it with a blame and shame. You want to actually be able to create a narrative and a message that helps people see what are the risks associated with this culture, this practice drift in the culture and how

[35:42] we have a responsibility and a duty to kind of get back to being on track with this certain standard. And so in a unit where I did this with medication management,

[35:52] I mean, we were having,

[35:54] we our numbers for, it's called narcotic loss. It's called a loss report from pharmacy. And so when a narcotic is pulled out of the medication dispensing cabinet,

[36:06] Everything has to be accounted for. Every dose has to be accounted for. Right. When it's a controlled assessment and it's accounted for by three ways, either administration,

[36:15] waste or return.

[36:17] And this particular unit had a very high,

[36:21] not only were they high, but they were above their own peer units in the same organization. But they exceeded the national average as well for their unit. So we knew it was a problem. We had to dig deep, find out what was going on and created an action plan really.

[36:38] And it took a year.

[36:41] We had to create a whole know how you're doing board,

[36:44] make it a more formally structured project.

[36:48] We created a, 

[36:50] I was not the manager of this particular unit, but we got that manager to partner with us and we assigned some key stakeholders to participate in weekly roundings where we began to disseminate information,

[37:03] educate people and ask about it. And so without getting into more weeds about that project, we ended up improving that and we became actually the best unit in the entire organization.

[37:14] And our narcotic loss dropped to even zero for multiple months because we were able to get people back on track to the standard.

[37:24] Michelle: Wow, I mean that's incredible. First of all, and as you're describing this whole process and being involved in this,

[37:32] I was thinking how cool is that? And you know, kind of like how, how fun it almost seems, I know it was a ton of work. I'm not minimizing it at all.

[37:45] But what a fun process to go through all of those steps and to find all of those,

[37:55] inadequacies and then,

[37:58] be able to work with people on changing that culture.

[38:04] And like you said, it's very slow. And when you said a year, I thought that was pretty fast.

[38:10] Randy: Well that was a smaller unit. You're right. But like when I think about the system change, right, that's going to, that, to tackle that, you know,  we had to do that same work in other teams across, so it's a multi year thing.

[38:26] and that's also with pain management. You know, we were really bad with our, like, I think it was joint commission or some accrediting body that would always ding us on, you know, not being able to appropriately document and round and manage pain.

[38:38] So pain was another thing, you know, where we had practice drift because people weren't not only just, it's not even just about compliance and obedience, it's actually around understanding the standard that you're expected to perform to and not just a policy, but an actual professional standard.

[38:57] And so in a lot of ways it may be painful,

[39:01] but professional practice, that term may make nurses glaze over because they don't know what it is, right? They don't know how it relates to the actual sensibilities of direct care nursing.

[39:13] But once you can connect the dots,

[39:16] they find it very empowering.

[39:17] It just simply, it can be a mental block sometimes. But there is something very practical in the way that you see yourself. You do feel more confident, you feel empowered.

[39:28] And it's amazing and inspiring to see me see nurses who begin to say, get it, you know, where they're not just a nurse because it's the name on the badge that my employer gives me.

[39:40] It's actually like I have a scope of practice and I have authority and I, with that have liabilities and I want to understand what those are. One of my most common talks that I give that I go to conferences and speak, I just got reached out to yesterday was to come talk about how people really are fascinated around how their documentation is used in litigation.

[40:03] And so I talk about the trappings of modern day charting and how nurses can really get themselves in trouble.

[40:10] And it has come for some reason to be my, one of my most popular talks. I even made it an online course.

[40:18] Michelle: Yes, I wanted to talk about your course.

[40:21] So Chart Smart: Preventing Pitfalls in Malpractice by Mastering Nursing Documentation.

[40:27] And I can imagine that this would be a very popular course because I mean,

[40:31] documentation is like,

[40:34] I don't know,

[40:35] 75% of what we do.

[40:37] Randy: You know, I would say people don't realize it is, 

[40:42] if not the most regulated, it's one of the most regulated activities we do in healthcare because it's not regarded as a technical skill like say restraints. Restraints are a highly regulated care activity in healthcare.

[40:57] Probably the highest regulated, I would say right up there with it is documentation. We just don't realize how much document the role of documentation plays in ways that we don't even foresee it can.

[41:09] Michelle: Well, what can nurses help to gain from taking that course?

[41:14] Randy: No, I like to say, first of all,

[41:16] I want to let nurses know, like you have to do a little knowledge sharing around what is it that documentation can, how does litigation work? First and foremost, right?

[41:27] How does a lawsuit work?

[41:29] And so I kind of briefly go over how does a medical malpractice lawsuit go from start to finish?

[41:36] What are the most common types and in that process,

[41:40] how your nursing notes could be used to influence that case,

[41:47] for better or for worse.

[41:48] And so I go over some very common trappings of modern day charting that nurses do that they don't realize is actually a risky practice.

[42:00] I talk about what I call dirty words.

[42:03] There's certain language and words and descriptors that we commonly use in our clinical documentation that could actually come back and bite you if your case was ever scrutinized by a jury in a lawsuit.

[42:18] But I like to think it's very practical and I think that's what nurses like. They want to, you know, nurses, oftentimes they just, they want to know what to do, they want to know what not to do.

[42:27] And I kind of balance a little bit of here's what you do, but I also want to go a tier above that.

[42:33] If you only ever tell somebody what to do, then if they're in a situation where you're not there to tell them what to do,

[42:39] and the situation they're dealing with has some variation to the situation you've previously discussed, then they don't have the ability to adapt to that new situation. And so this is what professional practice does.

[42:52] Like I can talk to somebody and tell them what to do, but really I want nurses to be the leaders of their own practice. So if they consult with me, I'm not necessarily going to go tell you this is what you need to do, fix your problem.

[43:03] I'm going to actually try to guide them with some reflective questions. We're going to review the standards and I'm going to let them to decide what they want to do for the practice.

[43:13] Michelle: That's very cool. I've said this before on this program that in my 36 year career I got one deposition.

[43:23] Randy: Oh. 

[43:26] Michelle: Yeah. And thank God it was just one because the whole process was just very anxiety-producing.

[43:34] And this is back in the day, Randy, when we didn't have electronic medical records. So I'm sitting in front of the attorney with my

[43:43] Randy: With your flow sheets that unfolded? Because I had those too.

[43:49] Michelle: My eight-page flow sheets and looking at my chicken scratch and trying to decipher what did I write?

[43:58] It was very humbling. And so from then on out,

[44:04] my handwriting got much, much better.

[44:08] Randy: Of course it did. A beautiful thing about electronic documentation, right? Handwriting, it goes away. Although interestingly, I just had a case where about two months ago where a provider wrote a handwritten prescription and a nurse was having to interpret it and they interpreted it incorrectly and you know, dispense the wrong medication and it led to a problem.

[44:29] I mean, like we're in 2025 and this is still happening.

[44:34] Michelle: Amazing, that's amazing.

[44:37] Yeah. But one deposition will certainly put the fear of God in you. And I think that course just has to be so valuable for nurses.

[44:48] I want to talk about your Instagram for a moment because you have a strong presence on Instagram as Dr. Nurse Randy.

[44:54] And I want to know what made you take your advocacy and education to social media and how has that kind of impacted your reach?

[45:03] Randy: Oh, that's such a good question. Sometimes I wonder, do I want to do this? Is this really what I wanted?

[45:11] Michelle: It's a lot of work.

[45:12] Randy: I don't, you know, it's funny because I don't particularly regard myself as a content creator. I don't really regard myself as an influencer.

[45:23] I don't have the capacity, first of all,

[45:27] that's required to even, like, achieve that.

[45:30] But I will say it's not lost on me that you can people knew and there is a sphere of influence that you can tap into.

[45:41] And I'm aware that there are healthcare and nurses, they're talking on it. And I think I became aware of this in the last two or three years. Research has come out and said that younger generations,

[45:54] particularly young millennials and gen z-ers,

[45:57] over 50% of the time,

[45:59] they don't go to Google,

[46:02] they search social media, they're searching, you know, YouTube, they're searching TikTok, they're searching Instagram.

[46:09] And I think that was my moment where I realized, like, you know, what if I really want to get,

[46:14] call it a brand, 

[46:16] call it a reach to just as a, as a campaign or,

[46:21] or whatever. I thought to myself, you know what, there's an audience on here.

[46:25] Nurses are on it, nurses are talking.

[46:27] Why can't I be one of these nurses talking?

[46:30] So I had my foray into it, I think probably maybe a yearish ago, I can't even remember when I started.

[46:38] I wish I was more consistent at it. I ebb and flow with my content creation. I do go through these, like, I have time off or I have the mood to do it,

[46:50] but I look at some of these people and they're just cranking out content. I'm like, oh, my gosh, I don't know how,

[46:55] I don't know how you do that because I also work full time and I do these other roles and, and I have a life. And so, like, my life doesn't, my life doesn't revolve around Dr. Nurse Randy.

[47:06] But I will tell you,

[47:07] I have really appreciated it and it has connected me with clients that I have been able to offer meaningful support and help.

[47:16] And I feel like I have gotten some feedback where people have shared that they appreciate and value my content,

[47:23] which has been informative and educational to them.

[47:26] And that's always,

[47:28] really encouraging to hear and that keeps me wanting to do more of it. So I feel like there's a whole new era ahead of me with it that it just hasn't manifested yet.

[47:39] Michelle: Well, you're such a natural at it and I, you're just, you're always so relaxed and you talk about serious topics but. But you do it with just kind of a,

[47:52] a light heartedness.

[47:53] Randy: Oh, well, thank you.

[47:54] Michelle: And yeah, and I just, I just really love it. And I would encourage everyone to check out your.

[48:01] Randy: Is there a particular one video that I created that stands out to you? I'm just curious.

[48:05] Michelle: You know, there's just so many. I really like the one that you just were talking about being a critical care nurse.

[48:13] Randy: Oh.

[48:14] Michelle: And you were like, you could be a critical care nurse like anywhere in the hospital.

[48:19]  they're not just, they don't just work in ICU.

[48:23] And I was like, that's a really important distinction that I think.

[48:27] Randy: And you know what, it's probably the third time I've posted that content. It gets, it has gone, you know, gotten some reach with it. It's still, people still respond. It's like, no, no, no.

[48:37] But if you're not an ER, ICU, then you don't have the level of credit. It's like people still try to ascribe a value statement to it. And it's like, it's not a value statement, it's a population.

[48:47] And what people conflate as well is that critical care is the status of the patient and they go throughout the whole healthcare system. So whatever clinicians are taking care of them and whatever care area,

[49:00] they're going to be taking care of a critical care patient and have a critical care body of knowledge and skills. But that doesn't mean that their skill sets. Because I create transition to practice programs at Academic Medical Center.

[49:12] I onboard new nurses, experienced nurses, and we cross train people into these specialties. And so we have a whole critical care track and pathway. And it's like, I'm not going to teach all of the care tasks that an ICU nurse would do in a surgical ICU to the critical care nurse who works in L&D to the critical care nurse that works in the cath lab.

[49:35] They're certainly going to have different devices and different, like tasks. But that doesn't make one or more, less or more of a critical care nurse.

[49:45] And, you know, that's where I think people kind of, like, forget is.

[49:48] Yeah. And we have this, I think, inflated esteem sometimes that if you're not in ICU,

[49:54] you know, 

[49:55] That somehow is the creme de la creme. And again, I've been an ICU nurse, so, like, 

[50:01] I understand that, but I also have been in other areas where I'm doing critical care nursing to the same vigilance, to the same skill level and acuity that I see nurses do it, but just in a different context of care.

[50:16] Michelle: Yeah, I love that. That brings to mind my sister. My sister Jennifer.

[50:21] She was a critical care nurse in labor and delivery.

[50:25] She was a critical care nurse in ICU,

[50:28] a critical care flight nurse.

[50:31] So, yeah,

[50:32] you can take those skills to any population.

[50:37] And I love how you said we kind of have inflated esteem. I think you said. I think that's great.

[50:45] We do that though as nurses.

[50:47] Randy: Right.

[50:47] Michelle: We have hierarchies. It's like, we're better than you. We're higher than you. We're. You know, that'll be.

[50:54] Randy: That's gotta be my next video. We gotta talk about this hierarchy. And it's like what's a better nurse than the other nurse? It's like, no,

[51:00] no.

[51:01] I want to talk about professional practice, because research actually says. I was talking to some group the other day,

[51:08] they were comparing ICU nurses to home health nurses.

[51:12] And I think the average nurse would ascribe that the ICU nurse is somehow more of a professional.

[51:17] But when they were actually 

[51:19] In this research, it identified that home health nurses have more markers of professional practice than ICU nurses. ICU nurses in this research worked in systems that had protocols and orders and people around them constantly telling them what to do.

[51:36] And they lacked a sense of ownership.

[51:38] Whereas home health nurses work much more independently. They have a stronger sense of ownership,

[51:44] and they have more markers of really owning the outcomes of their care and owning the decision making. And so it was very interesting. They had more virtue, more of professional practice than,

[51:56] say, an acute care nurse in an ICU ward inside a hospital.

[52:01] Michelle: That's fascinating. And that kind of research needs to get out and get distributed,

[52:08] you know, to just start breaking down these myths,

[52:12] because they don't serve us.

[52:14] Randy: Oh, not at all.

[52:16] Michelle: Yeah. Well, as we start to close, Randy, I want to know what is next for Prism Care Advocates and Consulting and your particular mission in healthcare?

[52:29] Randy: Yeah, that's a great question. You know, I am in a transitionary era of my professional career.

[52:35] I'm in the process of considering a relocation, change of specialty,

[52:41] maybe taking a jump more into academia.

[52:45] So I don't really know exactly. I'm really at sort of a

[52:50] place of reflection right now.

[52:52] But in the moment, I've got a partner here and I'm more kind of sticking to what I'm doing to support my partner who is in their own doctorate program and waiting for them to finish.

[53:06] And when that in the next year or two, and then I think I'll have a better idea of what it is. But, you know, Prism Care Advocates, we're still going and blowing.

[53:14] I still want to be a resource to support. I find my most fulfilling and rewarding role in being a mentor to nurses and being a support to patients.

[53:29] So if there's any way I can help educate patients to navigate the healthcare system safely,

[53:35] then that's what I want to do. If there's any way that I can help nurses become better professionals and leaders of their practice, that's what I want to do. So there might be some new ways that I conceptualize that going forward.

[53:48] Michelle: I love it. Wow. I wish you all the best.

[53:50] Randy: Thank you.

[53:52] Michelle: So I have received many great guest recommendations from my guests.

[54:00] And, and I know this question, it always kind of surprises people a little bit. And you don't have to answer on air.

[54:07] We can talk about it after. But is there someone that you would recommend as a guest on this podcast?

[54:14] Randy: Oh, interesting. Do you only stick to, say, nursing or do you go outside into other disciplines?

[54:23] Michelle: Okay, I'm open.

[54:25] Randy: You know, I have a couple ideas.

[54:29] Yeah, if you're open to other disciplines, I think it would be interesting. 

[54:33] I have a thought about maybe a physical therapist who subspecializes in chronic and persistent pain and what we get wrong about pain.

[54:47] Michelle: I would love that. That would be amazing. Thank you so much. Then where can we find you, Randy?

[54:53] Randy: Yes, sure. I am at my social handles. I've tried to stick with Dr. Nurse Randy,

[54:59] and I have that on really all of them. I think I'm on Instagram, TikTok, YouTube and Facebook, which again, I need to be better about keeping those with fresh content.

[55:11] But there's some good stuff there, though.

[55:14] And prismcareadvocates.com is also one of my main landing pages that really,

[55:22] that's probably my,

[55:24] my primary landing page. So prismcareadvocates.com that is where Prism Care Advocates and Consulting landing page lists and where you can schedule and book with me directly.

[55:35] And also in each one of my bios, I have a link to a place where you can book with me as well.

[55:39] Michelle: Yeah. And I'll put all those in the show notes so people can find. Yay.

[55:43] Randy: Thank you.

[55:44] Michelle: Yeah. Oh my gosh, Randy, I'm so glad we connected.

[55:48] I'm so glad that you came across my feed and I discovered you and I'm so glad that you said yes when I reached out. I think in the beginning you were a little bit tentative,

[56:01] like I don't know how I could possibly serve you. And I'm like, oh, you can trust me.

[56:08] So thank you.

[56:10] Randy: Well, thank you. Thank you for actually wanting me. So I appreciate that.

[56:14] Michelle: Well, you know, we're at the end. So at the end where I do this five minute snippet and it's just five minutes of fun.

[56:22] It's just some

[56:24] Some off duty questions to see kind of the off duty side of.

[56:30] Randy: Yes, do it. And my phone is about to die too, so maybe it's working. Just in time.

[56:35] Michelle: Okay. All right.

[57:17] If stethoscopes could talk, what do you think yours would say about your work day?

[57:23] Randy: Oh, use me.

[57:27] Don't leave me behind. Use me. I don't know. I say that. I say that because I don't tend to do a lot of physicals anymore, so even when I use, use them, I have to borrow somebody's.

[57:40] Mine are tucked away somewhere and I haven't pulled them out forever. It's not. And leadership. I just don't do them that much.

[57:46] Michelle: Yeah. Yeah, I love it. Okay, if you could write a prescription for anything, no rules, what would it be and who would you give it to?

[57:56] Randy: Oh my gosh. I would probably.

[58:00] I would take something like, I don't know, Ativan or Adderall and an aerosol and give it to my niece who's a kindergarten teacher. So that she could just spray over her classroom.

[58:11] Michelle: Oh, my God. I love that. That's amazing. Okay, what's the most bizarre thing a patient has ever said to you that you can legally repeat?

[58:22] Randy: Oh, man. I was in,

[58:25] I was in a post anesthesia care unit working as a PACU RN and recovering a patient from anesthesia. And yeah, they had had some dreams about me that they were very,

[58:36] They were very into it. So they were very,

[58:39] They didn't have any inhibitions about telling me what they thought of me. And it was a very odd.

[58:44] Michelle: Oh, wow.

[58:45] Randy: Yeah, they had thought we had had an affair and their husband was going to come in to the curtain and not to tell him when he came back to see her.

[58:54] Michelle: That's great.

[58:56] I love it.

[58:58] That's been so fun. Thank you for indulging me in the five minute snippet. And thank you, Randy, for everything you've brought to our conversation today. All of your

[59:09] knowledge and your expertise and your professionalism and your humor and your stories. I have really enjoyed talking with you, and I know our listeners are just going to absolutely love you.

[59:23] Well, you have a great rest of your day. Take care.