Beyond Nurse Residency

Building Culture Through Infrastructure

• Nicole Weathers, DNP, RN, NPD-BC • Season 3 • Episode 2

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Walk into any unit, and you can feel it—some teams come alive with connection, trust, and shared purpose, while others struggle under the weight of burnout, silos, or a culture that never quite clicked. In this episode, nurse executive Dr. Dan Lose joins us to break down why engagement isn’t about “getting people to care more,” but about designing systems, roles, and environments that make engagement possible. 

Dr. Lose helps us look beneath the surface to identify the core ingredients of a healthy work environment, especially for new nurses entering the profession during one of the most challenging eras in healthcare. We talk practical strategies—how leaders can free up time for real relationships by shifting administrative work off nurse managers, how roles like clinical practice leaders strengthen onboarding and ongoing support, and how intentional processes (like welcome checklists, QR‑code feedback, and consistent huddles) turn good intentions into reliable daily practice. 

We explore why engagement and retention require more than fair pay—they require psychological safety, teamwork norms, clear expectations, role clarity, and a culture that values both learning and belonging. Dr. Lose also shares how interview experiences signal culture long before a nurse is hired, why new grads need ongoing check‑ins beyond residency classrooms, and how leaders can shape unit culture through small, consistent behaviors grounded in respect for colleagues, the profession, and patients. 

We also take on some of the hardest realities new nurses face: night shift transitions, schedule misalignment, limited food or wellness options, and the tension leaders feel when budgets are tight. Dr. Lose offers solutions ranging from better support structures to protecting time for professional development, all while emphasizing that the strongest teams thrive when leaders carve out sacred time for relationships. 

If you’re a leader, educator, or preceptor supporting new nurses, you’ll find practical, actionable takeaways you can bring back to your unit today. 

Guest Bio: 

Dan Lose, DNP, RN, CNML, is a nurse executive and educator known for his innovative, collaborative, and people‑centered approach to leadership. He serves as the Acute Adult Director at UnityPoint Health–St. Luke’s in Cedar Rapids, Iowa, where he focuses on building healthy work environments and developing strong clinical teams. 

With more than a decade of progressive nursing leadership experience, Dr. Lose is recognized for translating complex workforce and operational challenges into practical solutions. An adjunct professor and mentor, he is committed to developing future nurse leaders and advancing the practice of nursing at local and national levels. 

Connect with Dr. Lose:
https://www.linkedin.com/in/dlose/ 

Selected Publications:
Lose, D., Lisk, J., & Hunger, S. (2025). Transforming nurse manager roles: Success through strategic clinical nurse leader integration. Nurse Leader, 23(3), 249–255.
Lose, D. & Joseph, M.L. (2023). Young nurse leader program: Inspiring the next generation for formal nursing leadership roles. Nurse Leader, 21(6), 658–663.
Boothby, J., Woline, C., Lose, D., McDaniel, J., & Nicholson, A. (2023). Unit partners: Creative role to recruit and retain students while delivering quality care. Nurse Leader, 21(6), 652–657. 

Supporting nurses is our priority. Visit https://nursing.uiowa.edu/ionrp to explore our resources for new graduate nurses and beyond.

Host Nicole Weathers:

You're listening to the Beyond Nurse Residency Podcast, an educational series where we interview experts on all topics related to the transition of new graduate nurses into practice and beyond. I'm your host, Nicole Weathers, Director of the Iowa Online Nurse Residency Program. Thanks for joining us. Let's jump in. One thing I've been thinking a lot about lately is how much the places we work shape us long before we even recognize it. As nurses, we're incredibly perceptive. We can walk into a patient's room and almost immediately sense if something is off. The same holds true for the places we work. When we walk onto a unit, we can usually tell within the first few minutes what we're stepping into. And that early read can shape how the rest of the shift feels. And while this matters on a day-to-day level for all of us, it matters even more for new nurses during their first year of practice. They're not just walking onto the unit for the first time, they're stepping into a brand new role, trying to learn, to belong, to find their footing. The setup they walk into can either help them reach their goals, engage in their work, and stay on the unit, or can make everything feel harder than it needs to be. We often talk about engagement like it's something internal, like it's purely about attitude or choice, but so much of engagement is influenced by what the system makes possible. So in this episode, we're going to look beneath the surface of engagement. We're going to name the core ingredients new nurses need at the micro level, the investments that truly move the needle, and what unit leaders can do to reduce the chance their residency programs end up on the chalk being block, especially in a tight budget year. And to help us dig into all of this, I have with me today Dr. Dan Lose. All right, Dan, welcome to the Beyond Nurse Residency Podcast. I'm so grateful to have you with us here today. So why don't we start off by having you tell us about yourself?

Guest Dr. Dan Lose:

Yeah, thanks, Nicole. Thanks for having me. I'm happy to share a little bit about my experiences and enjoy the dialogue with you. So I am a nurse leader. Currently work at Unity Point St. Luke's Hospital in Cedar Rapids, Iowa. Uh official role is called the Acute Adult Services Director. Say what it means as I get to the fortune of leading all of our inpatient units at the hospital, along with our respiratory care departments. Um, so those are the two big things. So really exciting. I've been there about two months uh prior to that, spent over a decade at the University of Iowa Healthcare as a nurse manager and nursing director. And so a vast majority of my nursing career has been within formal leadership roles. Very fortunate to continue to lead.

Host Nicole Weathers:

Well, thanks again for being here today. And a fun little fact about Dan, and he's probably like, I didn't know you were gonna bring this up, but uh Dan was actually on the group or on the task force of the people who put our nurse residency program together. So he was actually a representative at the time as a student nurse or new graduate. I can't quite remember. And so um, while you've been a nurse for quite a while already, um, you were kind of at the beginning of all of this.

Guest Dr. Dan Lose:

Yeah, it's really fun to see where it's coming. Gosh, almost 15, maybe not quite 15 years, but you're right. So it's fortunate at the time when uh the state of Iowa came together to say we've got to figure out ways to deliver nurse residencies to all of our new grads. And at the time I was serving as the um president of the Iowa Association for Nursing Students. And so uh that was sort of the role and said, gosh, do we have a student representative on this committee? Because I think, right? And so very fortunate that the leadership, uh, the dean at the College of Nursing and Lori was the chair of our group with were open to having me join as a student role, which is really awesome. So it's really fun to see where it's gone.

Host Nicole Weathers:

And I know some of your DNP work too was around kind of transition to practice and helping kind of better understand how leaders make decisions around um this type of work. And so I think um that it's just an interesting connection that I actually didn't think about until just now. Um, and this conversation that we're gonna have here today.

Guest Dr. Dan Lose:

I appreciate it. Thank you. No, it's you know, that beginning with residency as a student, even still shapes me. So I also volunteer uh through with CCNE um doing site visits for nurse residency accreditation. So it's really awesome. And so I think this has been a part of my identity, I guess, as a nurse leader is really seeing the value of residency programs. And so now get to travel around the country and see how other hospitals or health systems are implementing and sustaining residency. So it's really cool. It's been a part of my career my whole time as a nurse. So thanks for bringing that up.

Host Nicole Weathers:

Yeah, so that's gonna bring a lot of, I think, interesting depth maybe to our conversation today. Because I know we're talking about, you know, engagement and what are some of those core things that need to be in place for engagement to happen. However, you know, I think that's a huge goal of nurse residency, right? Is to begin to sort of build that culture of engagement uh with our new graduate nurses. And so, you know, this is one of those topics, podcast topics that is very pertinent to new graduate nurses, but also goes far beyond that. So before we jump into things, what's a workforce challenge that's maybe taking up some space in your brain right now?

Guest Dr. Dan Lose:

Yeah, thanks. I think it seems like pre-pandemic, through pandemic, I like to think we're post-pandemic now, right? But I think a lot when we talk workforce, a lot of focus is on getting the right people with the right training at the right place at the right time, is sort of a simple way to put it. But a lot of thoughts going around, you know, how do we have the right number of people working the right shifts? And then I think really it's when we connect engagement, right? We want the workforce, oh, a workforce, new grads, experienced nurses to really be a part of the work going on, right? That they have a say in the work that's going on. They're providing feedback to different system leaders on how we can do things differently or better for our patients. All I think within that umbrella of having to be a work environment that's conducive to our nurses wanting to work there, stay engaged, and then at the end, right, our patients getting the care that they need. So it's complicated, but I think a lot of focus is really around getting and keeping the right people right at the point of delivery.

Host Nicole Weathers:

And I think that this is a topic that we get asked a lot about is how do you, I mean, it's you know, sometimes it's a generational topic, uh, sometimes it's just current workforce today, but like, how do you get people to want to be engaged? Or how do you get people to to show up and have that voice in the work and do those sorts of things? Um, and so hopefully today we can kind of talk a little bit more about what you've identified as some of those core ingredients, if you will, um, to really set your unit or your organization up for success. So um, when you think about units where nurses are engaged, especially when we are thinking about new grads, of course, we want to keep that in mind. But what do you see as some of those core ingredients? What do you think has to be true in order for that engagement to happen?

Guest Dr. Dan Lose:

Yeah, I think it starts with, well, I'll start with calling it really a healthy work environment. I think it's an environment that is really conducive and supportive to uh people being able to speak up with questions, to ask, to learn, to grow. Um, and so there's a lot that goes into a healthy work environment. But I think it starts with that. I think of our new grads who enter the workforce. I mean, I think their experiences are different now than even they were three, four, five years ago, right? And so, as leaders, and that's when we kind of speak from that lens as most of my career and where I want to help our teams is, you know, our leaders have to know each person's strengths, what brought them to the workforce, what are they looking for, expectations. And I think that's core. And I think that's about that relationship and trust. I guess that's the one thing I've seen throughout my whole career is I think at the center of that, it's about that trusting relationship with me as a new nurse, but also all those people around me. And you got to be really intentional about developing and and maintaining that.

Host Nicole Weathers:

Um, that was something that came up in our conversation last month with uh Dr. Katie Boston Leary around it really needs to be relational, right? And we need to, we need to kind of know what's going on in the lives of the nurses that work for us. Um, and so we can um better sort of understand kind of the perspective that they're walking, you know, through the door with each day. Um, and not that we can fix all of the things for them, but just having a little bit better relationship and I think understanding of that positions us as leaders to make better decisions and to kind of um, I think be there uh to support that individual the best way that we really can in that situation.

Guest Dr. Dan Lose:

Yeah, absolutely agree. And I I loved uh listening to last month's podcast and you know some of the ideas of hospitals having to think of the color system, right? Or how you do and checking in with people. And I like that. But I think even if you don't have that formalized, I think what I've seen is our teams, you know, consistently having a huddle at the shift at shift change and just getting together, right? It's sometimes just seeing each other. Um, you know, you can quickly look and go, gosh, something looks off. Like I'm gonna check in as we get going, or it gives the chance to bring the team together. Um, I've been part of teams where you know that doesn't happen and you kind of get siloed and you kind of can miss those golden opportunities to see that something's off. Or the flip side, you know, someone's just beaming, you know, and you've learned like what's going on? Oh, I got engaged this weekend. I mean, right, there's fun things that come out of this too. I think we focus on the maybe when things aren't going well. But I think that connection is is so important as you get to know people. Again, I it's said earlier, I think it's really about you got to be intentional about different interventions to continue that. It's not, it doesn't happen by by luck, right? It's you got to be thoughtful. And so uh I'd like to even go backwards through that interview process. I think that's where you begin to establish that relationship. As a as a new nurse, you're really just you're nervous. You might like think back at some of the interviews I've been a part of, and you want to make the right impression and I want to get hired. But you know, on the flip side, it's also a good opportunity for for for the person being interviewed to to assess the people they're meeting with, right? And I think often you find those connections right away, even in that interview process where you feel comfortable, you feel like you're yourself. I think that's establishing that psychological safety that, gosh, this is a team I want to be a part of because as a new nurse, there's gonna be lots of ups and downs and having a team around you to celebrate the good times and be there to help pick you up and carry you when things are challenging. So I think it's starts early and it continues through for sure that first year and beyond.

Host Nicole Weathers:

Well, and I think there's so much you can tell, even in the interview process, about what that culture is going to look like. So um on both uh interviewee and interviewer sort of perspective here, I mean, we both need we we both need to be aware of that, right? That we're putting our best foot forward because maybe those people that we're interviewing are basing their decision based on sort of what that feels like um at that time. Um, but then also, you know, that the interviewee is paying attention to those things because uh ultimately, I mean, we everybody wants to make the best tire for the role. Um, and so if somebody's not a good fit, we don't want to get them in there uh in the first place. So, okay, so besides healthy work environments, any other sort of core ingredients, if you will, that need to be in place?

Guest Dr. Dan Lose:

I think it's two, right? We talk the healthy environments, I think some of that is driven and made a priority by the formal leaders. But then I think the key ingredient is also the rest of the team, right? You've got a lot of often team members and their role of knowing how they can help establish or you know, maintain an engagement. And engagement right is a very broad term. But I in my look at it as, you know, I have experience here and I want to make sure anybody new coming to our team is gonna feel welcome. And so I think that's part of the healthy, but it's beyond that, right? It's connecting the dots, really making sure that they know how to get through a day, a shift. When a problem arrives, they can be a connector. And then also our new nurses, I think, are a key part of engagement. That, you know, I think you have to come in with an open mind to listen, to learn, to be a part of it. Um, you can have a great team, but if you just kind of want to go through the motions, I think that's a it often I see that it doesn't lead to the fruition and overall engagement we all strive for. And I think it takes, you know, the person who's new to the team to really make a conscious effort to say, hey, I want to, I'm all in. I want to be a part of this. And so when it all happens, it's pretty awesome to see. And if that's uh very fortunate or the fortune to be with some pretty great teams that high engagements, you know, whether you take the surveys, we can get into that, you know, how you how you measure it, but it really goes beyond, I think, the once-a-year or however long an organizational survey. It's it's really the everyday. You walk around a unit, a clinic, whatever it might be, and you know, you see people smiling, laughing, working together, sitting together, it's those little things. A visitor or a family member comes through and you know, people will make eye contact. How can I help you? I think those are the little signs in engagement, but back to what creates that. It's that just you know, that culture of this is how we do things here.

Host Nicole Weathers:

And okay. Anything that you see maybe nurses, uh, nurse leaders focus too much on or not enough on when it comes to engagement.

Guest Dr. Dan Lose:

I think the piece that's so important is that connection, the one-to-one. And I think I hope we get into this a little bit is I'm very passionate about having the infrastructure and the resources for our local leaders to be able to drive that engagement. Um, like I said, I don't think it's as simple as, you know, I you send an email or the survey. It's the day-to-day, at-night, weekend interactions. And so what I see, you know, those those high-performing teams is those leaders invest time to get to know their team members. And so that's walking alongside, sort of, you know, coaching at the elbow on things come up and how do we work through it together? It's rounding and just talking about things, going, hey, gosh, Nicole, I, you know, last this last weekend you were gonna go visit some family. You know, how did that go? Right. Having that is is so important. Or as we talked earlier, when you recognize something's off for the positive, or, you know, it can tell you've had some stress going on. I think energy and the commitment that takes is hard to quantify all the time. Role as a director, that's something that I'm still working through and looking across the country who's kind of figured that out is, you know, how do we make sure that they've got the time to do those conversations? I think historically you could say sort of the soft skills or those people, but I think it's so important to really drive that business of engagement is it it takes time. You know, nursing, we're we don't often I'm thinking of the inpatient setting, but a lot of areas, right? You've got a lot of team members that are working a lot of different hours. And so to think that you've got leaders that are just here, you know, eight hours a day, we're missing the mark there. And so how do people have the bandwidth to still get their day job done, but be here, you know, to touch base with the the staff who work only on nights or on Saturdays? I think that takes planning and support uh to be able to meet that. So I think that's something we talk about. What do people do? Is is those connections and relationships are probably the number one thing our leaders should or do spend their time on.

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Yeah.

Host Nicole Weathers:

So let's, I mean, I you you brought up kind of this idea of infrastructure. So I think we need to talk about that because I do think that most of the time what we see is it's not that the leaders don't, you know, support their staff or they're not interested in their staff, but that middle leadership role is tough. Uh, because there's so many things that they're expected, you know, to do. And then making that connection with their staff on top of managing all the other things is just a lot. So talk to us now about the infrastructure. Like what do you see that needs to either be in place or what you've seen be very successful as being put into place to kind of help with this?

Guest Dr. Dan Lose:

Yeah, I think there's a couple different ways. I think the key is to really look at each microsystem unit clinic, right? What are those words to do sort of a gap analysis or what's going on, right? I'll just set if you've got a team that hires one new grad every two years, very stable, that that what that team needs might look very different than a large unit that hires 10 new grads every quarter to meet, right? And so I think understanding what's going on and what the people on the team need is is step one. And then from there, I think understanding what the leaders are spending time on or what's preventing them to meet sort of those targets of connections. And so things that I've been a part of or have seen across the country, it's you know, looking at things that can be delegated from nurse managers and say AONL is that allow with us too of looking. So those administrative tasks. So current organization I work with uh is trying to take some of the scheduling and payroll off of a nurse manager and shifting that to non-clinical staff. And so while there's some challenges there, I think the beauty is that frees up, you know, it can be up to an hour a day I've had leaders spend on just making sure people get paid correctly, right? And looking at tomorrow and next week's schedule. So that's just shifting some work that historically was a nurse manager can do and shifting it. Uh, partnering with other departments to do things like, you know, audits of space. You know, I've worked places where it's the nursing leaders that should go through and make sure that the environment of care is appropriate. And then I've worked places or have seen across the country where you've got, again, non-clinicians, they step up and they round and help. And so it's looking at all these things that we need to be compliant from a regulatory standpoint, and you can shift it. Uh, the last thing I highlight is I think there are different roles that you can add. So whether it's assistant nurse managers that can help. Big role I like is called uh clinical nurse leader or clinical practice leader, different ways of looking. And so these are, you know, uh at the university we had uh a unit where we brought in a master's prepared nurse leader who worked, and we really looked at all the different roles. And so they each between the manager, the assistant manager, the clinical leader, had different uh things that they were accountable to. And we were very forthcoming with this, the team members, right? The staff of who's doing what. And the outcomes were amazing, where you know, there was amazing focus on communication, on education, on onboarding. And so that took us hiring a whole nother leader to add to that team. Sure, a brief little story with it is you know, we were introducing this concept, and I had an experienced nurse pulled me aside and just said, I don't know what we're doing, right? We need people at the bedside. Why are we investing in another management? And so, really, listen, but challenged a little bit in the vision was it's not about hiring management, it's about hiring, you know, local leaders that are engaged with our staffing and help do these things right at engagement to help with that. And uh, you know, two years after we went live, total change and improving right dynamics of the team, the engagement scores, the retention, the quality outcomes all improved. And I think it was about not adding more management per se, but having expectations be able to, you know, meet reality. And so um that was a big one. And I really firmly believe in that too, is sometimes you got to invest in the infrastructure. And so we'll shift to that because again, there is this balance between, you know, when there are limited funds and healthcare, all the healthcare financial challenges now, you know, how do you make a good business case to say, gosh, you know, this role is so important and it's leading to good outcomes for our people, which in turn leads to really good outcomes for our patients.

Host Nicole Weathers:

And so and that you're that's kind of brings me to a thought that I've had a lot around this idea that, like, yes, culture is so important and these healthy work environments are so important, and they are the key ingredient before any of the other things, right? We've got to have this established. And with that, you do you need to have certain people because it it is a it's a it's a relationship, it's a connection, it's a belonging sort of piece of the puzzle. And so, in order to do that, I mean, I I true or false, financial health of the organization is very important.

Guest Dr. Dan Lose:

True. Yes. Yeah. Yeah. I think that is very true. Right. And we won't go too deep into that. But I do think you sometimes you can look chicken or the egg, right? You want to invest in these different roles to support our teams and our patients. But yet when finances are tight, it's hard to invest. But on the flip side, right, the failure to have the right infrastructure in place can lead to costs getting out of hand too. And you think about right, absenteeism and turnover and you know, the agency contract labor market. I mean, all those things are really expensive as well. That outcomes to patients. And so it's, I think, you know, would say some of the best partners nurse leaders could have are those financial members of our team too, right? As being in lockstep so that we're using the same language. All of this, right, is a business case to drive interventions that lead to that engagement, which lead to the the workforce everybody wants, which at the end, right, impacts the patients.

Host Nicole Weathers:

Well, and maybe sometimes it's it's cost avoidance, right? So we're avoiding some of these turnover costs because of maybe some of these, you know, clinical nurse leader roles or whatever that we've added.

Guest Dr. Dan Lose:

Yeah, that's correct. Yep. And I think it's just back to having the trust and alignment with, you know, the rest of the organization so that you know comes to fruition and making sure we're we're measuring it and can can capture it. So okay.

Host Nicole Weathers:

So we've talked about investing in maybe key roles to kind of help drive uh the culture, which helps to drive the engagement. Um, other things that you've seen that really do make a huge difference, uh, like when you invest in them.

Guest Dr. Dan Lose:

Yeah. Uh I would say, right? The other thing is process, I think structure um to call out, you know, when you hear feedback from from our teams floating, right? They go to a different area and there's, you know, didn't feel like they were welcomed or they got a tough assignment or whatever it is. I think hearing that and then doing something. And so I've been a part of, you know, make sure everybody who goes to a different area gets a brief handout with all the things they need to know that the expectation is that a charge nurse or somebody will look them in the eye, welcome them, give them the handout, you know, and then at the bottom or on the back of the handout, there's a hey, we, you know, we really care about your experience. And so let us know how we did. And so I've been a part of where they scan a QR code, give quick, you know, flickered scale back of how did it go and some comments. And the beauty of technology now, right? I can I get it automatically to my phone as soon as somebody fills an out. And so we're getting real-time feedback on how did things go for you this shift. Um, and I say that as I think this isn't about a person writer, but the expectation and the process is there so that we have quick follow-up. When things didn't go well, we can intervene like within a half hour at times. It's like, ooh, this is urgent. Let's let's let that person know that we care. That leads to better engagement and change. Flip side, when things go well, we can then recognize and celebrate, you know, the staff that welcome them. And so that's one example, but I think that's about process structure that leads to engagement, is you have to, again, be intentional and committed to it. Other things I see is you know, fun in the workplace, I was called, you know, that you gotta be intentional about we're here to have some fun too. And so I love the teams that will do shout-outs to each other, kudos. They'll have monthly, you know, social events to do you know different things. Uh, current organization, we've got a book club that we're doing. I mean, right? There's just those little things, but I think they add up to that secret sauce of engagement. It's one more, I shouldn't call it a secret sauce. I don't think there is one thing, but it's another, another piece of that puzzle that leads to, you know, where I see those teams that are thriving. And it's they do those little things well.

Host Nicole Weathers:

I love that. I mean, I think in healthcare sometimes too, we forget about fun. Um, because it's serious, it is serious business, right? And there's a lot going on right now. Um, and in general, in in the healthcare world, that fun sometimes probably falls to the bottom of the list. So I really like that you point that out because I do think you have to be intentional with that.

Guest Dr. Dan Lose:

And I, you know, there's a term, uh see if I can remember it here. More or less, I'm I'm blanking the exact term, but you know, almost uh forcing fun, right? It's like toxic positivity, I think is the word. I think there's a fine balance, but I I I rarely I would rather error on the side there. But I think you have to be you know thoughtful of of what's going on in the world, right? And a lot of current events going on now in the world. Like our teams, like we just talk about it, right? Things aren't great. There's a lot of concerns people are having, and they're concerned about their own or a patient's safety. It's so we just create a space to talk about that, and it's not fun, but I think those are also the moments you have to have to balance. And I'd like to think that leads to that strong engagement too, that we're we as leaders and our team are willing to have tough conversations because you have to. Again, we're part of that. It's not just everything's great. So I think it's that balance.

Host Nicole Weathers:

So we have we we need the financial health to hire the right people, put the right processes in place, and have a little fun while we're at it.

Guest Dr. Dan Lose:

I mean, I'd say that we can do that every day. That's a pretty good day.

Host Nicole Weathers:

Yeah, absolutely. So, do you see, is there like an investment that you think leaders think help with engagement, but really don't move the needle?

Guest Dr. Dan Lose:

Maybe it's controversial. I gotta be careful here. But I think for a while there, you hear a lot about compensation is you know what brings and keeps people. And I think there's a really important role for compensation. Um, but I I do believe at the end of the day that that is not a key driver of engagement. So again, not advocating you reduce it, but I think when compensation's fair and and good, then what keeps people really is all the other things we talked about.

Host Nicole Weathers:

I mean, I think it's important that you say it's fair, right? So we're not, it's not that, oh, we can pay them nothing. Um, because the the compensation is what maybe attracts them to your organization to begin with. But then I think what kind of that retention and engagement piece is really, as you said, all those other things that you're that we've talked about.

Guest Dr. Dan Lose:

Yeah, you said it well, like I really think maybe pay is I think a foundational, right? We are we are hiring nurses to do a job. So we'll be very clear there. Um, but I think that is that is uh a piece of the pie. And so, you know, it's easier really at times to just say, well, let's just increase pay and move on to the next problem. And I think the hard part is making sure that you've got the right resources every day, that there is that engagement. That actually, I would say is harder work from a from a leading standpoint, is that takes more time and energy than than that. But that's that's where you see, I think, the true value of people feel that sense of belonging and purpose.

Host Nicole Weathers:

Because I would say there's jobs where like it wouldn't matter what you paid me if that work environment was so toxic or so short-staffed or so so whatever, it's not going to matter what my compensation is. I don't want to be there.

Guest Dr. Dan Lose:

For sure. Exactly right. Yep. And our goal, I think, is to create an environment where people go, I don't even know what I get paid. I love, I mean, I get paid well, but I love my team. And that's like what drives me, right? Is that. So I think um, yeah, I think that's that's one way. And that's partly how you build those business cases, right? Of let's get the right people, the right roles, the right training. Um, that's where I like to see that investment of financial investment go. Is the people are already here and doing things right? Whether it's uh, and that's the fun thing. I we were talking, I think before we started, but in today's world, I think with the financial challenges, but still being able to invest in professional development for our team members, for our leaders is that's another one of those intentional, you've got to be committed to that. Because that's an easy thing to cut to when things are tight. But continue to invest again from leadership lens, we talk about engagement. I think it's constantly evolving of you know, what are best practices and what are people doing. So being able to invest in sending these, you know, frontline leaders and supervisors to go to a national conference or do some training is huge because they can bring back what's new evidence, let me, you know, fine-tune how I do things, and that will lead to to strong dividends at the you know, with our team members as we onboard.

Host Nicole Weathers:

So let's talk a little bit about nurse residency now. Um, and because you know, this is always the million-dollar question, too, is investing in new graduate nurses, thinking specifically about that first year as a nurse. Where do you see maybe new nurses struggling the most? And maybe it's because the system isn't set up the way it needs to be.

Guest Dr. Dan Lose:

A lot of overgeneralizations, I'm learning, right? With when you think about different generations and then people come to the workforce. I think, you know, we're seeing, I'm hearing from some of our new nurses now with different career goals than maybe they did, you know, a couple of years ago. And so a lot of people, it's, you know, this is a means to the end. Like I want to get my foot in the door and I, you know, I want to be an entrepreneur, I want to be an influencer with the nursing here within the next 18 months. And I think that, like, I, you know, having to pause and listen and go, okay, so how do I like make sure that we're supporting your goals and at the same time, right, helping you be successful long term. And so it's challenging some things of, you know, it used to be you got to work a couple of years and inpatient and med surge and this, you know, and it's people all wanted to be nurse practitioners for a while. And so a lot of our engagement was supporting them to gain these skills and go on to grad school. And, you know, people I've talked to are seniors, like they're not really a lot of them weren't as interested to go into graduate school now than maybe they were. So it's it just is always evolving. And so that said, when they get to the workforce, really understanding, you know, what is it they're looking for and and how do we meet them? And it goes back to listening, right? Part of the interview. And then I've learned even though when they get there, it's you know, how do we have those conversations again that first week, that first 90 days? So it's about what are their goals? Let's let's align expectations. I don't interview people directly, it's you know, then they're new grads now, but and I'm have these conversations and I'm rounding and meet with them. It's, you know, gosh, I know they mentioned having to work nights, but like that isn't gonna work for me. Like, right? My own well-being. Like, I don't do well in night, so I have to do days only. And so I think that's part of expectations meaning reality, just some of the simple things like what's your schedule gonna be? Um, helping managers see. I know you talked about an interview, but we're gonna have to go back to that.

Host Nicole Weathers:

I mean, that is the system, right? Like 24-7, 365. And maybe there's nothing we can do about that. I mean, maybe there's something that could be done about that, but I don't know. I mean, that I don't like to say never, but like some things aren't going to change. And that is probably one of them that we will always need care 24-7, 365. And so I think that is a very real place where new nurses struggle. Some of that is kind of the sacred cow of like, this is the way it's always been. So, you know, this is the way it's always going to be. Um, but I but I do think that is a huge driver for new nurses. And while you know that they talked about it in the interview, you don't really, they don't take the time to maybe really think about what that is like in in real life.

Guest Dr. Dan Lose:

For sure. I think some of them too like are new nurses, right? Maybe I hadn't worked night shift before. And so you start getting into it and it's a big change. I mean, I worked night shift a couple years and you know, early in my career, and it is, you have to get used to different eating habits, sleeping habits. People, you know, I was joked, the rest of the world store still runs on day shift hours. And so, how do you see friends and family? And so, you know, being able to connect and listen, and you know, I think that's really important too. Is I've had staff and team members just say, thanks for like talking about it, right? Because we can work through some strategies together. I can connect to you with things. Um, I've learned like oftentimes food in the hospitals overnight is is not the healthiest, best food either. And so, how do we then advocate to go? How do we have different options? Like if that's food carriers or you know, helping them realize like it's all right to go for a walk at night to get your exercise in, or you know, these little things. But if we don't talk about it and we just ignore it, you know, I think this is the engagement I would say from a new team member and a new nurse going through residency is you know, having that space, space to speak up to go, I'm really struggling. I want you to be aware and see what we can do. And to your point, Nicole, maybe there's not a quick fix, but at least let's let's open the door for conversations that we can work together rather than feeling like we lose somebody from a job or from the profession because they didn't think there was another option, I think.

Host Nicole Weathers:

And so yeah. And I think, I mean, I love what you're talking about here though, too, is this isn't a conversation that's just happening in the residency program. I mean, these are things you, other leaders in your organization, these are conversations you're having one-on-one with staff. True?

Guest Dr. Dan Lose:

Yes, that's what you're saying. Okay, yeah. I think that's key. I think when you talk about like where people succeed or when you see these engaged teams, I think that's this is an example of, hey, they they know when I'm struggling month three that I can, you know, I'm I know my manager's gonna check in with me next week and I'm gonna talk about it, or I know how to get a hold of them, him or you know, she, and so I'm gonna talk about it. And then I've had success where, you know, people's schedules do move, or let's let's partner you up, let's align your schedule with so-and-so because you guys have connected and they're an amazing mentor, right? I mean, there's things we can do, and that's where I, you know, I've been fortunate to work with really good managers and leaders, but you know, making sure that managers know it's not like this is the way it has to be, right? I went through this as a new nurse, they're gonna have to just suck it up for the first year. I really don't hear that much anymore. And I think that's great that people are, you know, leaders are challenging their own thinking and knowing, you know, I gotta be, I gotta be nimble and responsive and figure out how we connect.

Host Nicole Weathers:

But yeah, I think this is a really important point. And I think something that we sometimes see organizations struggle with a little bit is we put all of our eggs in the red nurse residency basket. So meaning it that's all being talked about in the program or in the classroom or in the whatever. So we don't think as a leader, maybe we need to worry about that. And we're always encouraging them to but you need to check in, you need to follow up, you need to talk about what are some of these same topics that are being talked about in the residency program. Because if the work environment doesn't mimic what they're being told or talked about in the residency program, that's gonna be a driver of engagement too.

Guest Dr. Dan Lose:

Yeah, absolutely. Um, things that I've I've seen or try to be intentional in my roles are, you know, when when we have our residency monthly sessions and really, you know, that the ability to connect with peers and that's I call it that safe place, right? Sometimes they just need to be able to vent. Um, I've had great relationships with our um facilitators that they know and they've established the trust with the nurse residents that they're gonna bring this to the leader because they go, hey, you know, we're not gonna speak specific names or but but what you're saying, you know, Dan wants to know this type of stuff because we got to make change. And you know, I would say 99% of the time they give permission to talk about it. I get briefed on it, and then we bring it back to our teams. And again, it's not about one person, one situation. It's when you have those system things. So agree. I think it's like sort of not exactly, but it's almost like you delegate things, right? I can delegate responsibility, but the authority still sticks with me. And I think that's true as leaders, is I think it's amazing when we have redincy programs that we've got directors, we've got curriculum, facilitators. That doesn't uh excuse my role at helping them on board or right, making sure that we're aligning. So I appreciate you bringing that up because you're right. It's you know, it's it's uh we gotta be in in integrated, I think, as a full team and making sure that we're supporting our new nurses.

Host Nicole Weathers:

Yeah, I mean, it really comes back to that idea that it really takes a village. Um the it the uh the residency program coordinator isn't the only person uh that is helping with this, right? Or that is really going to make a difference in in the success of this new nurse. It takes all of these different roles and a lot of the things that we've talked about today.

Guest Dr. Dan Lose:

Absolutely.

Host Nicole Weathers:

Okay, so I want to talk a minute here about kind of the financial piece because this is something that we see it see a fair amount of still. You know, when budgets get tight, really effective programs end up on the chopping block. Uh, nurse residency is what we're talking about. So, from your perspective, because I know leader, this is probably a decision maybe you help a lot of leaders with, but what what really helps nurse leaders make some of these resource decisions that truly support nurses and engagement? Um, and where do you think we sometimes miss the mark?

Guest Dr. Dan Lose:

I think making sure there's alignment and goals and follow through is really important. So, you know, not just at budget season or you know, I got to make a decision on scheduling. I think we talked a little bit before, right? The alignment of your, you know, the residency director or the facilitators, having that alignment with the managers. So, you know, ideal state is the managers see the value that this program brings, right? When the new nurses have that support, they come back, they learn something, we can connect. You can see it, right? And so I think successful transition for our new nurses is a huge investment that the managers appreciate. Because at the end of the day, they want to have a great team of people, right, they're working alongside. And so when that's cooking, you know, then it's really off the table from a manager. They're like, I want this residency because this is like a huge, amazing thing for our new nurses. So I think as you need to work away up decision-making chain of different people as you get further from it, right? It can become maybe appealing to go, oh, that's not maybe cut. It is that alignment. And so making sure your senior nursing leaders can speak to the value of what it's doing is is huge. Again, been fortunate, the two places I've worked the last 10 plus years, that I haven't heard that being part of something to cut. Because it's become integrated into the value of right our people. And so I think if you get to a team or, you know, as leaders listening to this, where maybe you don't see the value, I think that's where really going back in and talking to somebody like Nicole, really bringing your like team together to go, gosh, if we're having doubts about the value of this program, what do we need to do differently? Because I think when it's when it's operating well, right, there is so much value. And I can speak to that as I've gone across the country on these site visits. Like new nurses love the experience. Maybe some days are like, ah, I don't know. But but overall, when you get through the program and you say, gosh, that year I I learned a lot of hat support, you know, really feel like if we're where we are today versus 10, 15 years ago, there is there's a belief in the residency value.

Host Nicole Weathers:

A couple places where we can sometimes see a little bit different perspective would be um while you're in it's is I always compare it to going back to school. Like while you're in it and you're having to show up on those extra days off, or you know, you're having to do an extra sim day or whatever. When you're in it, you don't always value it the same as you do, sort of once you're done with it.

Guest Dr. Dan Lose:

Yes.

Host Nicole Weathers:

Does that make sense?

Guest Dr. Dan Lose:

Yes. You know, what one intervention to that that I saw um, believe it's someone on the East Coast, what I liked was as our nurse residents were finishing the program, like they wrote a letter to future nurses. And I don't know if this is something you've seen, but it was kind of a cool little activity. But they like spoke to that as pre then current residents as we were talking to were like, yeah, I read this, and it really challenged me, right? Because I had my own preconceived notions. But to hear from somebody that went through it and now sees value when you get to the end of the tunnel, I think that was more impactful to them than hearing it from someone in a leadership role or the program director. And so part of that is it's a good point, right? Is how do we we help people see that?

Host Nicole Weathers:

Mm-hmm. And I would say the other thing is sometimes, um, and maybe you've heard me talk about this, but sometimes they they put all of their eggs in one basket when it comes to like retention. So we maybe implement a program because we have a retention issue, maybe we have a pretty small staff. And so I still maybe have this nurse leave because of, you know, X, Y, or Z. Maybe doesn't have anything to do with the support they were getting through their first year or whatever. But so because I still am not seeing that retention goal that maybe I'm after, then it must be that the program's not doing its job.

Guest Dr. Dan Lose:

I would say to those leaders, step back a little bit, broaden your lens. I think most things rarely do you find one intervention that leads to one outcome, right? It's it's that um understanding is this a one-off special cause variation of so you're still going to be some turnover. Uh, but is the overall value in the residency program, for example? Um, again, trends I'm seeing nationally are, you know, that first year retention rate is not as high as it was before. And I think part of that is pretty mobile workforce, right? People are willing to move. And if they have an opportunity six months in, it's not necessarily a direct negative, you know, uh result of a poor residency or even a poor work environment. It's just the reality of, you know, I want to, I'm I'm mobile. And so I think you got to be okay with that too. And so I think with that, then is on the flip side as nurse leaders, when we make you know the business case for things like a residency or anything, if you put all your eggs in a basket to say, right, I need this, this investment, it's gonna lead to this outstanding outcome. You got to be cautious about what you, you know, you don't want to overpromise to, because I think then you're stuck going, oh my gosh, it didn't deliver and now I'm gonna lose it. And so I think those are those back to that conversations with our financial partners is, you know, rarely does one thing lead to a perfect outcome, but it's trying to hit multiple outcome measures.

Host Nicole Weathers:

Yeah. And I mean, I think that's what we talk to them a lot about is, you know, what are what are some of the other good things that are coming from this, though? Like, are they getting competent quicker? Are they becoming a charge nurse quicker? Are they ready to precept sooner? Are they, you know, engaging in some of these, you know, different committees or shared governance or unit based councils or whatever they are because they've been exposed to these things in residency. Um, and so I I agree with you having multiple sort of outcome and process measures that we can monitor to really show what the value is, because at the end of the day, there's so much involved in retaining a nurse, you know, um, and their decision to stay or go. Uh, that if we rely solely on the residency program or say that that's going to be the one thing that solves our problem, we're just missing the mark, you know?

Guest Dr. Dan Lose:

Totally agree. I love that, you know, often in curriculum is you know, the piece about performance improvement or quality improvement, for example, right? You get a taste of it, often do a project or part of a project. And, you know, it's not necessarily about what that project solved, but I think it's introduction to those concepts because, gosh, for the rest of their career, right? We're gonna have these conversations with team members. And whether it's, you know, as things tighten up, we need to reduce readmission rates, we want to reduce falls, you know, that engaging of how a leader sets a vision that we fall through is only gonna be as good as right, the team members actually providing the care, hear something, know what to do with it, see the value. And I think residencies have helped establish, you know, beyond just clinically, you know, to do certain skills, it's the you know, a little bit bigger picture of healthcare in the system we work in. And so the things that you learn in that first year, you know, maybe doesn't seem relevant at the time, but two years later, when you know your has got to work on something, are you engaged in it and help make a difference? And that could be the difference of a patient's right mortality, like as we follow the best practice and that save lives. I mean, there's so much impact that you could, it's hard to measure exactly in the moment, but I think holistically, globally, over the course of your career, these you know, the goal is that the nurses are, you know, are feeling like they're making a difference.

Host Nicole Weathers:

Well, we've heard from a lot of uh new grads too, that like they just have a better sense of what's all involved in making a change happen anyway. So, like when I think something needs to be fixed and it's not getting fixed overnight, that I now have a better understanding of what it actually takes to make change in my organization. Okay, so as you look ahead, five, 10 years, what do you think nursing units will need from a structural standpoint, from a cultural standpoint to keep new nurses engaged?

Guest Dr. Dan Lose:

Yeah, that's there's that's the million-dollar question. Um, I, you know, I think it's continuing. We're going through this this state of, you know, technology's evolved, right? I mean, I but I think it's still gonna figure out what what does technology look like? And engaging with our nurses, I think, right, that'll be huge. It's how it becomes a supplement and a supporter of the work and not a replacement. I think that's I see that and feels very strongly on that. Um, but the beauty of of new nurses entering our workforce is technology has been a part of you know their life forever. And so things that are very, you know, we'll have to lean into them and learn. So I think people entering a workforce today, they're gonna help set the tone for how AI helps, ambient listening, um, you know, whether it's remote care. But also at the end of the day, I think we still are gonna have to be able to connect in person with our with patients. That's I think something that'll never change. There's gonna be hands-on care, there's gonna have to be the ability to empathize and connect while at the same time, right? Managing and and leveraging all sorts of different technologies. And so I think that will be key, is we're gonna have to, as leaders and as a team, create an environment that does all those things. Because I think, you know, if we aim for technology to replace people, it's gonna fail. I think if we ignore technology and go, we just need more people, I don't think that'll meet the mark. And so our key will be to engage with the workforce to go, how do we leverage everybody's strengths, talents, abilities to meet the needs of our patients?

Host Nicole Weathers:

I do think that is always something that comes up, especially with new nurses, is you know, they are very comfortable with technology and they're not always super comfortable with uh human skills, if you will, right? The face-to-face stuff. And so while they can help shape where technology goes, maybe and how it's used, I think those of us who maybe aren't as um tech savvy or didn't grow up with an iPhone in our hand can kind of help also shape some of those more human type skills uh in our new nurses. So the best of both for sure.

Guest Dr. Dan Lose:

It is and that's the piece, you know, engaging with uh I had a nurse in our team 40 years as you know, at the bedside and in our conversations, just recognizing, hey, you know, she needs a different skill, different type of work. She has so much to give, so much experience, but the physical nature of our environments. And so really might be able to figure out what that looks like for her to use her brain and teach and mentor. And I think there's places that do that well. But I think that will be the key, right? Is connecting her strengths with somebody who has other strengths. And together it's pretty powerful.

Host Nicole Weathers:

Well, Dan, we've talked a lot today. We've talked about um, you know, how finance drives our structure and process and fun and and helps us create these healthy work environments. Um, we've talked about, you know, technology and and where technology sort of comes into play, developing leaders. Gosh, we've covered actually a lot uh in this conversation. Um, and so before we go, I have one question and I ask this of every person who comes on the podcast. But when it comes to kind of some of the things that we talked about today, what's one thing that you wish more leaders would do to improve engagement?

Guest Dr. Dan Lose:

Yeah, I think it is prioritizing relationships. I think there's a lot that goes on every day. And I think if no matter what level of leadership you're in is carving out in sacred time to be able to connect with with people closest to the care and, you know, especially in this case, our our new nurses into the workforce to have that moment to connect, whatever that looks like. I think that would be great for our profession and for our people.

Host Nicole Weathers:

Absolutely. Well, Dan, uh, thank you so much for taking the time to uh visit with us today. I know that I learned a great deal. I've already jotted down a lot of uh different ideas that I plan on sharing with our our coordinators, our residency program. And so uh hopefully we can do this again in the future sometime.

Guest Dr. Dan Lose:

Appreciate it. Thanks for having me, Nicole, and thanks for all your good work and your leadership.

Host Nicole Weathers:

Wait, before you go, I want to make sure you know all about our suite of resources you can use to support your new graduate nurses. This includes our Academy, a coaching program designed for organizations as they prepare for the implementation and ongoing sustainability of a nurse residency program. Work one-on-one with residency program experts to make sure your organization is residency ready. Our Clinician Well-being course is an asynchronous online course that aims to enhance the well-being and resiliency of healthcare professionals, equipping them with the necessary psychological capital to navigate challenges inside and outside of work. Supporting nurses is another asynchronous online course for preceptors, mentors, and coaches to learn the skills they need to support any new hire. Both of these offerings can be used as a standalone professional development opportunity or to augment any nurse residency program. And we can't forget about the program that started it all, the Online Nurse Residency Program. This includes a comprehensive curriculum designed to support new graduate nurses applying all the knowledge they learned in school to their practice. We focus on professional skills, personal well-being competencies, and new graduate nurses even get the opportunity to create real change in their own organization. Offered completely online and in a blended format, this program is highly adaptable to all clinical practice settings. You can learn more about all of these programs and more of what we offer using the links in the show notes below.