Safety First: How Psychological, Professional, and Physical Safety Shape Nurse Success

What does “safety” really mean in today’s healthcare environment—and how does it impact new nurses’ confidence, competence, and long-term success?

In this episode, Nicole Weathers is joined by returning guest Dr. Heidi Gilroy, Director of Nursing Practice and creator of the Trauma-Informed Professional Development model, to explore the critical role safety plays in nurse engagement and retention. Together, they unpack the three key dimensions of safety—physical, psychological, and professional—and why healthcare organizations must prioritize all three to create environments where nurses can truly thrive.

Dr. Gilroy shares how safe learning environments foster mastery and self-efficacy in new graduates, why transparency and accountability are essential leadership behaviors, and how a trauma-informed approach can support both clinicians and patients. The conversation also challenges traditional thinking about nurse culture and highlights practical strategies leaders can use to build safer, more supportive workplaces.

If you’re a nurse leader, educator, or residency coordinator looking to strengthen engagement and retention, this episode offers actionable insights you won’t want to miss.

GUEST: Dr. Heidi Gilroy
Director of Nursing Practice

Heidi Gilroy, PhD, RN, NPD-BC, NEA-BC, is a nurse leader, scientist, and educator. She serves as Director of Nursing Practice at Memorial Hermann The Woodlands and Course Director for Leadership and Management at Sam Houston State University. Dr. Gilroy earned her PhD from Texas Woman’s University in 2015 and has focused her research on better leadership and development of nurses from undergraduate students to experienced clinicians. She developed the Trauma-Informed Professional Development model, focused on supporting healthcare professionals in learning and practice environments. Her career spans academic, community, and clinical settings.

https://www.linkedin.com/in/heidi-gilroy-phd
https://www.researchgate.net/profile/Heidi-Gilroy 

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

Transcript

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Welcome And Why Safety Matters

Host Nicole Weathers 0:02

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. So, over the last several episodes, we've been talking a lot about kind of the these key ingredients that drive real engagement for nurses. What helps them feel connected, competent, committed to their practice. And actually, just yesterday, I had the opportunity to conduct a focus group on this very topic. And one of the themes that came up over and over again in every single group was safety. Not just being physically safe, although that's super important, but psychologically safe. So feeling like we can ask questions, admit when we're unsure, speak up when something doesn't quite feel right, uh, and professional safety. So there was a lot around appropriate staffing, reasonable patient ratios, um, systems that really support nurses, even when they're floated to unfamiliar departments or caring for new populations. So this month's topic couldn't be more timely. We're going to talk about safety this month, what it, what it is, why it matters, how it shapes confidence for new graduates, and hopefully how it influences engagement and retention and what leaders can do to really begin to cultivate safety on their units and across their organizations. So to help explore all of this, I'm joined today by Dr. Heidi Gilroy. You may remember Dr. Gilroy from season one, where we talked about trauma-informed professional development. We are so excited to have you back, Heidi.

Dr. Heidi Gilroy 1:52

Uh, thank you so much for joining us today. Thank you for having me. I'm excited to talk about this very important topic.

Host Nicole Weathers 1:58

So, why don't we start off by just having you kind of introduce yourself to our listeners in case they didn't meet you in season one?

Dr. Heidi Gilroy 2:04

My name is Heidi Gilroy. I feel like I've done all kinds of things in uh in nursing practice. I've done uh pediatric critical care. And then as you do in nursing, I went to the very opposite end of the spectrum and did some public health. Um, I've worked in research, I've worked in leadership, I've done a lot with uh professional development. Um, and so as a result, I kind of have all of these different clinical and leadership background experiences, and I've been able to really put some things together that I think can help nurses uh really be safe and more effective in their practice. So I'm excited to share some ideas with you today and you know continue this conversation we started in season one talking about uh trauma-informed professional development.

Host Nicole Weathers 2:52

In addition to hearing you speak about trauma-informed professional development, you had an article, uh it's been a few years, I think, about this idea of safety and healthcare and the importance of the different types of safety. So maybe we should start kind of there, kind of laying the groundwork around safety and what

Zero Harm For Patients And Clinicians

Host Nicole Weathers 3:12

it is that we're talking about and what it all really does encompass when we're talking about safety for nurses in healthcare.

Dr. Heidi Gilroy 3:19

Yeah, I think, I mean, in the last several decades, we've really made amazing strides in enhancing safety for patients. So we have moved towards this zero harm concept, which really back when I started as a nurse seemed so far-fetched and maybe even an impossible goal. But we really are showing that we can provide care in a way that is safe for patients and that we don't harm them. Just this week we celebrated our medical intensive care unit for 2,000 days without a CODI. And a couple of weeks ago, we celebrated the whole hospital for going one year without a CLABC. So we used to think, oh, some patients will be harmed by care. That's just how it goes. But we are no longer accepting that because the reality is we can keep our patients safe. That's high reliability. And we talk about that every day in healthcare organizations. But when we talk about high reliability and zero harm, we sometimes forget about one important group, and that's the clinicians. And nurses are definitely included in that, a big part of that, but really all the clinicians that are working in in healthcare. Just like patients, clinicians deserve the reassurance that they will not be harmed just because they're inside of a hospital or a clinic or other type of healthcare organization. So clinicians need what you were just what you were talking about, this physical, psychological, and professional safety to be able to provide the kind of care that that will then lead to the the safe quality care that we want for our patients.

Host Nicole Weathers 4:48

So where do you see, I mean, because I think nobody, no leader says, like, oh, I don't care about safety of my, you know, nurses or clinicians. So where do you see sort of the biggest disconnect between what leaders are sort of doing or thinking about when it comes to safety and what actually happens?

Dr. Heidi Gilroy 5:09

You know, I think we a long time ago we learned, uh, you know, as as part of some of those high reliability principles, that we needed to have a reluctance to simplify. That is a, if you do high reliability, you know about that principle. And that means that that you know that if something bad happens, it isn't just happening because of one person's error or one person's problem. It is really a complex issue. You know, if a patient gets the wrong medication, it's not because one nurse made a mistake or one pharmacist made a mistake. It's really a whole line of issues. And yet we often try to simplify some of the risk to our clinicians. Um, we either blame it on the clinician, you know, if if a clinician hurts their back turning a patient, we ask, would why didn't you use the machine? What did you do wrong? You know, or a clinician gets stuck with a needle. You know, why didn't you do something different? How why didn't you use the needle right? Maybe you need education. So we have this simplistic view of clinician safety. And I think it's time, and I a lot of organizations are are kind of embracing this, it's time to think of the complexity of clinician safety in the same way that we're thinking of the complexity of patient safety and look at all the different layers that are contributing to the risk that clinicians have when they walk into their workplace setting.

Host Nicole Weathers 6:34

Do you want to

Physical Safety Beyond Lifts And PPE

Host Nicole Weathers 6:35

talk a little bit more about some of those different layers that are impacting safety?

Dr. Heidi Gilroy 6:40

Yeah, and you know, we've got lots going on here. So, you know, when we're talking about physical safety, I think this is uh the most obvious type of safety for clinicians, but really a conversation I think is is still very complex and worth having. We used to, you know, I remember being a brand new nurse and all of the nurses, the older nurses would tell me you got to take care of your back. If you're gonna be a nurse, if you're gonna, if you're gonna stay in nursing for any length of time, you gotta take care of your back because we know that nurses are at risk for some of these musculoskeletal injuries. So we've done a good job of creating structures around the nurse to make sure that they don't have those. So we've got safety equipment now, we've got training, we've got different types of teams that can come in and help us move patients. And so lots of different things are going on to help uh help us with that physical safety. But really, there are new types of risks to physical safety. I mean, we just had a new pandemic. So clinicians are being exposed to diseases that didn't exist before. So, how do we how do we deal with that safety? Um, and so you know, a lot of conversations happened around PPE during that time, around, you know, do we have one group of people taking care of all of these patients or do we spread it out? Like, how do we look at that complexity? The workplace violence um situation. Obviously, we all know that clinicians are at huge risk for injury based on workplace violence. And this is a very complex issue that that you know requires training, that requires uh some policy discussions uh with our with our state and federal policymakers, requires all kinds of different things to talk about. And that's just physical safety. So, so this is the kind of complexity that we're looking at really for all of the different types of safety, but it's very important that we don't look at it like just a simple thing that we need to teach the clinician how to react to some of these situations better. We really need structures around the clinician that keep them safe.

Host Nicole Weathers 8:49

So you you've hit on physical safety. Let's talk a little bit now about psychological safety, professional safety. Like, can you explain a little bit more about what those two terms mean and sort of how they show up in the workplace?

Dr. Heidi Gilroy 9:05

Sure. So psychological safety is something that really has been a big part of our push towards

Psychological And Professional Safety Defined

Dr. Heidi Gilroy 9:11

patient safety. Obviously, when people feel like they can speak up and say they don't feel safe or say that they feel like something is a risk to the patient, that is psychological safety. We need that same kind of safety for uh for staff that feel like their safety is at risk as well. And and thinking about these things like workplace violence incidences. How does a clinician speak up about situations that they feel like are dangerous to them as a as a staff member? So uh so that psychological safety is really that ability to speak up and really feeling like something's gonna happen as a result of you speaking up. And then professional safety, you know, as we are kind of in a chronic stage of a nursing shortage, a lot of organizations are looking for different ways to make sure that patients are safely taken care of by having different structures and different nursing models. So if a nurse is placed in a situation where maybe they are working with a virtual nurse or with a PCT or other type of structure that maybe they're not used to, or like you were mentioning, floating to a different unit where they might not have all of the information or all of the resources. So professional safety is really making sure that those nurses, no matter where they are or or what nursing model they're working under, they feel like they can give the best care to the patient. They won't lose their license, they won't hurt the patient, and they won't hurt themselves as a result of their working in the healthcare setting.

Host Nicole Weathers 10:47

And that's where, you know, safe staffing, staffing ratios, things like that would kind of come into this conversation around safety.

Dr. Heidi Gilroy 10:56

Yeah, I, you know, there there are different models, different philosophies about uh about staffing and safety in that regard. I don't specifically have an opinion about what's the most safe way to model a nursing unit, but I do think it's important that nurses have the psychological safety to speak up about any risk they see when it comes to their professional safety as well. And even if we're talking about just a nurse floating to a different unit, how are nurses trained to communicate with people in a unit where they don't know the manager, they don't know the other people there? How are they trained to have those conversations? Is that adequate uh to help them keep that professional safety that they need, no matter where they are in the hospital?

Host Nicole Weathers 11:42

So let's talk now about the influence safety has on, let's start with new nurses. So, as a new nurse is coming into a new role, a new profession, um how does safety sort of influence

Self Efficacy And Mastery For New Nurses

Host Nicole Weathers 11:58

their progression through that first year, their confidence, their competence, all the things that we're working with them on?

Dr. Heidi Gilroy 12:05

I think an area that we've been looking at a lot in all the way through the spectrum from nursing students to newly licensed nurses is the concept of self-efficacy. So self-efficacy basically means that a newly licensed nurse believes that they can do a task. So, you know, some things that we might look at are the nursing students' self-efficacy around graduating from a program. Do they believe that they can actually do this? Or even something very simple. Does the nursing student or does the newly licensed nurse believe that they will be able to do a specific task? And so with self-efficacy, really this is built up with mastery. So when the nursing student under the newly licensed nurse is able to successfully do something over and over again, that builds self-efficacy. And we know that self-efficacy is protective for the nurse in terms of psychological injury based on situations. If a if a nurse feels very confident and feels like they have self-efficacy around doing something and then something bad happens, there's a lot less likely to be some of the negative feelings if than if the nurse felt like they weren't prepared for that and didn't have that self-efficacy or that belief that they could do it. So, and we obviously do a lot of things to help with mastery and build up self-efficacy. I mean, if you have a if you have a nursing student that's that's attempted in a university laboratory to put an NG tube in 12 different times, they're probably going to feel more confident in trying to do that in a real person in the hospital setting as a newly licensed nurse than if they never had those experiences of mastery. And then if they the first time they're putting it in a real person are successful, then once again, that mastery is going to help them to believe that they can do it in the future. If that first attempt at putting the NG tube in a real person is not successful, then they're probably going to need a lot more support going forward to try to do that skill again. And that that is the same for all types of different skills. It can be as simple as putting um, you know, putting IV tubing together to, you know, something very complex, running a code and stuff like that. So when we think about mastery, it's a lot easier to have mastery in a safe environment. So let's just give a scenario where you have a newly licensed nurse that's getting ready to put their first NG tube in, and their preceptor has 12 patients and is in six different directions and really doesn't have time to help them. So kind of runs in the room, throws the stuff at them, runs out of the room, says, Well, you did it 12 times in the laboratory, so you should be able to get this done. And because of that lack of kind of professional safety, um, that that likelihood of mastery probably goes down, even if the the newly licensed nurse has the same uh kind of skill setup and knowledge setup. So we can think about the safety of our organizations as really encouraging mastery for these newly licensed nurses. When they have a safe place to grow, uh, then they're more likely to have success when they come upon these new different skills. And when they're trying to walk through a problem, they're more likely to ask for help to address that problem. They're more likely to ask questions and speak up and do all these different things. So that increases that mastery, that increases then their self-efficacy. And as a result, our patients get better care and our newly licensed nurses really are healthier. Uh, so it really creates, it sets up an environment where our newly licensed nurses can really grow and succeed and really want to stay in our profession. So it's extremely important for our newly licensed nurses, probably even more so than some of our more experienced nurses.

Host Nicole Weathers 16:07

I think that's such an interesting way to sort of think about it because, you know, we do get questions from coordinators, residency coordinators on, you know, how can I help make my new nurses competent quicker or more competent? Uh and, you know, they're always looking for, I think, very tactical, you know, uh skill sessions, things like that as a way to get there. And so I think it's really interesting to kind of think about it from a safety lens on how actually improving professional safety, improving psychological safety is actually a way to grow mastery and self-efficacy. So when we think about engagement broader lens and ultimately retention, how do you see the relationship between safety and engagement and retention fitting together?

Safety Drives Engagement And Retention

Dr. Heidi Gilroy 17:02

I think we've known for a long time that safety is an important piece. I mean, the American Association of Critical Care Nurses put a lot of that in their healthy work environments model, have done a lot of work measuring that and then figuring out how those things relate to retention and satisfaction and engagement and all of those different things. And then even thinking about the original magnet model, which was based on the forces of magnetism, which measured how certain hospitals kept nurses attracted and kept them in their organizations. And a lot of that had to do with both patient safety and nurse safety. So I think for a long time we've we've kind of intuitively known that this was the case when people feel safe, when they know that their patients are safe as well. I mean, nobody wants to work in an organization where the patients are not having good outcomes. So they don't want to work in organizations where nurses are not having good outcomes either. So I just think now we're starting to put more of a focus on it. I think we've kind of figured out how to keep patients safe. And now we're moving on to figuring out how to keep our clinicians safe as well.

Host Nicole Weathers 18:12

And I think, you know, you're identifying that improving safety can actually improve mastery, self-efficacy, and kind of the re the connection there with competency as well, right? And so sort of, and and when we're more competent, we're a more safe practitioner, and it almost feels like it's this loop that feeds one another.

Dr. Heidi Gilroy 18:37

Certainly. I think that you build on safety. I mean, we know just from trauma-informed professional development work, thinking about safety as a principle of that. If you are having psychological symptoms, if you have something like post-traumatic stress disorder because of an event that was very frightening, and you're in an environment where you're still frightened, obviously you're not going to recover from that. So that's kind of a dramatic and medical example. But I think the same can be said for if someone got freaked out in their clinical setting by something that happened and that never gets resolved, they never feel safe in that clinical environment. It's hard for them to really move on and and and succeed. And I think that's why we see a lot of people leave the profession because they never find that safety that they're looking for.

Host Nicole Weathers 19:29

So if you're looking at a unit and all three of these types of safety are present, what what does that environment look like? Or what does that unit sort of look like? What are some key indicators?

Dr. Heidi Gilroy 19:40

So one of the areas that I think you'll see is a lot more involvement in like professional governance or or or nurses taking control of their environment. You know, we we found this in the patient safety literature when people started doing interventions to increase patient safety, a lot of times the variance reports or the reports of errors, the reports of bad things happening to patients actually increased. So we thought to ourselves, oh no, like this is these interventions that we're doing are actually making patients less safe. But that's not what was actually happening. What was happening is that people felt more comfortable to talk about it. So when you have more focus on clinician safety, and when clinicians are feeling more safe, they're going to start talking more about the things that are making them feel unsafe. So at first it might seem like, oh gosh, well, you know, everyone's all of a sudden started talking about not feeling safe. They didn't used to do that. Oh no, we've we've created lack of safety, but it might actually be a sign that things are getting more safe and people are feeling comfortable and actually acknowledging that this is an important part of their job. And certainly we'll see also some measurable changes. I mean, you're probably your absenteeism rate is going to go down. People actually want to come to work. When when people are so overwhelmed and frightened to go to work, you know, there you'll you'll take any reason to call off. But if you feel very comfortable at work, then you know you'll you'll see that absenteeism go down. Certainly your engagement scores. And I know that our our ability to measure different aspects of our employee engagement are going up with some of the new tools that we have. So looking very carefully at specific outcomes of our employee engagement scores can be helpful. And things like, like you were saying, turnover, when we are able to retain more nurses, that's a great sign that nurses are feeling safe

Transparency As A Safety Practice

Dr. Heidi Gilroy 21:36

in their environment.

Host Nicole Weathers 21:37

So if we now kind of talk about leaders, whether these are MPDs or unit department leaders, organizational leaders, what are some effective ways that they can, you know, begin to take small steps towards improving safety in their areas?

Dr. Heidi Gilroy 21:55

Yeah, I have a lot of concerns for nurse leaders right now. I think that as we went through the the COVID-19 pandemic and there was a lot of focus on clinicians and trying to keep them safe, that focus didn't didn't kind of translate to the management team. And I do have concerns about managers and their own safety. So I think the thing number one is that managers have to take control of their own, of their own safety as well. And I think that's important for two reasons. First of all, you know, it's kind of role modeling. So when the when the nurse manager is safe and is role modeling some of the psychological safety, professional safety, speaking up when they're seeing something that they don't think is right, um, taking care of their physical health in a very positive way, this is role modeling to their team that this is something important and this is something that as if I as a manager am worthy of this type of safety, then you as my employee are also worthy of that. So so doing that communication. But also I think it's empowering for the manager to to think about you know, what does their environment look like? When when we see um when we see a leader uh with great mental health, the likelihood that their staff has good mental health increases. So we want to make sure that that is happening with our with our management team. I think the the biggest key as far as behaviors are concerned for leaders when it comes to creating safe environments is really transparency. And this is challenging for a lot of leaders, especially new leaders. We did some research um during COVID-19 and found that a lot of leaders kind of wanted to keep some bad news from their staff. They wanted, you know, if something was going on, they gosh, I can't tell them that because they're gonna, it's just something else to talk to them about. But we know that when the team gets blindsided by information, um, it is much worse than if they have uh they have some knowledge of it coming. So as leaders, you know, and especially now we're looking at different economic situations and political situations, there might be some hard things that we need to talk to the staff about and making sure that we do have those open conversations. We don't try to gloss things over, we don't try to act like things don't exist or act like things aren't hard. We actually have some of those difficult conversations and practice authentic leadership. And that is a great way to build trust with your staff. And when your staff trusts you, they feel safer. So I think transparency is probably the biggest behavior when it comes to helping nurse managers and even higher uh create that safety among their teams.

Host Nicole Weathers 24:51

So even the certainty about uncertainty, even knowing that there's uncertainty. So even if you don't have the answers or you don't know what's gonna happen or you don't know what it's gonna look like, I hear you saying that even just sharing that with the team, that you're kind of certain that there is a lot of uncertainty here is helpful.

Dr. Heidi Gilroy 25:11

I think so. And and and we think about this with like newly licensed nurses. So, you know, if if we are having a group of newly licensed nurses come into a facility, it could be that we don't know what shift they're gonna work on, or we don't know who their preceptor is gonna be, or their preceptor might have to change, or we might have to adjust the class times, things like that. So we want to make sure that we're giving our newly licensed nurses as much information as we possibly can. But I think you make a good point that when we can't give them the information, when we just don't know, it's better for us to say, hey, we're not sure yet. This is probably coming in the future, and we'll give you the information as soon as we have it. And if you just continue to have those touch points with them, then they'll know that as soon as you know, you're gonna tell them because you've built that trust up with them.

Host Nicole Weathers 26:01

So transparency, you know, authentic leadership helps build trust, which in turn drives safety. What are some leadership behaviors that maybe unintentionally undermine safety?

When Being Too Gentle Backfires

Host Nicole Weathers 26:16

Like even though we have really good intentions, this is actually maybe backfiring a little bit.

Dr. Heidi Gilroy 26:21

So I have to say this is probably the most counterintuitive uh part of leadership and creating safety. But if you are too gentle of a leader, you can actually undermine some of the safety in your unit. So, just as an example, let's say that you are a nurse manager and one of your employees makes a makes a very serious error, but you know that this person is going through a divorce or something's going on in their life, and you're like, oh, I can't have a conversation with them. I can't, you know, put something else on them that's gonna cause them problems. So you don't hold that nurse accountable. And then a series of things happens. You're trying to do that nurse a favor, but you've actually created a lot of uncertainty and a lot of lack of safety for not just that nurse, but also everyone in your unit. So that nurse is kind of sitting there waiting for whatever's gonna happen to happen. They know that they've done something wrong, but you're avoiding the conversation with them, so they're not sure. So they're just they go home every night and they're like, is it gonna be tomorrow that we're gonna have the conversation? Am I gonna be written up? And um and then the staff sees, well, this person made this terrible error and nothing's happened to them. So that's not fair, and that seems risky and unsafe. And then when they're thinking about, okay, I need some help with my patient, can I trust this person over here? Can I trust anybody because the manager is not holding them accountable? So I think a lot of managers try to be gentle with their teams and they actually create problems by not holding people accountable. The other thing with really gentle leaders is sometimes you'll have gentle leaders that kind of they come to the end of their rope and all of a sudden they're screaming. Um, and this can be very disruptive and challenging and really alter the safety of your team as well. Because once again, when they know what to expect from you, if you are always kind of a certain way and then suddenly you're a different way today, it creates this uncertainty that causes them to have stress. So really holding folks accountable, being consistent and doing these different things is is uh is much more important than trying to you know be kind to people and and be gentle in a way that really can backfire.

Host Nicole Weathers 28:47

That is so interesting because I was not expecting you to say that, you know, trying to, you know, be super nice and I don't want to upset the Apple cart and I don't want to, you know, come down too hard on anybody, and I just want everybody to like me and and kind of some. I mean, we see leaders like that, right? And so um to think that that has impact on safety. And you did such a great job explaining uh how that that kind of dominoes all of these other uh reactions or actions and really eye-opening, I think, for non-just me, but I'm sure our listeners are kind of thinking the same thing because we always think of that a positive thing, right? Kindness um and and kind of that gentle nature.

Dr. Heidi Gilroy 29:30

Yeah, and you think you think about this in parenting too, you know, as you're as you're raising a child, giving boundaries is the most freeing thing you can do for that child because they know exactly what they're allowed to do and and what is safe for them to do and they don't have to question what they're supposed to be doing right now, because you have given them good boundaries. And so they can they can be free to occupy that whole space. But if there are no boundaries, then they're not sure where they cross the line or where what becomes dangerous. And I think it's the same for staff. If they don't have those boundaries in place or the boundaries move, then then they don't feel safe because they're not sure what they're supposed to be doing.

Host Nicole Weathers 30:14

I was I was just thinking too, like the consistency there. As I'm thinking about my own kids and parenting, and you know, we if it's not okay today, it can't be okay tomorrow, right? Like you always have to continue to be consistent and in where those boundaries lie and and where do the consequences come in. And and sometimes I think that's a difficult thing to do, probably for some of those middle managers where they have um lots of irons in the fire, so to speak. Uh, it can probably be challenging sometimes to remain consistent in that space.

Dr. Heidi Gilroy 30:48

And I think that's where the safety for the managers comes in as well. So if if they're supported from their leaders and they know that they can be confident to have the conversations with their staff and they know the boundaries that they have, then it's easier for them to then have those conversations. But if a, you know, if a manager is exhausted, you're not gonna want to have an accountability conversation. You're gonna want to stay as far away from that person as possible. If a manager feels, you know, is having symptoms of some of these psychological um concerns that we know are common in nurses, then they're not gonna want to have those conversations. So maintaining that safety for the manager is is huge as well

Building The Future With Trained Leaders

Dr. Heidi Gilroy 31:31

to make sure that they can do what they need to do to hold their folks accountable.

Host Nicole Weathers 31:35

Okay, so kind of changing the focus here a little bit and thinking into the future, what shifts do you think we need to make in the next five, 10 years to truly build support for our workforce?

Dr. Heidi Gilroy 31:51

I think we have to start early on in in nursing school and in some of the programs for clinicians and let people know that if they if they did have challenges in the past that they might, you know, if they had, if they experienced adverse childhood experiences, if if they experienced trauma as children, if they're having some of these symptoms now, then they might have a little bit more trouble transitioning to practice. I think that's a big, uh, a big thing that we need to do. I also think, as I mentioned, looking at employee safety in through a more complex lens, just like we look at patient safety is essential. We have to be able to think of all the different um, you know, if we think of patient safety in the Swiss cheese model, you know, when the when the holes align, that's when something bad happens. So we we are now looking at all the Swiss cheese slices for patient safety, trying to find those holes, trying to close those holes up. Uh, we haven't done the same thing for clinician safety. So where are the slices? Like, do we have, you know, do we have clinical pathways for people coming into the emergency room with a psychiatric emergency? Do clinicians know exactly how to react to take care of that patient, to make sure they're safe, the patient is safe, and the clinician is safe at the same time? Are we, you know, are we prepared for different kinds of infectious disease that might come our way? Are we prepared to detect that disease? Do we have a plan for making sure that our employees are safe from that disease? So, so we have to to kind of look at all of these slices and see see how we can we can close up some of those holes for clinician safety. And the other thing that I think is really important is really addressing manager competency in dealing with uh employee safety. A lot of times, you know, nurse managers especially, you'll they will be an excellent, excellent clinician, and and someone will say to themselves, wow, that person's a great nurse. I'm gonna make them a manager. And then I'm not going to give them any training, I'm just gonna make them a manager, set them loose, they'll be fine. They were able to take great care of patients, they'll be able to take great care of staff as well. So filling in those gaps specifically about how leaders can influence employee safety and clinician safety is absolutely essential. So making sure that nurse managers have those competencies and feel confident and feel that self-efficacy of being able to address any kind of risk to clinician safety in their units, I think that will play a big role in the future of keeping clinicians safe and really assuring zero harm, not just for patients, but also for clinicians.

Host Nicole Weathers 34:43

So I want to pause and talk about two things. One is what you were just talking about related to manager competency for employee safety, and what we talked about earlier related to self-efficacy and mastery for new nurses. And the same is true for nurse leaders, right? So I think a lot of times we assume that, oh, these are experienced nurses, they're moving into leadership roles. Like you said, they're the best clinician on the floor. Um, and so they'll just know how to do, they'll just already be competent or competent in these areas. Um, but that's not the case, right? So this is a new role, it's a new transition. We need to build mastery and self-efficacy differently, different skills per se. But um, you know, in order to kind of feel safe and bring all of those things kind of full circle that we talked about, that whole pattern needs to repeat itself in this other role. For sure.

Dr. Heidi Gilroy 35:37

Yes. And I think there are lots of opportunities to uh to help managers with competencies. Professional development practitioners, I think sometimes have a complex relationship with managers on units because they're kind of partners, but they can also play a big role in helping those managers develop competencies. Look, professional development practitioners, one of our wheelhouses is that role development. So we know how to help people move from one position or one specialty practice to a different one. We know how to do that. So we might not know exactly how to be a manager if you're a unit-based educator, but you do know how to connect people with certain resources. So I think uh professional development practitioners can certainly play a big role in manager development. Uh, I think managers can play a big role as well. And that's something that we've done in our organization. So we actually changed the structure of our organization

Manager Development That Actually Works

Dr. Heidi Gilroy 36:33

to kind of facilitate some of this competency building for leaders. So we we changed from a charge nurse structure to an assistant nurse manager structure. So we actually have people who are clinicians who are working at the bedside, but they also have that assistant nurse manager um title and they get education every month on leadership skills, and they're able to shadow directors and they're able to do all these different things because they are identified as people who will probably be moving into the manager role eventually. And then our managers, we actually developed a manager development work group. So, you know, lots of times managers go to meetings and people come and yak at them, you know, so they get lots and lots of information at these meetings, but they don't always have the opportunity to develop themselves and to talk about situations that are affecting them. So the whole goal of this particular work group is to increase retention for managers and increase their engagement. So they do their own learning needs assessments, they figure out who, you know, what kinds of education they need, they figure out how to get it, they figure out different projects to really enhance the capacity of other managers. And just some examples are like we had a whole session where very experienced managers came and talked to the rest of the group about doing annual evaluations. That can be a place that can cause lack of safety in a manager when they're having to have some of these conversations with employees and they've never done it before. So being able to get the information from an experienced manager increased their self-efficacy, and then they were feeling much more comfortable when they came into those conversations, which probably made the conversations a lot better, which then ended up increasing safety for their staff. So these are some different things, and it doesn't take a lot of time. We spend uh an hour and a half every month doing these things, but we don't have turnover among our managers, um, except for those who have been promoted to director. We've had a couple of those, and they have very high engagement scores. So, you know, just having them come together and concentrate on how can we as a manager group work together to make sure that we retain our managers and we increase our engagement, that can be a huge, um, you know, a huge plus for managers. And obviously that has effects on staff and patients as well.

Host Nicole Weathers 39:09

So many great things about that example, you know, the the agency for the the nurses, their kind of power and decision making on what competent, you know, their needs assessment, what it what is it that we need more of, and then getting them that education and building those skills. So I just really like that example. Well, Heidi, this has been such a great conversation. I think we've talked about so much as far as you know, different types of safety, why it's important, uh, how it impacts things like confidence and engagement, and then some really great ideas of where to start. I very much appreciate this conversation, but before we go, um, like I ask all of our guests, uh, what's one strategy that you have seen organizations use that has been making the biggest difference when it comes to safety and something you wish more organizations

Ask Nurses What They Need

Host Nicole Weathers 40:05

would adopt?

Dr. Heidi Gilroy 40:07

So we are really looking into a concept called community-based participatory research as a way to strategize around improving nurses' health. When organizations do wellness activities, a lot of times they're not asking the clinicians beforehand what they need or want. And we know from public health that that doesn't work. So if I, as some random person, some random public health professional, walk into a neighborhood and say, okay, I know what y'all's problem is, and this is how we're gonna fix it, the likelihood that I'm gonna make any difference in that neighborhood is very, very low. But if I go in and I meet the people that are there and talk to the leaders and get to know, you know, okay, Grandma Jo is who everybody listens to. So I gotta make friends with Grandma Jo and make sure that she's on board with what we're doing. Um, and you know, all these different things. We know how to do that in public health and we do that all the time. But yet, for some reason, we go into the hospital setting or healthcare and we say, you know what clinicians need? They need an on-site counselor. But we didn't ask them if they would actually want that or if they would feel comfortable using that at their workplace, or if there were issues around it that maybe would make them uncomfortable to use it. Or, you know, maybe they just can't get there because they have this shift that they're working and they can't, they don't have a chance to go downstairs for an hour and talk to a counselor and really, you know, kind of let their mind be open to get that intervention. So I think it's important that we use some of these principles and community-based participatory research is a way of asking communities, which nursing is a community, it's a community of practice, asking communities, what's going on with you? What's going on with your health? What are your what are your health priorities? You know, the the joke on nursing social media is like if something bad is happening in the hospital setting, what are they gonna do? They're gonna have a pizza party. So pizza parties are like the answer to everything. And I think if you have a healthy environment and if you are having good open conversations about what the staff need and want, then pizza parties are great. Everyone's excited when a pizza arrives in the in the unit when you've got other things under control. So really talking to clinicians about their about their safety and what would help them feel more safe and really how they perceive their own safety is is something I'm seeing more organizations do. And I think that's really gonna be the key to coming up with good interventions that will actually help clinicians.

Host Nicole Weathers 42:58

That sounds like a really great concept. And and as you're describing this in my head, I'm like, well, it's like patient-centered care, but for nurses, like what is important to the nurse, and that's what we're gonna focus on versus all the things we think the nurse should be worried about.

Dr. Heidi Gilroy 43:13

Precisely.

Host Nicole Weathers 43:14

All right, Heidi. Well, this has been a great conversation, and I feel like it could go on and on and on. There's I always learn so much from you. You bring so much knowledge, uh, you're so insightful, you've got so much great information to share, and I just really appreciate you taking the time to be here with us today.

Dr. Heidi Gilroy 43:31

Well, thank you for the invitation, Nicole. I'm I will always say yes if you ask me to come back.

Closing And Resources For Support

Host Nicole Weathers 43:45

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 the 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 learn 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.