Crossing the Streams: Supporting Development across Health

In this episode of Better Every Shift, Naomi and Tubi dismantle the rigid boundaries of nursing career "streams"—Educator, Manager, Clinical, and Research. We explore the "bland job description" trap and why our current systems make it nearly impossible for brilliant clinicians to move between roles, even when they have the exact transferable skills the organization needs.

Naomi shares the story of her own "impossible" jump from educator to Nursing Director—a move three levels up that many said shouldn't be done—and how she sustained that role for 18 months. We discuss why business resilience depends on workforce flexibility and why the "clinical voice" must be articulated with clarity if we are to survive the next five years of healthcare. Stick around to learn how to "flip the script" on your next job application and why the most powerful thing a leader can say is, "I don't know yet".

Key Discussion Points

The Streaming Paradox: Why we justify senior director positions by creating rigid lanes that actually decrease organizational flexibility.

The 3-Level Jump: Naomi’s lived experience moving from educator to executive and what it teaches us about imaginary career boundaries.

Articulating Transferable Skills: How to translate research budget management or educational feedback into "elite leadership skills" for an interview panel.

The "Bland" JD Trap: Why simplifying job descriptions to reduce administrative chaos has stripped away the creativity needed for staff development.

Sitting in Tension: Why the need to have all the answers is driven by fear and why "holding your ground" on uncertainty builds more respect than a quick, wrong answer.

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Transcript

SPEAKER_02 0:01

Healthcare systematically values certainty. But the need to have all the answers is actually driven by fear. We've created bland, simplified job descriptions to reduce chaos, but in doing so, we've stripped away the creativity and the flexibility needed to build a truly resilient workforce. If your organization tells you that you can't move from research to management because the skills don't align, they aren't being efficient. They're probably being short-sighted. You're listening to Better Every Shift. I'm Naomi and I'm here with Tubi. Together, we're exploring the small, tangible steps that improve how we show up for our teams and ourselves. Today we're tackling the paradox of the nursing career span. One of the problems is that we underdevelop our managers and disrespect non-clinical expertise. Yet we expect leaders to have savior levels of knowledge. Today we were going to talk about some streaming that happens in nursing, particularly. And I have had a few examples where this has come up really strongly for me or teams that I've been part of. So I was working in an educator role and got tapped to step up to a nursing director role, which was three levels above the role that I was in as the educator. And the nursing director role sits in a different stream. It's very much a management stream. I was very much an educator stream. But I was tapped, I think you can do this, give it a go. Ended up being in that job for over 12 months before it was permanently recruited to nearly 18 months. During that time, there were multiple conversations, including with the people who had tapped me to go into this role, about nurses moving between educator roles, manager roles, and research roles. There was a thought process amongst many groups that people shouldn't move between educator roles and manager roles. Yeah, there were many people in our teams doing it and doing very well when they did it. It was really challenging. Probably 12 months into me being in that role, I was part of one of the committees looking at the structure of what our job descriptions look like and have since been on it again. These things have to be done so frequently. But re-looking at how that structure works when we in our streams, so in our service, we had a particular stream set. But having to justify that actually there's value in people moving between streams was actually quite challenging because there were so many that thought that if you're on a research path, you're on a research path. If you're on an education path, then you can't possibly go up to a manager and can you jump up two levels? And twice moved from, in fact, very often I've moved from a low level and jumped more than one level, I've jumped two levels. I don't think that's common, nor should it be common, but there are instances where that will happen for a variety of reasons. And part of it is around the systems that we have around those roles. But I thought it would be interesting to chat today around how do we do streaming better for nursing and what skills should we be encouraging nurses to get, particularly in an environment where there's now more specialization that nurses can go down with the nurse practitioner, with nurse prescribing. There's more clinical opportunities, which is a good thing, but we haven't really sorted out yet how to manage our streams well. And now we're adding more to it, so we run a risk of not doing it well. What experiences have you got in that space?

SPEAKER_03 4:12

We've got streams and educator manager clinical and research. Are they sort of the streams you would identify? I think also uh one of the other areas of what I see as boundaries, specialties, peas, theatres, ICU, ED, whatever. What I want to understand actually from you first is what is the purpose of streaming? What does it give us?

SPEAKER_02 4:44

I don't think we're clear on that. Or a lot of organizations are not clear on that. Part of it is about a purpose and a cohesion of we sit together, and part of it is about justifying a senior level director position, dare I say it, that now they've got a stream to manage. Right. I suspect. So it means we recruit so many people into nursing that our job descriptions become very simplified. And in our service, there was a plan, which I think generally has been a good thing to simplify all of our job descriptions into those three streams. Prior to the most recent process, there were a million different job descriptions. They didn't look the same, the tasks didn't align, you couldn't see any transparency. And with some really good work now, each at the same level has got these key elements, and they're slightly different between the streams to better identify what their role is. I'm not sure that streaming fixes that problem. And it may have been better to have very generic, just one of each, and then putting in some differences, but there was a decision made to stream it in our service. So it was around reducing duplication of work, which it has done because now nobody needs to go and write a new job description. We change one sentence, which means they're all a bit bland. You can't be very exciting in your job description. You've got one or two sentences you can change that does take away from the work and the chaos that otherwise ensues things like job descriptions.

SPEAKER_03 6:23

One of the things, just right at the end, one of the things you talked about was job description is quite bland. One of the my main roles in the organization where I'm at at the moment is how do we have better, we call them development conversations, but better performance conversations. And I think this is where creativity comes in, nursing and nursing education, nursing leadership, because when the role description is bland, it's providing um broad boundaries, but you get to fill in the hole. What's required from this role in this team? There are certain elements you have to be at this level, but that's the other part of it. It's not just what's required in this specialty, in this team, in this role, but at this level of seniority or level of expertise, it then becomes very personalized when you're talking about performance or development. Yeah. This then becomes a skill that I think is not well done at the moment, but it's a skill that can be taught to leaders and managers to better develop their team members in the different streams in the team to be able to address the service need. But it's dynamic, these are principles, they're not a prescription. There's more uncertainty than there is certainty, and all of those things create a high level of discomfort for a lot of managers who are in a very busy role and don't necessarily feel like they have the emotional bandwidth to get creative about someone's position.

SPEAKER_02 8:14

Oh, completely. And people look to those job descriptions as both managers and individuals as a definition of their role, which it can never be. Like it would need to be 30 pages long. It does not describe all of the activities that you are responsible for or could be responsible for in your role. We have to be very aware that could not exist well. You're right, there's a level of discomfort that should sit with it because it should be dynamic. It can be useful as a tool, but it is a very teeny part of the toolbox. Right. It's not the whole thing. We actually have another tool around those development conversations, which is not nursing specific, it is very generic across all of government agencies, which makes it difficult, but is useful in those more senior roles. It struggles in the lower level roles because it doesn't talk specifically about nursing skills.

SPEAKER_03 9:21

Yeah. And I think this is one of the things that I notice in workshops that I deliver is that people really struggle to identify those transferable skills. Yeah. And I think that's very true when you're talking about streams. Across each of those streams, there will be transferable skills. If you've worked in an educator role, you will have worked closely with people, teaching them how to do particular skills, providing them with feedback, and working with them where they're at in the moment on the day. That is an incredibly important leadership skill, actually. And man, when you're working in research, you've got to be curious to think about what could this mean and what else could be possible. That's a really important leadership skill because sometimes you're faced with problems where you do have to think more broadly about hang on a minute, we can't solve this the way we've done it. Streaming or no, we need to get better at identifying what are those transferable skills that will allow people to move more successfully between those streams. What I'm curious about is with the people who are in favor of the very clearly defined streams that once you're in that stream, you're in that stream. What's the challenge for them around transferring between?

SPEAKER_02 10:46

They struggle to see how they will articulate the information across for that person. So when we talked about interviews a while back, when they are employing people, they find it difficult to work out how that skill or that activity will work in the new place. So I think it put unfortunately, I think it puts a lot of requirement on the individual applying for the job in a different setting or stream to sell their ability to move from that place or that stream to the new one. Um, I don't think everybody needs them to do that, but I think people should assume that others won't do that well for them when they're applying for those jobs. Those things are very transferable, and you need to be able to articulate that when you're moving or when you're thinking about moving. You it means that you need to be able to describe it with clarity about what it is that you achieve, how you achieved it. So, for example, if I was working in a research project, I may have been responsible for arranging funding, seeking grants, and I might have been very successful at obtaining grants, and I may have had to manage quite a complex budget related to that piece of research. So if I'm applying for a job as a manager, there'll be many people that are interviewing for that, you're holding the interview panel that won't appreciate that, and I'll need to articulate it really carefully. This was the budget that I had, these were the number of stakeholders, and this was the level of reporting that I had to do around that. In fact, I've actually got very strong budgeting management skills. I haven't had to manage this element of procuring or whatever, but I have had to do all of these other things at this level. I think I can learn those other things.

SPEAKER_03 12:49

A voice inside my head goes, if they get to interview. One of the barriers here is that if you don't articulate it in a way that's meaningful for the people recruiting, which might be people at that manager or leadership, senior leadership level, and they're looking for a particular thing and you're describing it, but not in the context that they understand, you're not going to get to interview.

SPEAKER_02 13:18

No. You need to be able to articulate it really clearly early. You need to be able to articulate it in your cover letter, and you need in your context of where you've worked, you need to be able to highlight that. Don't waste time in lots of hoo-ha down the bottom that detracts from it. Be very clear, and it might mean that you remove skills that are not relevant to this role. That would be easy for people to recognise and acknowledge. But if that finance has been a big element, that's what you need to highlight. That this was a big part of the job. This was my percentage of clinical, this was my achievements.

SPEAKER_03 13:58

Systemically, healthcare values, certainty. And so people, as they become more senior, they feel the need to have all the answers, as you've said. There's a double-edged sword to that, then you become the font of all knowledge. People cease to want to make their own decisions, but also if you don't know, boy oh boy, does it stick out? Yes. The other side of that is that none of us will have all the answers ever. Because while I might have had years of experience in ED, I certainly didn't see everything that could ever come through those doors on the face of the earth. I saw what I saw. My capacity as a more experienced team member, as an educator, is the capacity to actually solve a problem when we don't necessarily have the answer laid out in front of us or we haven't been here before. I think one of the really key skills that sits across educator manager, clinician, and research is that capacity to be curious and to manage our need to always have all the answers, to be willing to sit in tension. I agree with you. Ask really good questions. Um, and use language. I really like language like, wow, this seems like quite a big problem. Can we just sit just talk for a minute about what are some of our options to solve this together? What ideas do you have to actually sort through this and figure out how we're going to approach it together? Um, we haven't talked about preference, talking spoken about preferences in the podcast yet, but I think the Herman brain dominance instrument and its assessment of ways pref preferential ways of working, thinking, and communicating isn't about being right or wrong, but it's about understanding we all have different needs. And in some of those preferences, the need to tick stuff off and get stuff done overrides the need to be curious. And so, how do we build willingness to just entertain a question for a minute rather than seeking always the right solution? Because we're not always going to get the right solution. We might have to try a few things.

SPEAKER_02 16:24

It is one of the challenges when people step into roles to really just hold their ground on that because people will push them for an answer really quickly and they will feel the tension of needing to answer. They will be much stronger if they can hold and just say, I don't know yet. Just hang in there. We'll get to an answer, but it's not right now. They will end up having much more respect, but that it is a very difficult thing to do.

SPEAKER_03 16:49

The need to have the answer and be in that savior role is actually driven by fear. It's fear you don't respect me, fear I'm not credible, fear I'm not worthy of this role. All makes people want to give the answer. You can still feel the fear of those things. Boy, right now I'm feeling like I'm just not worthy of this role. But actually, I'm gonna challenge you on seeking a quick answer. And let's just sit for a moment and think about what else could this mean. So moving into those behaviors above the line, being the challenger, being the coach, being the co-creator sets people up so much better in any of those streams. Yeah, that's a transferable skill. The capacity to move from needing to save it or tell someone what to do or get someone into trouble, but actually to bring them along, that's a huge skill that sits across all of the educator, manager, clinic, clinician, and researcher roles.

SPEAKER_02 17:54

If we look at just two of the streams, so if we look at management versus education, think the unspoken kind of standards are in each of them. I suspect it's about efficiency. There's a real tension there because there's a thought that managers are being thorough, but I think there's a push to being efficient and jumping to emails and responding to crises as they occur rather than probably think of crises. Yes, yes, yes, yes. They're labelled as crises. I remember not convinced that they are. Whereas the stream of education is allowed to spend time outside of being efficient, and there's probably not an expectation that they're efficient.

SPEAKER_03 18:36

When actually I think there could be real value in efficiency in education. Because thoroughness, from my perspective, and I've been sitting heavily in this space for the last six months. Thoroughness is not about me ticking every box and getting everything done and going to the quickest, easiest solution. Thoroughness is actually, and I did it today, bringing the team together and going, we need to sort out two things. We need to sort out how are we working with comms because their team has changed just as ours has, their capacity is reduced just as ours is. How are we going to work more efficiently with them to help them manage their workload? And so we're not double dipping with stuff that we're doing and our message is getting out there clearly. I want to know what you all think first. Where should we start? And that was not the most efficient. The most efficient might have been seen to be what updates do you have? Have you emailed them to comms? That's ticking stuff off. But ultimately, it's not going to get us where we want to be. So always, always, what's the outcome we're seeking here? And what are we balancing?

SPEAKER_02 20:00

Education's tricky. There's been a lot of posts on social media this week around what we expect from what do we expect as our outcomes when we're teaching in the adult learning space. And a lot of what's requested is the wrong thing that's requested. But for education teams to stand up and go, no, I'm not producing that. That's a waste of everybody's time, is a very difficult thing to do.

SPEAKER_03 20:25

So we got asked to do some work. And we knew the expectation wasn't going to be what was most effective for the participants and what they actually needed. And it's been really interesting because while the outcome hasn't happened the way the organization would like, in the timeline the organization would like, people are getting much clearer about what's okay and what's not okay in their teams, in how they do their work. And so they're learning to ask questions of each other and of the work that they do to make sure that they're doing the right thing. We're not having to go in there and tell them what to do, they're leading those conversations because of how we ran the workshop. What stops educators from saying, no, that's not going to work? We need to do it this way.

SPEAKER_02 21:20

One is the number of people that will ask over and over, and the authority of those people. So the level of those people. And the seeming clarity that it comes with when it comes from a quality request. Why we don't have our quality teams working with our education team as a that they actually sit in the same team is beyond me.

SPEAKER_00 21:45

Mm-hmm.

SPEAKER_02 21:47

That would make so much more sense and would be so much more beneficial to our teams.

SPEAKER_00 21:54

Mm-hmm.

SPEAKER_02 21:54

Most of our educators across healthcare and certainly in Our IT spaces, very few have got good learning backgrounds, learning educational principles. There are a lot of nurses now that are starting to move into that education space, but they do it, they've just done it. They've just done their masters, they've learned the principles. They haven't really embedded yet. And there's been so much crappy theory about how people learn and the pop psychology of how people learn, and that's what's freely available. It is about what is your outcome and how do we get that outcome delivered, which may be education, it may not be education, it may be actually we just need to remind people. It might be there's a whole bunch of skills deficit here that we've got that we do need to embed and we need to do a whole bunch of stuff about. Unfortunately, compliance has got a lot to answer for. And unfortunately, the way that the standards have rolled out has not helped. There's many elements they haven't helped. They came from a really good place, but they have not helped the way that we train. We're focusing on compliance instead of actually what behaviours are happening.

SPEAKER_03 23:13

There's also an element of behavioural insights where we're not setting up a process where the desired behaviour is the easiest one to do.

unknown 23:21

No.

SPEAKER_03 23:22

We're not thinking about that. Which is not education element. It's not education.

SPEAKER_02 23:27

I had many arguments about AMR setup. The training should not be complicated for it because this is a digital solution. It should be very easy to follow the correct steps. I shouldn't need to make 50 clicks when I can make two. And if I can make two clicks and it takes me somewhere else that I don't want to go, that's not a good thing. That is not an education thing to teach around that and about how to click 48 clicks. That is a system design problem. We don't have enough people that understand human factors in that way, which is really problematic.

SPEAKER_03 24:04

One of the other things that sort of came up for me when you were talking just now was something else I've noticed is that there's a real deference to other people's clinical expertise, capability. There is a real dismissal, and I would even say disrespect of other skills and expertise that is non-clinical in the healthcare setting. What's been your experience of that?

SPEAKER_02 24:36

I completely agree. We are not good at recognizing the wide variety of skills we need, and we have been really slow or not at all able to implement roles that we should have within healthcare that other systems have done well. That occurs in education, that occurs in IT, that occurs in building, that occurs in a whole bunch of places. We don't support people to really develop that skill properly. And we don't support them when they have them. We don't pull those people back in and say, tell me what you know. And we don't do it with corporate knowledge either. The corporate knowledge of what worked and what went wrong, we are too quick to dismiss that. And that is so valuable. And it is becoming a bigger issue as our turnover of those higher positions increases in a lot of places.

SPEAKER_03 25:42

That kind of strikes me as a bit of paradox here when we're talking about the streams, right? Because we underdevelop managers and leaders. I don't think we well develop educators. I've been teaching different things for probably 20 years, and I've done my own education, as have you. And when I ask educators what training have you done, they might have done facilitation on the run or whatever it's called. But that's all they've done. There's a real gap there. The same with research. I think within the clinical sphere, there is some support to teach people how to do research. But actually, if you're talking non-clinical within healthcare, there is zero support to help people understand how do I research the contribution that I'm making to healthcare through the work that I'm doing. So there's this real paradox between you can't change streams. There's not transferable skills here, but also a disrespect of those skills because you can just pick them up. I've been a senior clinician, I can teach leadership. We've got experts in our organization, but I can teach leadership. It's not that hard. So, how do we manage that paradox in a way that supports the education of people, the education and development from across the career span? Acknowledge that there are niche skills in niche areas, but actually teach people how to develop transferable skills or see their skills as transferable.

SPEAKER_02 27:33

I would love to see that services really had a plan for this is where our funding is going towards education. Some services do it better than others, but I'm not aware of any that do it really, really well. Love to hear if anyone wants to share. Yeah. But mostly it's, oh, we haven't put that money out yet. We've got these grants available, or there's stuff available, we should make sure people know about it the week that it's due. We should have a calendar that these are the things that are available, and we should have a plan in our services about what is it we're gonna need in the next five years. We're gonna need two diabetic educators. We should be training three now. We're gonna need two people in IT. We probably need to train five because we haven't got a big skill set in that space. They're actually gonna need to support each other. We need our leaders to be doing these things. Let's start training a whole bunch of people. And the way that we train them should be different. Some should be an internal program, some it should be there's this program we want five of you to go do. Some of you we're gonna support this many people to go on and do your masters. But we should have a plan about what that is and articulate it openly so it is very transparent. These are our goals. We're supporting these. It might only be five positions. But be really transparent and be really proactive. The impact that would have ongoing for services to show this is what we're doing, these are the skills that we value, this is where we think we need to go, says so much.

SPEAKER_03 29:19

But also creates investment and buy-in. I want to work there because they're investing in that.

SPEAKER_02 29:25

Yeah. I know that their IT stuff's gonna be good in five years because they've got five people that are all doing this massive program to get there. And they've got a follow-up in two years that three more people will get the opportunity. I'm gonna be there so that I've got the opportunity to do it.

SPEAKER_03 29:41

You wanted to talk about streaming today. Have you covered what you wanted to talk about and what haven't we talked about that you thought might come up or you think is important?

SPEAKER_02 29:54

I think we've covered what we needed to because really it's a conversation about what are we valuing. Okay, why do we value it and how do we change that? I suspect we need to think more broadly about what skills is it that we're needing. The streams, not streams, it doesn't matter to me. If you want to write that as your JD, I don't have a problem with it. But as a service, we need to be much better at realizing that people can move and should be supported to move because there's a whole lot of good that comes from that. And what do we need from our nurses? And it's their skill set, their willingness to work with teams and develop their teams and bring their skills and knowledge and perform to their best of ability.

SPEAKER_03 30:40

That flexibility and capacity to transfer skills builds enormous business resilience. I don't think we're investing enough in that now, and it is leaving organizations vulnerable.

SPEAKER_00 30:55

Yes. Thank you very much.

SPEAKER_03 30:57

That was a good conversation.

SPEAKER_01 31:03

Thanks for listening. You can check out the show notes and find lots of further resources at federeveryshift.com.au or find the link to the link. If you enjoyed today's episode, leave all the further information in the videos in description.