When Healthcare Workers Speak and Nothing Happens: Breaking the Silence

Discover why healthcare workers are ignored when they speak up and learn how to close the gap between voice and action. Featuring nurse advocate Kimberly Maurer on breaking systemic silence.

What happens when you speak up at work and nothing changes? For healthcare workers, this isn't just frustrating, it's systemic. In this powerful episode, we sit down with Kimberly Maurer, founder of the Unapologetically You Collective and veteran nurse leader, to uncover why silence isn't what happens when people say nothing, it's what happens when people speak and nothing happens.

This conversation will empower you to reclaim your voice and demand the accountability healthcare desperately needs.

In this episode, you'll discover:

• Why concerns raised by healthcare workers disappear into the void, and who's responsible
• The difference between burnout and moral injury (and why it matters)
• How to close the gap between speaking up and leadership taking action
• The infrastructure metrics leaders should track to know if their people are truly safe
• Practical strategies to break isolation and build coalitions on your unit
• Why resilience training isn't the answer, system redesign is

Your voice matters. Your experience matters. And you're not alone in this fight. This episode will remind you that silence isn't your failure—it's a symptom of broken infrastructure. Whether you're a student just entering the field or a seasoned professional fighting burnout, you'll walk away with the tools and courage to turn your voice into action.

My Recommended Stethoscope
I still use my Littmann from 2011 because it lasts. This is the modern version of the one I carry.

Disclaimer: This post contains affiliate links. If you make a purchase, I may receive a commission at no extra cost to you.

Transcript

0:00

We keep asking nurses to find their voice. They already have one. Silence is not what happens when nurses say nothing. It is what happens when nothing happens after they speak. Nurses are not voiceless. They have plenty to say, and they are using many strategies to say it. The real issue may be the failure of systems and leaders to respond. When concerns are ignored, delayed, are buried under hierarchy, silence gets mislabeled as a personal failure. But the research makes something clear. When systems do not respond, silence becomes a system outcome, not a nurse's choice. And still, nurses find ways. They use silence not as a surrender, but as space to practice care in ways that still matter. That is resilience. That is creativity. That is love for patients that refuses to die, even in broken systems. But resilience should never be used as a substitute for responsibility. Senior leaders have the power to set strategy. They have the power to change structure. They have the power to close the loop between voice and action. If nurses keep speaking and nothing changes, the failure is not theirs. Silence is not always oppression, but ignored voice always is. Together we rise. Welcome back to MAP, Medical Pathways for Success. I'm your host, Fred Nazario Alvarado. And as you just heard, we have a special episode today. We train healthcare professionals to be vigilant. We tell them, If you see something, say something. We drill into them the importance of being a patient advocate, of being that last line of defense. But we rarely, if ever, warn them about what happens when the something they see isn't a single error. But the system itself. What happens when their voice is met, not with action, but with a deafening silence? My guest today has given a name to that silence. She says, silence is not what happens when people say nothing. Silence is what happens when people speak and nothing happens. She's the founder of the Unapologetically You Collective, a nurse leader and a powerful voice who refuses to let coping be a substitute for redesign. Today, I introduce to you, Kimberly Maurer. Kim, thank you so much for joining me and discussing this topic today. Hi, nice. Thank you. Thank you. I want to start right at the heart of your work with your quote, because it's what stopped me in my tracks. it's silence is not what happens when people say nothing. Silence is what happens when people speak and nothing happens. So for the new medical assistant, the nursing student, or the seasoned professional listening right now, who feels like they're shouting into the void, what's happening in that gap between their voice and leadership action. So many times people are speaking up and people are bringing to the table and to leadership, hey, know, something's just not right. Something's just not right here. you know, there's, I see this as happening. I have ideas to change it. I have ways to make it better or how we can, you know, come to a solution and make it better for everyone. And sometimes I've seen it where I've been, this happened to me myself. where you bring those things up, you bring concerns up and nobody's listening. And then people see other people, well, she said something and now she's got the really crappy shift. You know, she's now not able to pick up extra overtime. She's now gotten, you know, the worst load of the day. So there's, punishments without being completely obvious. And to those around you, it's completely obvious. Yeah. completely obvious. you know, when I, when I say that they're, they're speaking up and that there's no response on it, it's because look at, look at everything that's broken right now. Look at all of the conversations that we're having today, every day, all day long. And it's like, like you said, we're, we're speaking into the void. We're, we're talking to the abyss and it's, everything is so obvious to all of us that are the foundation of the system. All of the people that are inside the system, because the system, it is a business, healthcare is a business, but you have to take care of your people first. So when I'm saying that, I encourage everybody, if you see something, say something. You know, we have that signage everywhere. It's in airports, it's in bathroom stalls, it's wherever you go. If you see something, say something. But so many times than not, you're saying something. And it goes unheard. I just say, keep using your voice. Don't be afraid. Do not let the golden handcuffs break. They make you fearful. It just infuriates me every time I see people so afraid to leave a toxic situation, even to leave a toxic environment because they don't want to lose their pension. They have kids to take care of. The bills are due. There's so many things that just weigh so heavy. on staying instead of pivoting and realizing that you have other options. Your current situation is not the end of your chapters. It's not the end of your book. Those pages are still to be written. I just always encourage people use your voice. If something's not right, talk about it. Say it. If somebody's not doing well and you're just like, Hey, it's okay to not be okay. Look at what we deal with every single day. Look at the trauma that we witness every single day. know, and there's just so much. mean, Frederick, you're going to need more than like this podcast because there's so much to talk about. We can go on and on in regards to this. So that's my take on that question. I hope that answered your question. It does and I mean, I don't know it feels like... No matter what we do, if we say something for just to be safe for a patient, whether it's to be safe for ourselves, we're always getting knocked down or silenced because we did something right or we want to do something right or we want to change something. And it's so true. People are so comfortable with the way things are uncomfortable and so afraid of change that they'd rather just have it be, this is just the way it is. How many times have heard that? This is just the way it is. This is how we do things here. Okay. Well, it's not working and obviously it needs to change. can't, you can't continue doing things that don't work just because that's how you've always done it. How are you, how are you, and what are you teaching the new people coming in that role? You're teaching the same toxic, the same toxic leadership, the same environment. You're, you're, you're trained them to, to believe that that's, this is acceptable. This, this is how we do things here. And that makes it right. And like said, sit down, shut up, don't say a word. Just do your job. Just do your job. Don't go Bob, Exactly. So we are talking what actually factors inhibit nurses from speaking up. And in this research that I did recently, a nurse gave repeated accounts on all of the units that when they tried to reach out to their unit administrators to voice their concerns about patient safety and workplace help, they were ignored or responses were unempathetic. Many nurses spoke of a lack of response when they tried to use their voice. And a few respondents concluded that there was no way to reach the unit manager when they needed help. One nurse who worked on the cardiology unit started, when we do communicate with them, we don't get responses, we don't get phone calls, we don't get anything. It's like radio silence and email silence. There is nothing. So many of us stop trying. In the oncology unit, a nurse had a similar reflection of the lack of effectiveness of trying to communicate his concerns in their unit huddle. That was the end of it. That was the end of that conversation. And that's the last people heard of it. So there was no change. He said there was no change in the practice. So they're bringing things to people that they're speaking of, but it goes nowhere. It goes nowhere. Like he said, radio silence. How many times have we said that? Well, I went to the manager and I told, you know, I mentioned that this is happening and we need to fix this or. You know, I have a concern. God forbid if you raise a concern, you know, whether it be in regards to equipment issue or it be in regards to a patient issue or staff issue, anything. I don't understand. I really just do not understand what the hell is happening right now. Exactly. mean, that brings up this literally my next question, which is, so like a study in the healthcare management review, they found that 40 % of healthcare workers are not confident their organizations would address the concerns they raised. And when a concern is voiced and it just, like you said, disappears, what does that do to the spirit of the healthcare professional over time? Like what is the communicative, emotional and psychological cost of being ignored. That's like the million dollar question because I describe it as you carry suitcases around with you. Now you put all the trauma, everything in a suitcase and you carry it around with you, take it home with you, maybe drop it, but then you pick it up again the next morning and take it back. Take it back to that same environment with you. If you are not creating an environment where your staff feels psychologically safe, They have a voice. They're able to come to you with concerns. You, you're not a leader. If you say, well, I have an open door palace. You can come talk to me, anything. can't tell you all my times. I've heard that one. And you do go to them, but like radio silence, there, there's nothing. So can you imagine time and time again? of trying to speak up about things and being shut down, being shut down over and over. I think that so many are feeling that they're feeling like, okay, if I raise my hand, I'm going to be shamed. If I ask a question about something that I probably should have really known, but I haven't been trained on it enough to where I feel comfortable. So I want to ask a question, but how many times do they get looked at like, Oh my God, what does she, why is she working here? She don't know what she's doing. You know, and then again, that's beating somebody up, beating somebody up. Just everybody is so traumatized. It's not by the patient care. It's not by taking care of patients. It's by what we do to each other. High school and scrubs. I've said that a million times, high school and scrubs and bullies. You didn't become a bully when you took this position. You didn't become a bully. You were always a bully. Now you have a title on the bench. Now what does that make you? bully with power. A bully with power. So the psychological safety, it's truly just breaking down, breaking down, breaking down. Nobody feels safe. Everybody's so afraid. Everybody's so afraid to be at work and to make a mistake and ask for help. There's just none of that support and humanity anymore. It's just gone. I don't see it. I just don't see it. And when I was a patient, I didn't see it then. And I barely thought, I don't want to be a nurse, wanted to quit the profession. I was so ashamed of how I was treated. And I they were short staff. And those are things that I can see as a nurse. But as a patient, I wonder what we're projecting out into the universe. What are we projecting to patients? They may not remember your name. They will always, always remember how you treated them. Yep, I say that a lot on my podcast too. It's one of the most important things. And that was like one of my episodes when I talked about staying silent to that one patient that was asking her to be recognized as a he or sorry, excuse me, as a she, but the nurse kept calling her he. But I stayed silent and that impacted the patient itself because she lost trust in me. Just my silence is self-impacted, it's silence is just. Just staying silent is what's the problem. And then the other problem is that when we aren't silent and. It just gets ignored. That itself is starting to force us to just stay silent again. Again, mean if you're beat down enough, what do you do? You don't do it anymore. Talk about it anymore. What does everybody, everybody says? Well, they're not going to change anyway. It won't change. It won't change. So people already have that reflection of what past has been, how it's always been. Right there's the problem. There's the problem. Shouldn't be the same. It shouldn't be doing the same stuff over and over again. shouldn't. I mean, you said the real message for the system is often, speak up about danger, as long as danger isn't us. Exactly. So how does a professional who is ethically bound to advocate for safety, protect their integrity in a system that seems to only want them to support the safe problems? And again, what does that come down to? That comes down to the golden handcuffs. That comes down to, I know what I'm supposed to do. And if you are an ethical person and you have morals and you live by those morals and those values, you will not be afraid to bring that up. You will not be afraid to talk about it. You will not be afraid to fix it. But if you are not, You're just thinking about, I can't lose my job. I can't lose my job. My job's more important. I gotta, I gotta support myself. What am I gonna do? Where am I gonna go? So I think, I mean, and that's just my opinion. Everybody may else, else may have a different opinion, but I feel that again, everything is, is based on, I can't lose my job. Where am I gonna go? They had to ask themselves, where does their integrity actually lie? Because if it's just lying in, I need to protect myself and my job. You're not advocating for yourself. You're basically just protecting yourself instead of making things better for yourself. You're closing yourself into this box. and the box itself is going to start to get crushed and get smaller and smaller to the point where you're suffocating because you're no longer able to help yourself. just protected yourself for all that time and it's actually caused you more harm in the end. And so the answer really is, it's all about your integrity going beyond that so that you can better yourself. Probably nine times out of 10. I wouldn't say nine, nine. I'll go, I'll give it some space. I'll say six out of 10. Six out of 10 would choose the team and choose the right thing. know, we're supposed to be able to like, I'd say, you know, look to your left, look to your right. Now that's your team. That's, that's who you're protecting. It's who you're helping survive. We want people to thrive, not just survive. Wouldn't it be nice if we could start thriving in this business? If we could start thriving as a team, as a cohort, as collectively working together? And it's so obvious, right? It's so obvious what we're not doing and what we need to do. Yep, it really is. Again, falls on everybody. Pull your head out of your ass. You know, look around you. If you want things to be better, get better yourself. We can all improve. Ain't nobody perfect. Look in the mirror. mirror. Think about how your day went. How did you talk to people? Were you present today? Did you go around and meet people that you haven't seen and you haven't met yet? Or just a name on your roster? Have you done that? Make people be seen. Everybody wants to be seen and heard, respectively. Being heard because it's noise. Being heard just because they need to know that they are worth something and that you value them. And if you can't do that, then you're not a leader. And you need to get out of there and roll and move or for somebody that will do just that. You have to get in the trenches. You have to meet your people. And I feel too that if you're doing that, as a leader, get out of your office, out of your boardroom, in the trenches, then you have all of the insight, all of the knowledge right in front of you, right beside you. And if something's not right, you're like, I need to take care of that. I need to fix that. And the gratitude that people see around you because you showed up, because you made yourself present and you didn't leave them feeling like, Have you seen the manager today? Nope, have you? Nope, nope. We never see her. She never comes out of her office. I had that conversation not too long ago. Never comes out of her office. Like, okay, so. But if you are in those trenches and you're walking around, you see what's broken, you see what needs fixed. And if you're having to do the role or you're having to work the floor because there's no staff and staffing is so short, you are. First row at what they're talking about, what they've been telling you over and over again that you have completely ignored. They brought it to your attention. Now you're trying to do their job and huh, look at that, it's not working. Huh, oh, I do remember so-and-so came to me not too long ago about that. I forgot. It's, you know, it's those conversations. like, my God, it's a reality check. I think everybody in the boardroom. oh All people in the CBXV, they need to walk the floors. Just as a human being, not in a suit, not in your clipboards, just walk the units. Look at your system. Look at your environment. Are people walking around unhappy? Are patients taken care of? Do they look happy? What about the families that are waiting in the hallways and in the waiting rooms? Do they look happy? Do they look like they've been updated? Do they... There's so much silence. There's no communication. All of this is so broke down in every aspect. That thought just came to me and it's like, they just walked around, someone off the street, a visitor, a family member, whatever, and somebody didn't recognize them, that'd be fine too. But just to walk around and to really witness what's going on and what's broken. I mean, you wouldn't have to be on the floor, what, Fred, five minutes to see it? Five minutes, it would only take you five minutes to see. And so like on the show, I've talked about building armor to survive the emotional side of healthcare. But your work challenges that idea. And it suggests that we are often asking people to endlessly adapt to systems that refuse to change. And you make a powerful distinction between burnout and moral injury. Why is that language shift so critically important? And What is the difference between a healthcare professional who is just tired and one who is morally injured? You know? Moral injury comes in so many, so many forms. And you, if you've been in healthcare long enough, you've seen it over and over, over and over again. And we're told to suck it out. It's your job. You can do this. If you don't, if you can't do it, I'll find somebody that can. You know, there's, there's always those, those events that. happen, the situations that happen that just continue to break somebody down where, you know, they told me you just, just you need to be more resilient. You can't, you know, whatever. This is just how it's going to be. This is just how it is. Why does it have to be that? Why do we have to wear that armor all the time? Why do we have to feel like we have to just shield ourselves from harm all the time? It shouldn't be that way and unfortunately more times than not it is that way. And like, I, like I said, in my episode 14, when I talked about networking, I've mentioned about creating a board of directors, because that's also a form of building armor is having yourself people that can help you. talk about having a mentor, someone that can actually look out for you, walk you through steps because they've been through it. I talked about having your peers, the people that are there on the same level and understand what you're going through. These are the people that are going to be able to help you. take off that armor and carry it so you're not carrying all that weight yourself. We were told to be resilient, right? What we were never told is that resilience was being used to hold together systems that refused to repair themselves. So burnout is not a personal failure. It's the visible signal of structural strain. The question is no longer how much more caregivers can endure. The question is how long systems can survive without redesign. Restriction to resurrection begins when we stop fixing people and start fixing structure. exactly. It's such a tough topic. It's such a tough question in all honesty, being resilient and burnout and moral injury. Everything that everyone has a story about. Everyone has a horror story. Now, when you ask, you ask people, I you could sit in a room right now, you could sit in a room with say five people. And they wouldn't even have to be in health care. You have to be in health care. They can you ever do you ever have a do you have a really good story to tell about maybe a time that you were a patient and in the system or a family member was and what do they do? That's it's not oh yeah I had this wonderful nurse and she took such good care of me. No it's like oh my god you know you wouldn't believe this and they go into that. It'd nice to not have to have stories like that anymore wouldn't it be nice to not have that injury that trauma that. the trail that break down and every every aspect of everything that we do every day. Exactly. uh still understand how people continue being so mean. oh It's just that, it's not people being mean, it's people of else's remaining silent about those people being mean. Yeah, invisible bullying is. I literally read a reddit post the other night last week on the CNA forum about it was one of the CNAs asking whether she should report their co-worker because they were transporting a patient and they kicked the patient's leg to get it back on the bed. Exactly. I'm like And she was asking about whether it should be reported or not. it's like, this is patient safety itself. Like you're being silenced just because you saw someone and you don't want to get on their bad side or get them fired. it's like, silence itself is another issue. The silence isn't just about affecting us. It's also that silence that we're holding in is also affecting the patients in turn. Absolutely. You know, sitting here listening to you say that example, it's like, how many times have we seen somebody, somebody do something like, well, we don't say anything. They don't say anything because it may be a friend. You know, it may be the boss. Maybe someone you don't want to get on their bad side. would be worse. So yeah, that that made me look at it at a different perspective, different outlook at that because I hadn't really thought of it as that silence. hadn't really thought of that silence, Fred. So thank you. Thank you. Yeah, my wheels turn in. Yeah, like I said, the silence isn't just affecting us, it's in turn affecting the patients as it trickles down. It's not just like you said with the 10 million nurses leaving the field. That trickle effect isn't just going to affect those MAs or other attacks and everything with more workload. That trickle effect is also going to the patient because they are going to start feeling that workload and be inferred out and getting more moral injury. And in turn, you're going to have those patients, they're not patients, but MAs and techs that just turn sour and have attitudes because of the injury that they've sustained. and it's going to be brought out on the patients and then the patients are going to feel it. It's definitely a different way to look at it, but it's something that's definitely happening. You once posted a quote about, or from Alexander Dumas, wait and hope. But you argued that in healthcare leadership, wait and hope has been weaponized. You call it abandonment with better language. And that's a heavy statement. So, I mean, can you unpack that for us? how has this, how has the simple human act of hoping been turned into a tool for inaction? you know, that that call, it just it happened to be on a show I was watching. He said that, I'm like, oh my God, he could be talking about healthcare right now. He could seriously be talking about what's happening in healthcare right now, based on that, because what do we do? We hope things will get better and we wait. We hope that we'll get more staff. We wait. We hope that we won't have to do this anymore. We hope that he won't have to carry so much anymore and that we will actually be seen. And then we continue to wait. Nothing changes. happens. Or, or what's even worse, I think, is when something does change for just a couple of weeks. Change is just enough to say we tried. You know, it looks good in a pamphlet, looks good on the side of the building, but it never lasts. Never lasts. look at all of the millions they spend on getting consultants in to fix something that they, you know, they are saying is broken. we just need some help with this, you know, bring in consultants, pay millions and millions of dollars. You have all of those people right next to you, right inside your system. need to go outside. Again, until you look around and you look at the brilliant minds within the system, within the walls, the business is people. Without the people, there is no business. People are the business. It's not about money. It's about people. I've just seen it so many times. It's not about the people anymore. You look at the CEO's money. They're making on yearly basis. And like you're saying, they pull in these contractors and stuff for a redesign. And I mean, they have the staffing right there, but the other thing is redesigning a system feels massive and overwhelming for someone who's working a 12 hour shift. So like, how do we bridge the gap between the grand vision of redesign and the daily reality of just trying to get through the day? What is the very first step in moving from a mindset of passive hope to one of active change? First off, you don't have the right people at the table. You don't have the nurses at the table. You don't have the providers at the table. You don't have the right people. You're not asking the right people questions. And if you just sat with those people and had like a town hall and brought those questions and allowed people to speak up and speak freely, Things could be fixed. The design is not hard because anything that's fractured can be fixed. Anything that's broken can be fixed. Exactly. None that matters. Patients don't go there. They don't get good care. You know, we all know those stories. God, don't go to that hospital. uh No, not that one. We all know in our communities where you go and where you don't go. That alone says something. my God, that alone says. And it takes me back to the story of the valuing the people, you know. It's like if one more leadership team tells me they value their people while people are breaking, I'm going to hand them their own retention data. I'm just going to hand it right back to them. Yup. staying. Exactly. Right here. Because people are not the cause of doing business. You know, they are the business. It starts with the people and it comes down to the people. The people that we're caring for. and the people that need to be cared for, you know, both of us. You have to yield the healers. You have to take care of the caregivers. It's like we've been talking. Everybody, you get burnt out. There's compassion fatigue. You go numb. Eventually you're so tired. You just don't give a fuck anymore. Just get me through the day. Give me through the day. me just do what I have to do and get through the day. Cause you just can't keep compiling and compiling and compiling. Because every single healthcare crisis we're facing right now, staffing shortages, burnout, retention collapse, quality gaps, traces that to one truth. We've been optimizing systems for business metrics while treating people as expendable. And then we'll be surprised when the whole thing breaks. There's gender inequality in nursing. There's racial disparities in leadership, immunization of care work leading to a systemic devaluation. Scope of practice restrictions that protect turf instead of patients. Hierarchies that silence frontline expertise. These aren't separate issues, They're all symptoms of the same disease. Systems designed around power and profit instead of people and care. Because you cannot fix retention by offering endless wellness literature when the problem is moral injury. You can't fix quality by adding metrics when nurses don't have time to actually nurse. You can't fix leadership accountability by creating more committees when those committees exist to protect the institution and not the truth dollars. People over metrics, image, impact over image. That's not a nice slogan. That's the entire transformation because here's what I've learned after 36 years in healthcare. Business doesn't suffer when you put people first, the business thrives. Nurses who feel heard stay longer. Patients who receive compassionate care have better outcomes. Leaders who build real accountability create cultures where innovation happens instead of extraction. But you can't get there by performing interests in people while optimizing for throughput. You get there by building structures that prove people matter. more than the image of caring about people. Intake mechanisms that track concerns to resolutions. Response structures with clear ownership when nothing changes. Closed loops so people know they were heard. Protection for truth-tellers so speaking up doesn't end careers. That's accountability. Not because it's good PR, because it's what happens when you actually believe it will come before metrics. And if that makes the system uncomfortable, good. Discomfort is often the first sign that truth just walked into the grove. It's something we could talk about for hours. It is. And I'm glad that you brought up infrastructure and the leadership and you said that exit interviews lie. Infrastructure tells the truth. You pointed out that leaders track turnover, but they often ignore the system reasons why good people are leaving. So if you could give one piece of advice to the future leaders listening to the podcast, the ones who will be running these clinics and hospitals in the next five years. What is the one infrastructure metric they should be looking at to know if their people are truly safe and their voices are genuinely heard? You need to have, I'm trying think how to word this because I've been working on this leadership accountability audit and I have 35 questions that I ask leadership and trying to give them a gap analysis on where they're failing. The biggest fail is complaints. The issues that are happening are not making it to the CEO. They're not making it to the top. They're staying within the walls of the departments. So under leadership, just below the C-suite. So when things are being brought to managers, because what do they look at? They look at... your scores, everything is so metric driven, obviously, and keeping your leadership role, your managerial role, know, accountability, dah, dah, dah. But if those things are staying within that department and they never get brought to light and the CEO or the C-suite never knows that's happening, which is what my audit's been finding because people are so reliving their jobs. So they think just turn under the rug because then it will look bad on me because my team is complaining. It will look bad on me because they're not happy. You know, and you have these, these surveys that ask all these questions and it's supposed to be anonymous. Why do we fill out those surveys? Why do they even ask us our opinion when it goes nowhere? We never hear back of anything that we suggested in the surveys. We never hear back from the company that sent the survey. So how How is that working collaboratively? How is that working coll... That's not. So, really paying attention. If you're going to have surveys, if you're going to offer surveys to people, be realistic about those surveys and be comfortable with getting uncomfortable because you're going to hear the truth. So if you're not comfortable with the truth, you're not going to do anything when the truth is brought to you. Now I can't help you. No one can help you. It's not going to change because you don't want it to change because admitting that there's something wrong means you have to be accountable for what was wrong. And then where does that go? Where does that go to next? Does it get shoved under the rock again? Because you have stakeholders. You have people that are looking, looking from up higher than the C-suite. So those gaps, that's what I'm seeing. there's so many things that... I was looking at and what you're asking with that question, with the leadership audit and just simple questions. I'm going to share a few with you right now, friend, just so the listeners have an idea of what I'm talking about and what questions couldn't be answered. So when nurses speak and nothing changes, silence is not what happens when people say nothing. Silence is what happens when people speak and nothing happens. This week, healthcare professionals saw the truth about what ignored voice in nursing. Hundreds of you commented. Dozens shared your own stories of speaking up into silence. Question I kept hearing. So what do we actually do about it? Most leadership assessments measure what you say you value. This one measures what you, what your people actually experience. The gap between policy and practice. But built, this is built for my 36 years in healthcare. I've been a nurse for 29 years on the front lines and hundreds of conversations with leaders who want to do better, but don't know where the system is actually breaking. So the audit I went through and examines five critical systems and organizations. Okay. So voice to action loop, how concerns move from frontline report to leadership response or where they disappear. Next. There's the protection of infrastructure, whether truth telling is structurally supported or just promised in posters. Where we come back to image. In fact, visibility. The people doing the work can see that their voice centered and created change. Organizational Contacts and Leadership Involvement. In reality, leaders are working within. Work force stability, reasons people leave, what staff are saying about safety, trust and voice. So now accountability transferring governance responsibility. What happens when concerns reach leadership and whether responsible uh responsibility is truly exercised? or quietly transfer without resolution. So this survey that I'm doing, I'm simply asking 35 questions and starting from the beginning. Like how many employees do you have? I mean, just simple questions, you know? And what happens when someone speaks up? Is there a process? How is it escalated? Where does it go from there? You know, and they get to the first six questions and get to the 10th question and by then they're lost. You know, the next question, they're like, I don't know how this works. I don't know where that goes. So there's such a breakdown as in everything, right? Communication. Communication is the worst breakdown ever because people aren't talking. People are afraid to speak up. Then you have the silence all over again. So, you know, with people bringing concerns, talking about things. That's how we're gonna change what's broken. So here are the six questions, okay, some of them question you a little bit. What percentage of concerns result in visible change and how is it tracked? Question two, who owns the handoff when concerns move between departments? Question three, has anyone experienced negative consequences after reporting a concern and what happened? Question four. What happens when a document in concern receives no action within the stated timeline? One, how often do exit interviews reference concerns that were previously raised but never addressed? Question six, at the board level, who is ultimately accountable when concerns are raised but change does not occur? So by the 10th question, most leaders realize that they don't track concerns end end. And by the 25th question, they see that staff often have no way of knowing whether their voice mattered. By the final section, they recognize that accountability is assumed more often than it's measured. And about blame, visibility, viability. Because, It's simple. The questions are simple. But if you're not willing to face what's broken, if you're not willing to take on making a broken system, broken organization, better? then you are in the wrong business, you are in the wrong seat. Because people at the top, they have the power, Fred. They have the power. Even like I said, if you just rounded all your floors one day in street clothes, and you just saw, just observe, because we're trained, we read the rooms. know how to read the room, retained observers. You've just walked around every floor in your hospital just one day. and you wanted to make change. You truly wanted to make change and make things better. You would. That's what's so sad. You would, you would, you would make those changes. It takes one day of walking around your hospital, your organization, your clinic, wherever you are. It only takes one day of doing that to see the disconnect. Exactly. To see, to see what's, what's really, really happening. So I have one final question before we close out the show. So for the future leader listening, what is the most important mindset shift that they need to make right now to ensure that when they are in charge, the gap between voice and action is finally closed? say the biggest thing that you need to do is get into the trenches. Be seen. Be heard. Because if you're not and you're just the manager, the boss, but nobody sees you, nobody has respect for you. If they respect you, it's because they have to because you're their boss. They don't have to respect you because they respect you. When you get on the floors and you make yourself seen and you see your team is drowning. and you offer to help, that's something that they will never forget. And people always remember how you treated them. Always remember. And if you have that type of relationship where you truly care about your team and the patients, get out, help them, make them trust you. I don't even say earn their trust. You have to earn their trust because you can say you're their leader. But if you're not, If you're not, it's just a title. This is the title. A leader is someone who beats, who does everything within their power to create growth, to promote growth, to make things, something live and thrive. It's like I was talking the other day of watering a plant. You don't water a plant, dies. It wilts up and it dies. You don't nurture it. You don't need to take care of it. It dies. People are no different. Your team is no different. Think of it that way. If you feed it, it will grow. And if you build it, they will come. You build it, they will come. If you build a safe organization, if you build an environment where people thrive and patients are happy and caregivers are happy and they're paid with their worth, they are valued. And a badge is just a rule. That's not your value. But if you took care of the people within the system, within the business, you would have a flourishing. I mean, it would be like epic. There'd be freaking fireworks and stuff, you know? I can see it. You know, everybody would be so excited because it's like, wow, wow, look at this. And everybody would be fighting to be there. You would be an example as a leader. Wouldn't you want to be an example? Wouldn't you want to, to be a legacy and look what I did. Look what I brought together. Everybody's together because one person can do is going to take all of us. You know, that's why I was saying together we rise. But if you bring everybody in. And you all have that mindset of we can be better. Everybody can do better and do it collectively. system, my God. Again, to all of us, it's so obvious how to fix it. It's just the people with the money that are pulling the strings that don't want to show up. uh Because you just brought something that it reminded me like After I got out of the military. I had a time where I wasn't sure what I was doing anymore I didn't know where my life was going. I ended up working at Chick-fil-a and Here's the interesting about Chick-fil-a There's so many of them around But every single one Can be traced back to its proper owner owner because The owners are only ever allowed to have up to three Chick-fil-A's. And the reason for that is because they want the leadership to be out there checking on their stores. They want the leadership in there to connect with their workers to be seen and so that they can actually control the growth and the performance of the Chick-fil-A from the floor, like we're saying. And it's that kind of mentality that should also be happening in healthcare. Cause if it was things would be so much different when I worked at my Chick-fil-A and I became an assistant director, assistant director, sorry, assistant coach. The owner would have monthly meetings with the assistant coaches and coaches. And it wasn't just a regular old, how is this going on? Or what can we do better type of meeting? It was an actual leadership meeting. Like we would sit down and we would talk and discuss leadership roles and becoming better as leaders. so that we could implement that when we actually go back to working on our floors. And in that time, we also had the opportunity to speak up about what's going on. And it wasn't, you're speaking up and you're going to get in trouble for saying something. It was, I'm speaking up so we can make it better. And our customers, or as we call them in Chick-fil-A, our guests could have a better experience. So it's interesting because like I said, Chick-fil-A, the owners are only limited to have three stores at max because they want those leaders out there patrolling, seeing what's going on, getting a better understanding of the community itself and their workers so that they can make sure that their store is always thriving. And that's what healthcare needs. They need their leaders to be out there patrolling. on the floor, seeing what's going on, helping, because I will tell you that the owner that I worked with, he would get behind the counter and start helping us if we were falling behind. That's the kind of leadership we need. That's what the leaders need to do in order to figure out what's going on out there and how to better things. You have to get your hands dirty. And again, how much more respect did you have for him because he did that? I can still tell you that it's Saying it not here because it's... national thing but... Yeah, but know that again, it's so obvious. It's so obvious what can be done and how to fix it. So simple, rounding, round every single day, make your presence known. You know, get out there, help your team, jump in, dive in, don't be afraid to get your hands dirty. So simple, so simple. Take notes. Take notes. Alright Kim, I want to thank you so much for joining me. It has been a really incredible show and powerful and necessary conversation that just needs to be heard. So thank you so much for being here. Yeah. thank you. Thank you for having me. And I hope that was good. I hope to nut your. Now, before we wrap up, it's time for your map moment. time for your app-a-movin' a quick little push to keep you goin' stay focused, keep strong your pathway to success is on- uh conversation we just had can feel overwhelming. The idea of redesigning the system can feel like trying to move a mountain with a shovel. So let's bring it back to you. Right here. Right now. The core of the issue is your voice. A voice that the system may have tried to quiet, but that it has not extinguished. Your challenge this week is what I call The one degree shift. It's not about shouting into the void again. It's about finding a new direction. Step one, identify your audience. Think about the last time you had a problem and nothing happened. Who did you speak to? A manager? A supervisor? Now I want you to identify one other person. A trusted colleague. a mentor, someone in a different department who might see the problem from a different angle. Not to report it again, but to validate your experience. Just to hear them say, yes, I see that too. This is about breaking the isolation the system counts on. Step two, reframe your concern as a question. Instead of stating the problem, reframe it as a curious question. For example, instead of saying this workflow is broken and unsafe, try asking the trusted colleague, I've been wondering, have you noticed any changes with how we handle x? I'm trying to understand the process better. This isn't about being passive. It's about being strategic. It opens a conversation instead of hitting a wall. Step three, document your win. Your win this week is not fixing the system. Your win is finding an ally, having your reality validated, and successfully starting a conversation. Write it down. Today I spoke with colleagues name and they confirmed what I've been seeing. That's it. This one degree shift doesn't change the system overnight. But it changes your position in the system. You move from being a lone voice, shouting at a wall, to being one of two people starting a conversation. And that is where every single meaningful change begins. That is how you reclaim your voice. Not by speaking louder, but by speaking. Smarter. Your voice matters, your integrity matters, and you are not alone. That was a heavy conversation. But in this field, we don't have the luxury of avoiding the heavy things. The most dangerous lie a broken system will ever tell you is that you are the only one who sees the cracks. It wants you to think that because your voice was ignored, your voice has no value. It wants you to feel isolated. Because isolated professionals are quiet professionals. But you just learn the truth. Silence isn't your failure. It's a symptom of their broken infrastructure. You cannot out-resilient a toxic environment. You cannot carry the weight of an entire hospital on your own shoulders. But you can refuse to be isolated. When you execute the map moment for this week, when you turn to the medical assistant, the tech, or the nurse next to you and simply ask, do you see this too? You destroy that isolation. One person speaking up is a Two people speaking up is a coalition. You do not need a C-suite title to be a leader. You don't need a boardroom to change the culture of your unit. You just need the courage to look at the person standing next to you in the trenches and say, I'm not staying silent anymore. Build your coalition. Protect your integrity. And remember that the future of healthcare doesn't start in an administration office. It starts with you, right there on the floor. Until next time, keep learning, keep growing, and keep following your map, your medical pathway for success. I'll catch you on the flip side.