SPEAKER_00 0:04

Welcome to ACNL in Action, brought to you by the Association of California Nurse Leaders. I'm your host, Charlene Platon. Today's guest is Dr. Rhonda Foster Smith, an accomplished nurse executive, leadership coach, consultant, and fellow of the American Academy of Nursing. She has spent her career developing leaders, strengthening healthcare teams, and helping organizations build cultures of nursing excellence. Today we'll explore the experiences and lessons that shaped how she leads. Thank you so much for joining us today, Rhonda. So great to see you.

SPEAKER_01 0:38

Charlene, it's great to be here, and it's good to see you too.

SPEAKER_00 0:41

I'm very excited because there's a lot to dive in with your journey. There's so much expertise that you have. And the first question that I want to start with just goes in relation to your own journey with nursing. And I wanted to ask what first pulled you to nursing and what made you stay?

SPEAKER_01 0:59

A long, long, long time ago. Actually, my high school guidance counselor, I was always interested in something science and healthcare. And what I thought I wanted to do, he talked me out of. And it was some of the best advice that I could have ever been given. And he suggested nursing. His sister was a nurse. And I'm curious. I'm like, so why? Why would I want to do that? And he said, because you have flexibility, da-da. He listed all the advantages. And if you don't like one department, you can work in another. And if you don't like one hospital, you can go work in another. And you can do a variety of things. And at that moment, I was so Charlene.

SPEAKER_00 1:44

So well, that is amazing because, as you said, there are so many avenues in nursing. There's so many directions you can go. And one of those directions is actually in leadership, which we are all about leadership in this podcast, too, with the Association of California Nurse Leaders as well. And I am wondering who shaped the way that you lead before you ever had a leadership title?

SPEAKER_01 2:06

I think two people. She was viewed as an expert in med surge nursing. And she was someone that was really, really, I will say, in looking back, somebody might say, oh man, she was hard on you guys, because not a lot of people wanted to work on her unit. But I did. I knew she was hard. I knew if I were going to be a good nurse, it was going to be under her. The other person was a supervisor who I was frustrated one day, and she said, never lower your standards. And I still say that all the time. I won't lower my standards.

SPEAKER_00 2:57

Yes. And that was really great at wisdom and advice. And I actually feel that it's transferable to many different levels of nursing, whether you're at the bedside providing providing clinical care, or whether you're in leadership and you have different staff that you're managing or different teams that you're managing. And I wonder too, if there was, you know, related to the two individuals that you shared with us about, was there any specific experience from either of them that changed your definition or changed your perception of a great nurse leader?

SPEAKER_01 3:30

They round, they did rounding when round rounding wasn't sexy. They um asked how your night was going when that was not a scripted question. They asked if you needed any help before that was something popular to do. And I think the way they worked informed how I was shaped as a nurse and a nurse leader.

SPEAKER_00 3:56

That's great. And, you know, the two things that you spoke to, those examples, they actually remind me a lot of what people refer to in many ways as emotional intelligence, you know, emotional well-being. And this is way before COVID, right? It's way before we even way before. Way before. And that is actually very progressive. Like that is actually transformational leadership in action. And I think it still is, to be honest, right?

SPEAKER_01 4:25

I do too. I think it is. I think the difference now was they had more time. And when I say more time, my first manager only had one unit. Now managers have two or three units. My supervisor had a partner in supervision. And so they could go the house up and down the elevators to check on everybody because they would split the house. And a lot of times that's not how things are set up anymore. I'm very empathetic to leaders today because I don't know that we resource them appropriately, that they have the resources they need to do an excellent job.

SPEAKER_00 5:12

Right. There have been so many changes right throughout the years in healthcare and what it looks like now. And, you know, I come from a family of nurses. My mother's also a nurse, and she tells me stories about what she experienced in nursing. And it does sound very different than what I've experienced, you know, what others have experienced now. And so when it comes to leadership from that standpoint, with all of these changes, there's this idea of change management, or, you know, I believe you've also called nurse managers as real change leaders.

SPEAKER_01 5:44

Definitely.

SPEAKER_00 5:46

And I'm you read that. Yes, yes. And I I just want to know for those listening, what separates those who drive change from those who simply manage it? Because there are so many changes.

SPEAKER_01 5:57

I'm going to use the word again, Charlene. Curiosity. The what-ifs questions. What if we tried it a different way? What if we find out what's best practice? What if we see what another unit's doing and maybe we can do the same thing to be more successful? I was having a conversation just the other day about INOs. We are talking about INOs. And we were talking about INOs from the perspective of the importance of accuracy. And you look inside and you look at the policy, and it may not match the practice. But we shouldn't get mad, we should just do better. And we shouldn't fuss up, I mean, because the the work is in, oh I have to change the policy, and I gotta roll it out, and what if they don't want to, and all those factors that come in. And I think we have to resource how they do it. Involve nurses that take your patients in the decision making, as well as the decision making and the implementation. So much comes down to the little things.

SPEAKER_00 7:10

That's right. Because any any change, even if they're perceived as small changes, are actually still big changes in practice.

SPEAKER_01 7:19

When you have a lot on your plate. Mm-hmm.

SPEAKER_00 7:22

When you have a lot on your plate, when you have two or three units to manage, and maybe twice or three times the amount of staff to manage as well, right?

SPEAKER_01 7:30

Absolutely.

SPEAKER_00 7:31

And so now if you have this one topic of eyes and o's as the example, and now not only do you have to change practice for one team, but two or three teams, that becomes a much bigger task, right?

SPEAKER_01 7:42

And think about the numbers. So what's the the number of team members? That's change. People have multiple shifts they're working, there's staggered shifts, there's all kinds of hours that they're trying to cover. And it's like finding out, keeping them in the loop. Because the last thing you want to find out with the implementation is nobody told me.

SPEAKER_00 8:09

Right. Which I I do still see and hear that a lot, right? Where do we go wrong with that? Because that seems to be a pretty common occurrence. How do we involve the leaders to be part of that process from the very beginning?

SPEAKER_01 8:22

Professional governance and making sure that the leaders understand their role in professional governance, allowing them to help shape and provide resources. As well as knowing what's a stop, start and continue. What can we really do? What can't we change? Charlene, you might have a great idea, but what are some barriers to your great idea and implementing it? And so we have to think about those things. But that's a that's an ongoing discussion. That's not just when Charlene brings forth an idea. That's an ongoing discussion about, hey, how are we doing? How checking in. How are we doing? What could we be doing differently?

SPEAKER_00 9:08

And that was such a powerful insight because it is an ongoing discussion. And that actually might be the crux of why it's missed, right? Because it might not be part of that regular conversation, especially if you don't have that professional governance and governance in place. And you spoke to a lot of different challenges, a lot of things that leadership will encounter. And I'm curious if you have seen, you know, what is the toughest leadership lesson that you've had to learn firsthand? It doesn't always filter down.

SPEAKER_01 9:40

And I think the other lesson that I think many organizations are still struggling with is strategy and what's happening on the unit may not align.

SPEAKER_00 9:52

Right. Kind of reminds me of the example you said with the policy, right? What's written in policy is not necessarily what happens in practice. Right.

SPEAKER_01 10:00

So we can so I'll use this example because talk about a leadership lesson and a big old aha moment. You know, we use that term alignment a lot. And are we aligned? And I thought, okay, at first, now we have to define alignment. Do you like ice cream, Charlene? I definitely do. Okay, so we're aligned around ice cream. We both like ice cream, but what's your favorite kind?

SPEAKER_00 10:27

Oh, yeah, that's complicated.

SPEAKER_01 10:29

If you had to pick one, what are you gonna pick? Chances are it's gonna be different than what I would pick. So I think alignment, we stop at, we need to get to a point of agreement where we can agree if we're going to the ice cream store, that either we're gonna each get to do our own thing or we're gonna agree on a flavor and both be happy. And that's an oversimplified example, but it's real because we stop at alignment. So we might align around intake and output. Yeah, we need to do it. And yes, it needs to be accurate, especially in intensive care units. We align around that. But do we agree about how it should be done consistently?

SPEAKER_00 11:14

And that alignment is so important because it it actually drives much of the practice, much of the relationships in the team. And that's what is actually the key, right, to accomplishing goals together and working towards that same mission, right? Because if you are aligned on that, then they're that's really what unifies the team. It should.

SPEAKER_01 11:38

It should. You're right. It should. And now the point that you made earlier about how does this, how does this get communicated? Well, now we got to figure out once we're aligned and once we agree, how we're gonna roll it out and engaging the end users in a rollout, as opposed to sending someone else to roll out an initiative to their unit, to another man's team.

SPEAKER_00 12:03

Right. Yeah, that's that's where it could be pretty complicated. And you know, I do want to talk about Magnet too because of your expertise in Magnet. And this is how we do incorporate a lot of professional governance as well. And I was wondering after helping organizations pursue magnet recognition, what have you learned about creating excellence that lasts beyond the designation? I feel like this kind of ties with a lot of the topics we're discussing here.

SPEAKER_01 12:35

Keeping the importance of nursing-sensitive indicators and outperforming your peers front and center so that you don't worry about are we meeting, you know, as a majority of our units, the majority of the time being able to accomplish this. I think having a culture of feedback where you're constantly creating a culture where people feel it's safe to be curious as well as safe to give suggestions or offer alternatives and bring best practice forward, bringing evidence forward, saying, hey, you know, don't just send a bunch of people to the magnet conference or then don't send anybody to a conference ever, because we should be getting ideas and changes in practice from that, and the excitement should last for four years. Right. But we shouldn't just get excited, whoop, whoop, and then and the only the other reason I say this, and this is not an indictment on organizations, but it is a bit of an indictment on how we roll out and go again, roll out and keep going, roll out and go to the next thing, roll out, and they treat magnet designation like a rollout, and it's not. It's a culture, it's a belief system. It's creating environments within environments and cultures within subcultures that want to do bet the excellence to perform excellence in patient care.

SPEAKER_00 14:08

I really appreciate how you phrase that and how you share that because it really goes beyond a checkbox, right? Of okay, we have to do these magnet requirements. It really becomes, it becomes part of the fabric of how we practice nursing, right? It becomes this model of care. It does.

SPEAKER_01 14:25

And it makes things better. I tell people all the time, even if you're not going for the designation, you can use the standards to be better and to have excellence in care. You can't go wrong with those sources of evidence. You can't go wrong with doing engaging professional development and having interpersonal relationships helping you solve problems. You can't go wrong.

SPEAKER_00 14:49

Right. There's so much to gain, right, from having those in place. And Magnet gives tools for people to be able to structure that in an effective way within their organization. And so that's why even if you're not pursuing the designation, or even if that's not currently in place, you could still benefit from a lot of that structure.

SPEAKER_01 15:10

Absolutely can benefit.

SPEAKER_00 15:12

And, you know, there is so much to talk about too when it comes to leadership and nursing. And as we wrap up our conversation for today, I did just want to give you t the floor just to share any advice that you may have for developing leaders. You know, what do you hope that the next generation of nurse leaders does differently?

SPEAKER_01 15:30

If I were giving, and I've had some of my leaders go on to be chief nursing officers or even uh go up to a director role, I would ask, are you sure you want to do this? I will and I not because it's a lot of work. It's new relationships, it's making decisions at a higher level. And have you had the opportunity to do that? Because the last thing I want from a person is to have them be an imposter around the table or feel like an imposter around the table. The next thing I would would recommend is identifying who your allies are, who thinks like you, and who's gonna tell you you're crazy. Who's going to tell you, tell you the truth? Who's going to tell you the truth without being harsh, without being mean, but offering it from a feedback perspective? Because at the end of the day, what leader wants to fail? And getting feedback is like that curiosity muscle. How am I doing? What should I be doing? Have you ever had an experience like this? And this is not a shameless plug, but it might be perceived as one. Having an executive coach, even if you have to pay for it yourself, many times organizations will, and I think it's really important, especially when on when you're onboarding it to a new role like this, that having somebody outside the organization that you can validate what you're saying and hearing inside the organization safely is always good. And it's cheaper than it's cheaper than therapy, Charlene.

SPEAKER_00 17:10

This is true as well. But I really appreciate that feedback. And that is a lot for new leaders to consider, right? It's the the challenge of the landscape of healthcare and leadership as well, as that skill set. And then managing the change, managing those challenges that come through. But then also being able to, you know, once you're in that position, being willing to develop and continue to develop, whether it is through executive coaching or whether it is through conferences, through Magna, any other modality, it's it's that willingness.

SPEAKER_01 17:46

You just nailed it. You really did. You just nailed it. And I think it's an investment in yourself to be great, not to be good, but to to be a great leader, even if the circumstances are not great. But a lot of times we look at roles up and say, Oh, I could do that. The easier they make it look, the harder the role is.

SPEAKER_00 18:10

That's definitely true. And it's this practice of demonstrating excellence, right? To create excellence. It is. And that's part of that's part of Magna too, you know, promoting nursing excellence.

SPEAKER_01 18:23

It is. I love the work.

SPEAKER_00 18:25

Yes, absolutely. And I just want to thank you so much, uh Dr. Rhonda Foster, for being here today and for sharing your wisdom with us.

SPEAKER_01 18:33

You gotta remember, it takes a village. It takes a village. So thank you for the opportunity to have a thoughtful discussion about these things. And it's good to see you again.

SPEAKER_00 18:46

Yes, it's so good to see you too. It's one of my favorite things about leadership, honestly, is the connections because I from what I've seen, you know, it'll be my tenth year in leadership um next month. And one of my favorite parts has actually been those connections because it those last for for a while. So it's it's been very, very great to have.

SPEAKER_01 19:07

And when there are true connections, you can pick up the phone and say, hey, I need to talk this through. Hey, I mean, I do it. I've had situations where it's like, oh, that felt icky. That felt real icky. Let me call, let me phone a friend. Because you need to talk it through and figure out whether or not you could have done something different, which always helps. Or are you asking the right questions?

SPEAKER_00 19:35

Absolutely. You know, we say a lot that nursing is a small world, but leadership is actually an even smaller world. And so those relationships mean mean the world, you know. Yes.

SPEAKER_01 19:46

Like you, I say the air gets pretty thin the higher you go.

SPEAKER_00 19:50

Well, we are so grateful for you for for being here and for sharing your wisdom with us. And thank you again for all that you do.

SPEAKER_01 19:58

Anytime, anytime, Charlene. Thank you.

SPEAKER_00 20:02

Our guest today was Dr. Rhonda Foster Smith, nurse executive, leadership coach, consultant, and fellow of the American Academy of Nursing. We would love to hear your feedback. Email us at social media at acn.org and connect with us on LinkedIn and Facebook at ACNLNurse. And remember, as always, if you like the show, please rate, review, and share. ACNL in Action is presented by the Association of California Nurse Leaders with new episodes every month. To learn more about the show or ACNL in general, visit us at acnl.org. Thank you for listening.