MODERN HEALTHCARE: I want to take a step back to give some advice to nursing leaders who might be going through a change in their health systems. You’ve gone through a health system that has merged and rebranded. What does nursing strategic planning look like when you’re headed toward becoming a new entity? Can you just give some advice and heads up for nursing leaders who might be in that situation?

KATHLEEN SANFORD: It looks just like as if you didn’t go together into a merger or come together.

MODERN HEALTHCARE: OK.

KATHLEEN SANFORD: I often say to people, if you can’t live in the gray and if you can’t take the multiple change that’s going to be happening, you’re going to be miserable. Because it’s going to happen repeatedly for the rest of our careers. Because the world is changing so rapidly and technology is changing so rapidly. And the reason I say it’s the same is — if you’re in an organization that’s been pretty steady for a while, it probably needs to change anyway. I believe we should be looking at our organizations, whether they’re going into something like a merger or whether they’re doing the same things. Both of them probably need major change. I don’t think it’s really all that different, whether you’re a merger of two or a merger of three or staying a single. Now, it is a little more difficult in a merger because people are hanging on to a couple different ways of doing it. And the most important thing is when you do come together, it needs to be about creating something new — not about hanging on to anything old.

MODERN HEALTHCARE: You know, if you’ve been doing the same thing for 50 years, 100 years, it is time to change — absolutely. So, what do you suspect is being overlooked or underappreciated when you’re doing this planning for the nursing workforce? You’ve already talked about nurses having a voice. Talking to that nurse that, you know, just keeps things going on the night shift and probably has not been at the table. But what else should nursing leaders be considering? Whether it’s salaries, training, work-life balance — what are some of the blind spots they need to really be on the lookout for?

KATHLEEN SANFORD: Well, I’ll tell you the things that they should be doing and then I’ll tell you the ones that I think are the blind spots, so it should help. I think we need to be reassessing how we work together as teams — what our teams are. We need to reassess how we can use technology. We need to reassess who’s on our teams. We need to reassess all kinds of policies, procedures — all of that, that has to be done. But what I think gets left out are things that are kind of sacred cows that are very difficult for people to understand that need to change. I think we have two right now. And one of them is productivity and workload. 

Now, that’s something that nurses have talked about for a long time, and we benchmark how productive we all are against each other. We need to totally relook that. We have different patients in the hospital versus outside of the hospital as we have a different acuities that we didn’t have before. As our patients may have totally different needs and we need to stop thinking just about acute care. So, when people come in, we talk a lot about making sure there’s equity of care and we talk a lot about making sure that we aren’t sending people back to bad situations, but we don’t do it. And that’s going to take time and energy and it’s going to be a new priority. So, we need to relook workloads, relook acuity. We need to stop what we’re doing right now and rethink: How are we actually staffing for what the people we’re taking care of need now? Not hours.

I’ve always been against ratios and I know that some states have them but I’ve always been against them. I had an opportunity to talk to my state legislature back when they were thinking about doing it in this state. They had recently done it in another state, had a ratio. “Oh, we’re going to protect the patients!” I said no, you’re not. You’re going to be tying our hands to do what’s right in the future, because if you’re stuck with ratios based on an old way of taking care of patients, you cannot be innovative. You cannot use technology to make sure that patients are getting what they need because you’re stuck with these old ratios. You cannot help staff, including nurses, work at the top of their license and do the right things for their patients. And even if the only change people make is to change the words from “hours for patient day” to “dollars spent per patient day,” that would go a long, long way.

The second thing that gets forgotten about is that your workplace is made up of all kinds of small things — small things that people don’t think about and they don’t understand how those things add up, maybe for themselves, even. Even subconsciously, right? We talk a little bit now more than we used to about microaggressions. We do talk about that, but there are other things that we wouldn’t think were aggressions that add up to saying to me as a nurse, or to me as a housekeeper, or to me as a clerk that you are less than. The entire team is needed and none of us are less than — and yet our very language makes us believe that. So, the small things need to be paid attention to, even if people say, “Oh no, that doesn’t bother me.” They add up! They do bother us and we just don’t know it.

So, I’m going to give a couple of examples. One thing is the way we use titles. I love my physicians. They’re in my family and I love my physician colleagues. But I don’t understand why your Dr. Smith and I’m Kathy — in the same sentence. We’re having a meeting with Dr. Smith and Kathy. Or we’re having a meeting with Doctor Smith, Mr. Jones, and Kathy. There is a message that’s sent that we don’t mean to send, even among our own genders. We send these messages that certain people are deserving of a title and others are not. And I don’t care if you call someone Dr. Smith, but then I shouldn’t be Kathy. And I’m really not saying I have to be called Dr. Sanford because I have a doctorate. I’m not even saying that — call me Ms. or Mrs. with my last name. It is a micro insult to different people when they are not treated with the same title respect as other people. So, that’s one example.

The second example is — as I moved up, it’s astonishing to me how when you get into executive practice, our systems think that the female profession — largely female profession, nursing — should report to the largely male profession, physicians. Now, why should one executive who’s running a huge part of an organization automatically report to another executive who’s running a part? Why couldn’t they be dyads? I don’t know if you looked at my autobiography at all, but I’m real big on dyads.

MODERN HEALTHCARE: Yeah.

KATHLEEN SANFORD: And they may sound silly or self-serving but those are two examples of the micro insults that all add up to a nurse on the front floor, or in any position, of thinking, “I’m lesser than other people.”

MODERN HEALTHCARE: That is incredibly powerful. And I think with our conversation about the nursing shortage and preparing for it, and how are we going to train and find these people — this younger generation will pick up on those microaggressions and they will not think that they’re being too sensitive. They expect them to be addressed and corrected.

KATHLEEN SANFORD: I agree and I’ve often said — I’ve probably said for 20 years when it used to be that we thought we were wonderful if we worked all the time and didn’t go to lunch. We didn’t go to the bathroom. Just look at me, look at me, look what I’m doing. This next generation is not going to put up with that. They’re going to want a life, and they’re right.

MODERN HEALTHCARE: So, speaking of the last question is for the sort of younger nurse who has her eye or his eye on the C-suite. They want to get into strategic planning, they want to be in more of that administrator role. What would you say are the top three pieces of advice you would give that nurse to reach that level?

KATHLEEN SANFORD: I’ll tell you the three that people say and then I’ll tell you the three that I think, which are not the three that people say.

MODERN HEALTHCARE: Great.

KATHLEEN SANFORD: People always say get a mentor. They say learn finance, learn things that you don’t know, and accept every new thing that you could do that you’re offered, so you can show you have a lot of experience. I think they’re wonderful things, but they’re not the three things that are going to help young leaders move up and feel good about themselves, and feel good about the work that they’re doing, and have a wonderful career. Because it’s not just frontline staff nurses we need to be concerned about, it’s our entire team. Our entire team has to have a wonderful career. So here’s my three and then I’ll tell you why. The first one is be competent. I’ll talk about that in just a minute. The second one is have a great sense of humor. And the third one is love. Now, let me tell you why I think those are the three.

So, the competency — all of the things that people usually tell you about helps you with competency. You need to have management and leadership understanding. I really believe that leadership and management — let’s just not talk about leadership for a minute. Management is a specialty. And it’s a nursing specialty, but we’ve never treated it as a specialty. We would think you’re a great nurse, you’d be a great manager. You’re a great doctor, we’ll have you be the chief medical officer. Right? It’s a specialty and it has as much research behind it — and practice proofs, I would want to say, behind it — as clinical best practices do. And yet, we don’t think we need to train that and learn that and understand that.

And so you need to be a competent leader. You don’t just need to be a competent nurse, since you have me talking to a young nurse. You have to be a competent manager and a competent leader, and you need to understand what that means and what the research says about what makes it. And it’s been evolving, too. You know, all the way from the Great Man theory— you know, the first one was the Great Man theory, and now we’re up to teams and dyads. So, understand — understand that research and understand the stuff that we all hear about, your own emotional intelligence, etc. Be competent and understand that being a leader is a specialty. A formal manager.

The second thing is to cultivate a sense of humor because if you cannot laugh at your mistakes, you will be miserable. I was the first lieutenant at the age of 21 and I had my own nursing unit. I was incompetent — and I had been trained to be an officer and I had trained to be a nurse. But I always tell people, I should write apology letters to the people that I first had because I made so many mistakes. And if you don’t have a sense of humor about it, you’re going to have a problem with that. I tell new, young people who first go into their management job — and anyone who’s ever worked with me will laugh — I say welcome to always being wrong.

Because when you come into management, you will always have someone who thinks you’re wrong. If you’re doing it to be popular, if you’re doing it because you think you’re perfect and you’re going to always make the right decision — neither of those things are correct. You’re not always going to make the right decision, and you have to have a sense of humor and the ability to forgive yourself just as much as you forgive other people. But you also have to have a sense of humor of, “Yeah, I know — doesn’t matter what I do, it’s going to be wrong to somebody.” And that’s just how it is. You just do what you think is right and what you’ve learned because you’re confident.

And the third one is love. We get a little antsy about saying that. I have a strong belief that our healthcare systems would be so much better if we balanced our love between a group of stakeholders — one of which are, of course, the people we take care of. The second are the people who work for us, that are our employees and what they have to do. The third is the communities themselves. We have to have love and concern for what happens to our communities. The fourth is the organization! We need to care enough about our organization that we want it to be wonderful and successful. And then the last one is managers and leaders, including themselves. Because every decision we make, you need to consider all of the stakeholders and what’s important for them. And what I tell people is, there will be decisions made that might not be good for one group and better for another. But as part of your leadership competency, you should consider the effect on every single stakeholder in those groups — the groups that I was talking about — before you make the decision so that you know what you’re doing. So, those are my three: competency, a sense of humor, and love.

MODERN HEALTHCARE: I love it and you’re right. I’ve heard every one of the first three you mentioned that everybody says on this podcast. So, thank you for bringing a different perspective to it. That’s awesome. Thank you so much for your time. This was so motivating.

KATHLEEN SANFORD: Well, I hope so. I think we’re in an exciting time. I really do. I feel bad when I look at my colleagues and we all look tired because it’s been — it has been hard. It is challenging. It is difficult. But it’s an exciting time to figure out how we’re going to make it better because some of the things that I’m talking about when you’re talking about strategy — those were things we should have done whether there was COVID or not. Now, we have an impetus to do the right thing — even more than we had before.

OUTRO COMMENTS: Thank you, again. That wraps up our conversation with Kathy Sanford, giving strategic insight on planning for the impending nursing shortage.

Again, I’m your host, Kadesha Smith, CEO of CareContent. We help health systems reach their target audiences through digital marketing that focuses on the right content.

Look for more episodes of Next Up at modernhealthcare.com/podcasts, or subscribe at Apple Podcasts, Google Podcasts, or your preferred podcatcher. If you’ve been enjoying Next Up, please go ahead and leave us a review on your preferred podcatcher as well. Thank you again for listening.