Intergenerational Management in Healthcare | E. 74

The Healthcare Leadership Experience

The healthcare demographic is changing as younger generations move into the workforce. Ryan Dos Reis shares his advice on leading and motivating employees with Jim Cagliostro.

Episode Introduction

Ryan reveals how advice from a world cup soccer referee influenced his leadership style, why the ability to ‘’reset your day’’ matters in CTICU. and explains why we should forget generational stereotypes in the workplace. He also shares his mantra of ‘’direct, motivate, develop’’, why hospitals need to hire with intent, and why communication and listening to understand are key to successful leadership.

Show Topics

• Lessons from a world cup soccer referee

• Resetting your day in the face of challenges

• The joys of critical care

• The importance of performance evaluations

• Look at the individual, not the stereotype

• Direct, motivate, develop

• Clear communication and listening to understand

03:03 Lessons from a World Cup soccer referee

Ryan explained how his experience as a referee informed his leadership style in healthcare.

‘’I was refereeing for like about 15 years. I was able to referee up until like the Second Division of professional soccer in the country. There was a lot that went into that, a lot of fitness testing, a lot of regiment, but then also a lot of leadership aspects of coaching. Going out to the field, what do you look like when you're off the field? How are you presenting yourself? Are you well-groomed? Making sure your shirt's tucked in, your socks are off and not necessarily down, or your socks are fully up, so that whole presentation. Then, also command presence and your aura that you bring when you're either off the field and then on the field. That was something that was really instilled in me by a former World Cup referee at the time. That was something I always worked on is, how are you communicating with the players on the field? How far are you away from them? Then, also that perception is reality. Maybe I'm talking to them face to face, but maybe from somebody that, I don't know, half a mile away, it might look like I'm screaming at them, so just being aware of like my body mechanics, my language, my body language. All of that, then, translates into nursing when you go into leadership. It's a lot of that, so I find myself, even to this day, and I've been a leader now for about three or four years, I find that I play back a lot of what I learned through refereeing in my leadership style.’’

07:57 Resetting your day in the face of challenges

Ryan said the nature of critical care means your carefully planned day can rapidly be flipped on its head.

‘’Yeah, you know, it's every day is a new day. I have a little agenda book, and yesterday before I leave I write down all the things that I need to work on today, coming in on Friday, so it's all written down. Then, you walk in and there's multiple other things that happened. I walk in and maybe there's a patient that now all of a sudden is on ECMO and you're just like, "Oh, where did that come from? They weren't here yesterday." Then, maybe there was another patient who came up from the OR who was also really sick, and the nurse was feeling a little overwhelmed and had a lot of questions. Or maybe we had a newer charge nurse that needed a little bit of support, and then maybe something happened overnight where they wanted to run it through you. Now, you're walking in where you're thinking like, "Okay, my day's set," and then next think you know it's like people are coming in and picking at you like, "Hey, I want to talk to you. Hey, I want to talk to you. Oh, you just released the schedule. I wanted to talk to you about that." Now, before you know it, it's 9:00 and you're like, "Wow, I haven't even been in my office yet to go through some of the things that I just wanted to go through." I think that sometimes can be challenging in these critical care settings where you think that you have things mapped out for the next day, and then you come in and it's like flipped over on its head. Just being adaptable, being flexible to just know how to reset your day and not let that completely ruin your day, I think, is a really big challenge that leaders in a critical care setting will face.’’

07:57 The joys of critical care

Ryan said that seeing patients recover is one of the most rewarding parts of nursing.

‘’There are a lot of joys actually that come with the job and from both aspects. It's the patient that was here, maybe the patient was someone who was a little difficult and then maybe didn't do so well, and now went to the OR and came back. Then again, doesn't do well and we have a code on our hands, but we're able to revive them and they're pulled through, and then you're able to go in and visit them and see them. They're talking to you, they're doing well. They're all teed up for potential discharge in the next couple of days, and it's like being able to sit with them and just having that conversation, just kind of like seeing where they are and seeing what they remember, it's so, so rewarding as a nurse. Not even just as a leader, just as a nurse in general, so rewarding to be able to see that and take that moment with them. That’s one big joy.’’

11:55 The importance of performance evaluation

Ryan outlined his performance evaluations and emphasized the importance of one-to-ones to build staff relationships.

‘’I think the other piece of it is one of the things that we do here and all the managers have to do is we have to do performance evals, but then we've actually started doing one-to-ones with all of our nurses. I find those one-to-one being so beneficial. I just finished up all of my one-to-ones with every nurse and it's a moment for me to just connect with them and say, "Hey, so you're a preceptor, you're a charge nurse. How's that going for you?" Or, "Hey, you're not precepting, you're not a charge, but we've identified that you would be good at that. What are your thoughts on it?" Trying to see how they feel about it, and not necessarily saying like, "Hey, you need to precept, hey, you now need to be in charge," but giving them the opportunity to have a say in that. Then, the other piece of it is also looking at like, "What are your goals? You set up goals last years. Where are you in achieving them? If you're not quite there, what can I do to help support you? What can I do to make sure that you get there?...We set out these goals together. You need to meet them." I think just in general now with the new generation and across the country, we need to really be mindful of we're here to help. We're here to foster relationships and really make sure that everybody's growing and not so much just like leaving you alone to just sink or swim and, "Oh, you didn't meet your goals? Great, so now you're not going to do well on your eval." It's not the same. That's the one thing that I will say is we've been doing here and I think has helped with keeping people feeling like they're a part of a team.’’

15:35 Look at the individual, not the stereotype

Ryan highlighted the importance of looking at individuals, rather than trying to categorize them

‘’I found that there's times that I think we generalize generations of like, "The Millennials are X, Y, and Z, and the Baby Boomers are X, Y, and Z, or A, B, C, D. The Gen Z's are now W, X and Y." I think that sometimes the generalization, okay, we have an idea of what that generalization is, but now let's look at each individual because maybe each individual person might not necessarily fit that generalization because their upbringings might have been different. I think that it's really important to kind of hone in on each individual person and understand what makes their inner clock tick. I do think that sometimes coming into nursing, and a lot of it might depend on where you came from in terms of schooling, but my mindset is maybe they don't know or not aware of the empowerment and they're not aware of what we can actually do and what we can actually change. I recently had some of this, a discussion with a couple of nurses where they were asking all these why questions like, "How can we use this on a back check valve, but we can't use this type of sticker on a Alaris pump? Is it an infection prevention issue? Is it this?" I just sat there and I was smiling the whole time and I thought to myself, "You know what? I'm just going to chime in." I was like, "You know, if you find evidence that would support best practice on how to manage a CVL, and if you think that it might not coincide with what our current policy is, then bring that forth and let's challenge the policy. Let's challenge the status quo and say, 'Hey, we found this. It's validated evidence. We currently practice this way. Could we take a look at this?"(things) can be changed if you have the supporting evidence behind it. I think that sometimes people aren't aware of that. Here's the generalization. I do think that the younger generation is very much like, "Okay, well, the organization, the institution is saying that this is what we do, so that's what we have to do." They don't necessarily always think outside of that box to be like, "Oh, maybe I can challenge that."

20:44 Direct, motivate, develop – three tips for intergenerational management

Ryan explained his mantra for successful leadership.

‘’Yeah, actually, I have a piece of paper on my wall that's actually currently covered up, but I will uncover it for a second, and it says... There's three words on here. It's direction, motivate, and develop, and that to me are the three key things that I have to focus on. I need to provide direction for the unit and for all the nurses that are here. I need to motivate each individual nurse and tech on the unit. Then, I also need to look at development. Where does each one of them want to go? In terms of, for example, let's say my charge nurses. It's like, "okay, we need to look at the charge nurse and the charge nurse role. So I have been spending a lot of time on making sure that we have monthly meetings with my charge nurses. I send out an email every two weeks with just any operational updates, things that they need to worry about or focus on. Then, I also provide them some of the learnings from our academy that we have here on leader of self, so things on emotional intelligence, things on how to deal with disruptive behavior or conflict because those are not things that we typically get. Any institution typically it's like, "Okay, hey, you're going to be in charge." You go to a charge nurse class, it's maybe four hours. Then, you do some type of shadowing experience on the unit, but we're not really providing the charge nurses with those soft skills on being a leader, which is charge nurses really being... You're air traffic control. We're now asking these people to four-hour class, maybe one or two shifts of orientation. Then, we're saying like, "Hey, now go manage all this traffic, patients coming from the OR, patient's leaving, nurses coming, calling out, patient placement calling you, asking you to put a cath lab patient here and there, and you're trying to figure all this out while also rounding the unit, so supporting the team, and making sure that people are taking breaks. Yeah, yeah, so to me, it's really important that we spend some time developing and figuring out what it is that they want, and I think that's key.’’

23:54 Clear communication and listening to understand

Ryan shared his leadership advice for working with a new team.

‘‘It’s really important that you as a leader, even if you're new to the position or new to the role, that you set up where you want to take the unit, where do you want, what's your vision for this unit? How does it align with the hospital vision and mission? I think some of that comes from just getting to know your staff. When you're first onboarding and you're first starting out on a new unit with a leader, I think it's so crucial to meet each individual employee, each individual team member and just do a like, "Hey, how are you?" introduction. Get to know them outside of work a little bit about work, and then get to know what makes them tick and where do they see the unit going. Then, you kind of categorize all of that and put that into buckets, and then you come with where you want to take the unit and you create a mission or vision for that unit that is embedded with what you got from each employee with also some of your core values. Then, you communicate that out clearly to everyone so everyone knows exactly where you want to take this unit and where we're all working towards. I think it's so important to be very, very clear with that because that comes down to that first word that I mentioned, direction. …. In terms of things that I've learned that I really put into practice today is listening. It's so important to listen to understand and not listen to respond.’’

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You’ll also hear:

A need to get involved; Ryan’s early career in healthcare, from med-surg and progressive cardiac care to CTICU. ‘’I really love leading initiatives and really looking for initiatives and really looking for areas where we can improve. Knowing that we have that say to make that happen.’’

The joy of supporting new nurses through their onboarding and orientation, ‘’Just seeing how much they've matured, not only just as a nurse but as an individual, is really one of the biggest joys that for me, at least, I just sit back and I smile. I'm like, "Man, I did something right. We did something right here as a leadership team, and look how wonderful it is to see somebody just propel in this environment."

The importance of ‘’hiring with intent’’ in a post-pandemic era. ‘’ … they're not leaving because it's me. They're not leaving because of the culture. They're leaving simply because maybe there was just this funky time when we were just hiring to try to fill voids.’’

Encouraging young people to challenge the status quo in healthcare. "Figure out like, "Could we do something different?" The answer is always yes initially until we meet a roadblock and say, "Actually, we're not going to be able to do that because of here's why." Right? ‘’

The move towards servant leadership, ‘‘At some point, it was transformative, the transformational leader, and now it's like, "You're still a transformative leader, but now it's also like, "Well, there's a servant leadership aspect of leading nowadays that needs to come out."

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