The Workforce We Need: Nurses as Healers, Leaders, and the Future of Care with Dr. Beverly Malone

Speaker A: Welcome to Turn on the Lights, the Institute for Healthcare Improvement's podcast about what healthcare needs now and who's helping us see the way forward. This season, we're asking a simple but urgent question. What. What does healthcare need now? At Turn the Lights, we believe stories are evidence, data matters, dignity matters, and the people closest to care often see what systems miss. Today, we're turning on the lights around nursing, healing, leadership, and the workforce healthcare needs. Now, when we talk about healthcare workforce, we have to talk about nursing not only as a profession, not only as a state staffing category, not only as a pipeline challenge. We have to talk about nurses as healers, nurses as leaders, nurses as educators, advocates, innovators and system shapers. That's why I'm so honored to welcome Dr. Beverly Malone. Dr. Beverly Malone is President and CEO of uh, the National League for Nursing, where she has led since 2007. Her career spans nursing education, policy, administration, clinical practice, and global nursing leadership. She served as Federal Deputy Assistant Secretary for Health under President Bill Clinton, became the first African American General Secretary for the United Kingdom's Royal College of Nursing, representing 400,000 nurses, and currently serves as the Chair of the IHI's Board of Directors. She's helped shape national and global conversations about nursing, education, diversity, evidence based practice, and the future of the profession. Dr. Malone, thank you for joining. Turn on the light. I'm truly honored to be in conversation with you.

Speaker B: I'm delighted to be here, Phil.

Speaker A: Thank you. My friend. This season we're asking the question, what does healthcare need now? And when we ask that question, we have to talk about nursing. But I do not want this to be only a conversation about shortage, staffing, burnout or pipelines. Those issues matter, but they are not the whole story. In our initial conversation, you named something I want to hold at the center of this conversation, nurses as healers and leaders. And before we move into the broader workforce conversation, I want to start somewhere more personal. In our prep conversation, you spoke so powerfully about your grandmother as a healer, and that feels like such an important doorway into this conversation. Would you tell us about your grandmother, who she was, what you saw in her, and how she shaped the way you understand nursing, healing and leadership?

Speaker B: Sure. Uh, it was really my great grandmother. She was in the black community, a, ah, healer. And, um, she was. She raised me. She raised my mother, she raised my grandmother, and she raised anybody who needed a child raised. So she was known throughout the community that if you had nothing to eat, come to Ms. Addie's house and you can eat. There she was also a bootlegger. And so she was an entrepreneurial woman, as I called her. And she ran her own business and did her numbers in her head. She only got to the third grade. And so for her, one of her dreams for me was to be a nurse, but she wanted me to be an educated nurse. She just didn't want me to be a healer in the community the way she was. It was for her very important that I go to college. And she had tried to get my mother, my grandmother, to go. She had not succeeded with any of the previous two generations that were before me. And, and so it was on my shoulders that I was the one who was going to go to college and she was going to make sure that that happened. Wow.

Speaker A: Um, that is such a powerful place to begin because it reminds us that healing is not abstract. It's lived, it's embodied. It's also passed down in various forms. It's practice and also it's witness. And it helps us understand why this conversation cannot just stop at gratitude. Gratitude definitely matters, but gratitude without structural support is not enough. And this conversation cannot stop at staffing, because nurses are not simply staff nurses are central to the future of care. So today I want to explore what nursing helps us see about healthcare systems we have and systems we need to build. The question I want to hold throughout our conversation is what does the healthcare workforce need now? And what must systems change to make the work sustainable? So, Dr. Malone, let's begin there. When you look at healthcare right now, what do you think we need to see more clearly about nurses, not only as workforce, but as healers and leaders?

Speaker B: Someone told me a long time ago that people don't go to hospital for hospital care, they go for nursing care in hospitals. And I think that clear message says what it's all about. So when the dollars are being added up and counted, it's the nursing staff that makes it happen in hospitals. But I would challenge anyone that it's only in hospitals, that it's in the community, that it's every door where healthcare is being delivered, not just in the US but around the world, that there are nurses there who are making that difference. And more than anything, nurses want to be recognized for the work that they do, just like any other provider worker. And so many times it's relegated to just these are soft skills that nurses are doing or anybody could do it. And that is just has no truth to it. It is scientific based evidence of what we use in terms of the care that we deliver. And it is with skill, it is with empathy, it is with caring, integrity. And we always have that equity piece in there that leads to the excellence that nurses deliver.

Speaker A: I love that empathy and excellence is so important. So, Dr. Malone, M. What are nurses seeing, that system that the system is not fully listening to? What's the vantage point that nurses have?

Speaker B: One of the things we've always thought about, Phil, was that we're part of the housekeeping kind of. I mean, it's. There's nothing pulled out about nursing and the contributions we make. If you're looking at hospital care, it's like, oh, it's part of, you know, the biggest budget there is, is what we pay nurses. But it is the central part of the care that is necessary to keep the hospital afloat. It is what hospitals do. So this recognition that nurses are just not. Anybody could do it, or nurse is a nurse is a nurse. That recognition, some of it is tied over into being mostly female. You have to play that in there. And then nursing has a, uh, really good sense of equity and of a balance across all kinds of ethnic groups. Not that we are way up there, but it's that we done it with making sure that we have the people that we serve. We pay attention to that. Who are the people we're serving? There are all types of races. We give care to everyone. And that's that integrity piece. It's the one respecting the dignity and moral wholeness of every person without condition or limitation.

Speaker A: Yeah. And you, you are the ones who are so close to patients and families and communities. What does that vantage point allow you all to see?

Speaker B: Yeah. My definition of a nurse is someone who accompanies an individual, family, community through their life journey. That's what we do. We are your companion. We are there to accentuate your life, to make it a better place for you to be in that skin, in this place on this earth. So when I think about that, Phil, it means that it's not just about the interaction we have. Right now. I'm concerned about how are you doing when you get up in the morning? How do you put on your clothes? Are, uh, you having trouble with it? How does your day proceed? How does your family interact with you? What is the mental health? I, uh, look at the whole person as a nurse, and that's what my colleagues do. I don't think with integrating all that together and then sometimes orchestrating the care. It is such a unique, valued, wonderful opportunity of us giving of ourselves to make a difference in the lives of others. That's who nurses are and they're professional at it. It's not a that anybody can do it kind of thing.

Speaker A: Yeah, I hear in that the difference between seeing nurses as a role and seeing nurses as witness to what care really requires. I mean I'm going to try to hold it together because it was a year ago today that my dad was in a facility and Dr. Uh, Malone, I can't tell you how important the nurses were in his care. Sometimes translating the mood of the doctors, you know, we had one nurse say it's okay, it's okay, you know, he's in a bad mood today or you, you have to speak to him this way. So I'm just reminded of all the many spaces and things that you all hold and carry for the patients and their families. So you said that nurses are healers. What does healing mean in nursing?

Speaker B: Healing is a gift. From my perspective, that nurses have the ability to be invited to that people allow us into their lives, whether it's their families or just that individual. When you go into that patient's room or in the community, when you go into that home, they open up space for us to work with them. It is one of the most lovely, inviting, invigorating things that can happen when you join someone in providing the care. You see, we don't do the healing by ourselves. It's an interactional, a uh, transactional kind of process. And unless you let us in, there's very little we can do. And so the fact that we are, that we have the trust of the nation, as the Gallup poll has said for the past 20 years, and means that we have sort of a built in bridge into the lives of other people that allows us to do work with them, that and they don't even sometimes know who we are, but we are given access. We are the bridge between them and technology, between them and AI, between them and the system, the hospital system or the healthcare system or the neighborhood system, whatever system they're in, and we're very aware of that responsibility, how do we prepare them for when we're there? Right. But also how do we prepare them for when we're not there? And to me that has so much to do with the healing and then there's a piece of hope that comes with healing, that nurses have a self generating mechanism of hope with us at all times. And that's part of what we bring to the care that we give to patients is that hope. And that's part of the healing business. I know that I'm a healer because I mean I'VE I don't know about you, Philip, uh, but I've sat next to people who I don't know on a bus or train, a plane. Before I know it, they've told me their entire life story.

Speaker A: Yes.

Speaker B: And things that they would not tell other people. But I know that's the healing in me seeping out. Yeah, Nurses have that. It's a gift. And we give that. It's a skill, it's an art, it's a science. But we give that to others.

Speaker A: Yes. Yes. And Dr. Malone, how is that gift, that healing, how is that different from simply delivering care?

Speaker B: I talk about feeding people with a long handled spoon. Sometimes you can give care with a long handled spoon. Um, I'm giving it to you, but I'm standing way back over here giving it to you. Healing means I'm coming in close. I'm giving you that energy. I'm giving. I'm sharing it with you. I'm not giving it, I'm sharing it because I'm getting from you. I don't want to give you the idea that nurses giving is just one way. What we receive from patients and families and communities, it blows your mind. It's the reciprocity that's involved in the exchange, in the transaction, that gives you hope for the world. That makes you feel a lot of joy with what you do. That gives you that satisfaction that you're making a difference in the lives of other people.

Speaker A: Yeah, that's so important. And again, thinking back to my own family's experience, it definitely felt that hope, definitely felt that joy. And I appreciate that because it reminds us that healing is not just sentimental, it's a real part of care. And so when we think about health care, you know, healthcare often expresses gratitude for nurses, but what's the difference between gratitude and real structural support?

Speaker B: There should be career paths. Right. There should be dollars assigned, valued that way too. There should be, uh, an emphasis on the well being of that nurse. That when you're giving out like that, when you're sharing, when you're healing, you gotta also make sure that you take care of yourself. And part of the system's responsibility is to make that happen, is to help that happen. Not all of it. I would never say that the person has some individual responsibility, but the system that they're working in should have a culture of well being, a culture of giving to the providers so the providers can give more to the patients, to the community, to those that they're serving. If it's just considered like a deficit, a dollar Deficit that we've got these nurses and we need it becomes then mechanical instead of human feeling and human giving and human transaction. And the caring piece, our definition at the National League for Nursing of caring is basically respecting the dignity and moral wholeness of every person without condition or limitation. It also includes promoting health, healing and hope in response to the human condition. I mean, these are things we live with. These are not idle thoughts. I mean. Oh, so that's a nice sounding message. No, this is what's incorporated into how I give you care.

Speaker A: Yeah.

Speaker B: Now, if, say, for example, I'm working with someone who doesn't want to receive it, Philip, who has some biases that they don't want this particular nurse to work with them, then my job is to say, I hear where you are. In fact, I know where you are. I can see where you are. But I take that into account, and I'm still giving you the best care possible. Knowing who you are, knowing how you feel. That can be flipped back to me. There may be patients that I may have difficulty working with, but my job is to say, okay, I know who I am. I know I have difficulty working with that particular patient. So let me give the best care I can within my limitations. Knowing I have limitations. I owe that patient. I owe that person even more than I can give.

Speaker A: Even more than I can give. And again, it makes me think about the organizations and what should organizations stop doing if they are serious about sustaining nurses?

Speaker B: I'd rather say what they need to start doing than what they need to stop doing. I, uh, believe that it is to value. It's a valuing question that you're asking.

Speaker A: Yes, ma'.

Speaker B: Am. And value can be in dollars and cents. I'm aware of that. The value also means in terms of promotion and opportunity to be at that board meeting where decisions are being made about how that hospital system and culture is going to be managed. There should be nurses involved in that. So I. And I, uh, know that many times the chief nursing officer is there at the table. But I've been on boards enough to know that they are under constraints that, uh, they are reporting to someone who is listening very closely to what they say. So that nurse who's not in that particular situation can add such value, not owing anyone anything can say you do need some truth tellers, uh, on your boards. And I think nurses can be excellent truth tellers of systems, of whether there's the working across borders with patients, working across bridges with people. Nurses are adept at that.

Speaker A: Nurses as truth tellers. I love that I love that. Dr. Mo, you also wanted to make sure that we talked about nurses not only as truth tellers, but as leaders. What does it mean to recognize nurses as leaders not only in title, but in how decisions are made?

Speaker B: Philip, I think it goes both ways. I think nurses need to recognize their own leadership ability. M. And there's no way you can give care to eight patients and not understand leadership.

Speaker A: Yes.

Speaker B: I mean, it's inherent that if you give quality care, safe, quality care to patients, you've had to integrate the systems of all the other people who are providing services to make sure that they get given to the patient, accessible to the patient in a way that is healing and hopeful for that patient. That's a lot of coordination. That's a lot of navigation, um, and empower. You have to have some power to be a leader. And I know that some of my nurse colleagues are saying the bev. You know, power. No, no, no. My heart is here. And I'm saying that we have to convert those thoughts and ideas into understanding. The power is simply moving an object from point A to point B. Moving patients in the hospital to out of the hospital is a very powerful thing. That's power. And so how we use our power, how we acknowledge it, helps us to be better leaders. Leaders are people who co create and implement transformative strategies with daring ingenuity. And that's what nurses do. We co create. It's not just about us. We work that entire system. And I think it is amazing, the complexity of systems that we manage and still give good care to people and still manage to take care of ourselves and the whole system. So I'm looking for nurses to acknowledge that they need power to be leaders. And I'm looking for them to be acknowledged as leaders by others. So it's more than just either or. You don't have to. Just tell me, Dove, I know you're a leader. I know I'm a leader. And I. My job is to convince other nurses, step up, step into your leadership. It's there. It's there. You've been doing it. Acknowledge it, own it, claim it, name it, package it. It's yours. And patients don't need powerless nurses. They need patients need nurses who understand the use of power, who understand how you take a system and get the safest, most quality care out of that system. That takes a powerful nurse. That takes a powerful leader.

Speaker A: Step up and step into your leadership and your power. Okay, I'm going to pause for a second. Tell everybody to call every nurse that you know and Tell them to tune in. Because, Dr. Malone, that. That was beautiful. And I'm also wondering what would change if healthcare treated nursing voice as strategy and not just staffing.

Speaker B: I think that the more nurses can run systems and hospitals, that will happen. I believe that systems that are progressive, innovative, creative. And there are systems out there like that.

Speaker A: Yeah.

Speaker B: That you see nurses who are clear about their power base and clear about how they do that. Leadership piece.

Speaker A: Yeah.

Speaker B: So I think that it's, uh. It's starting to happen more and more all the time. One of the things that sometimes happens is when nurses move into those roles of being the chief executive officer, it's almost as if no one recognizes that they were nurses and that they still are nurses. It's like, okay, so you're a chief executive officer now. You could never have been a nurse. I mean, you're so different than all those other nurses. And what I do, when people try to pull me out of the nursing ranks and say, bev Malone, you're something else, I say, you don't understand the powerful group that I come from, that I work with, with. These are. I'm just one of the representatives. So if you think I've got something to offer, my goodness, you should see where I come from.

Speaker A: Yeah. Wow. That just opens the door to different leadership questions. Not just how we support nurses, but whether we trust nurses to shape the future of care. I love that. And your leadership has shaped nursing education and professional formation. So how should we think differently about preparing nurses for the future of care?

Speaker B: I am. I'm a clinician by heart, by education. I. I'm a psychiatric mental health nurse. And. And then when I decided to get my doctorate, I got it in clinical psychology, because at the time I got it, there were no nursing clinical doctorates. I got it early. I. I finished when I was 30 or something. 31. I finished my doctorate. And so understanding that what I wanted to do in terms of being that excellent clinician had to be moved to something in terms of leadership. It took me a while to get to there because I just wanted to get. I just wanted to work with patients. I just wanted to give care m. Mental health care, psychiatric mental health care. But I really said, beth Malone, if you're such a good nurse. And I did believe I was a good nurse. I've always believed that if you're such a good nurse, how can you help other nurses do that too? It's not enough that the patient gets this kind of care. When you're there, what kind of care are they? Getting when you're not there, don't you have a responsibility? If you think you have some good ideas about quality and safety and leadership, don't you have an obligation to make sure that this is transferred, transmitted into your other colleagues? And that's called education. That's called teaching. That's called sharing. So it struck me, and that's called leadership. So it struck me that I couldn't just say, uh, I'm a clinician, I'm a very good clinician, I needed to do more. If I'm such and such, then the obligation is for me to transmit that, to share that. And I hope that not just nurses, but all providers think like that. That if you're so this and that, don't you have an obligation to share the good things you do about healthcare, the safe things you do, the quality things you do? Isn't there a level of responsibility to transmit that to others?

Speaker A: Yeah. Yeah. And not only that, you know, it makes me think about the connection between nursing in practice and what needs to change, if anything. So that's my question to you. Do you think that there are things in that connection between nursing education and practice that need to change to support this vision that you're laying out?

Speaker B: That's been a question that's been hounding us for quite some time about how does one bring it together? And the truth is that it does help to have folks who are in clinical who are not educators. My first part of my life I was clinician, and so now I'm in education. And so I have an appreciation that they have to work in tandem. They have to work hand in hand. There's no, there cannot be a, ah, gulf between it, because who really falls through is the patient. The nursing students, as they move into becoming clinicians, they fall through the cracks. And I say to my colleagues, you cannot prepare nurses in your educational institutions and then drop them off on the curb and tell the clinical people, come pick them up, we're finished with them.

Speaker A: Right?

Speaker B: No, we've got to make sure they're educated to move totally into the clinical setting, whatever clinical setting that is. The only way to do that is called collaboration. It's called working with those who are in that setting. I don't know everything that the clinical setting needs. Now. I, at one time I was in the clinical setting. I had a better idea. But I've been in education now for quite some time. I need my clinical colleagues, my clinical leadership folks to sit down and we come together as a collaborative effort to look at how we get that wonderful new person through the education and prepared to enter into the clinical area, whatever that clinical area is. And how do we support them as they transition from three patients simulation into having sometimes seven patients and coordinating and having colleagues who are testing them a little bit. How do we manage that whole system? It's going to take this interconnectedness of the clinical and the educator. And when that happens, that's when the magic starts. That's when we know we're doing it to the best of our ability for the patients that we care for.

Speaker A: And I love that magic, you know, because it also makes me think about what new nurses need, but also what experienced nurses need in order to keep growing, to keep leading and staying connected to purpose. That's right, yeah. Dr. Malone, you've had a remarkable journey in, uh, leadership, a leadership journey in England through your work with the Royal College of Nursing. And you've advised senior public leaders, including Prince Charles and Tony Blair, I guess King Charles. Now, what did those experiences teach you about the public visibility and power of nursing?

Speaker B: Philip? I think that I started to get ahead of it while I was here in the States when I worked very closely with President Clinton, and I would go into the Oval Office and meet with him. Not regularly, but meet with him. Maybe during my presidency of the American Nurses association, maybe about four or five times. I met with President Clinton.

Speaker A: Yeah.

Speaker B: And then, of course, with Hillary, because she was so committed to health care, and that was her agenda and his agenda, too. So it was at a time I was at the right time at the right place, and I was able to do that. And from there, then I became the deputy assistant Secretary for health, and I worked with Secretary Shalala, Donna Shalala, the Surgeon General. And so I. I had these incredible experiences. But it wasn't until I got to England, when I would sit down with Tony Blair every other month, M. For 45 minutes to talk about nursing. I had never had that opportunity with any of my American leadership people. And it was a very powerful kind of opportunity where I could get something changed just by conversation and the dialogue that we were having. In fact, that's how we got prescription authority through. I was. I. I rode with him over to an event, and, um, he always said, how's your. How is your president? And I said, well, you know, you're his friend. It was president, one of our presidents at the time. And I said, you're his friend. He said, well, someone's got to talk to him. And I had just this really lovely relationship.

Speaker A: Yeah.

Speaker B: Easygoing, relationship with the prime minister. And so, uh, he said, well, what are the problems in nursing right now? I said, well, you know, we can stitch up somebody in emergency room, but we can't order the medication to numb the pain. He said, that doesn't make any sense. I said, doesn't make any sense to me either. He said, well, what does it take to change it? I said, for you to change it. For you to say it's changed. He said, well, let's do it. He said, I can't. You can't ride with me on the way back, so ride with the head, the minister for health, and tell him I want to change right now.

Speaker A: Yes.

Speaker B: And that's how we changed it. Now, I could think that, oh, Bev Malone did that, but I know it was all the years of nurses working on that issue, and I was just able at the right time to have the opportunity to push it home. So, to me, those are the kinds of things that I learned. And I didn't have a great opinion of Prince Charles at the time. I liked his sons. But when I went to his home and had dinner with him, I found that he was one of the most amazing people that I had ever met. And my opinion was upgraded similarly. Uh, so to have those kinds of opportunities, to see nursing as a platform for the opportunity to say, we are the healers, we are the folks who are caring about safety, about quality. We are the ones who will be there with you for your entire journey, know who we are, value who we are, and when. Now the king of the country has invites, uh, me to sit at the table with him for dinner. Out of all the people that were there because he likes interesting people, I know that nursing makes a difference, and I know that nurses make a difference.

Speaker A: Yeah, that's such a powerful story because it just demonstrate what changes when nurses are present, when nurses are literally at the table. I mean, you're having dinner with the future king, and you're making a difference in that moment. That experience also raises a question for healthcare leaders everywhere. Who is in the room when decisions are made and whose wisdom is missing? You just happen to be in the car and he happened to ask you that question, and you stood in your power. That's such a great example. Such a great example.

Speaker B: Let me give you one more example. When I was a nurse in the hospital clinical area, one of my physician colleagues, he was a great doc, he asked me, he said, bev, I'm going into the board room for a meeting. And you always have some interesting ideas. Is There anything you want me to carry for you into the boardroom? And I said, yeah, please tell them to save me a seat. I'm coming. So I knew even at that time that I would get to the boardroom, that I didn't need anyone carrying my water to the boardroom. I would be there. I would have a seat at that table to share about the wonderful nature of nursing, the incredible gift nurses are to the people we serve, and what an incredible gift the people we serve are to us.

Speaker A: Such great stories. Dr. Malone. I have. I had two nurses in my family that I'm going to call immediately after this and just tell them how much I appreciate and love them. But, you know, you've also centered diversity and belonging throughout your leadership. Why are diversity and belonging workforce issues, not side issues?

Speaker B: You know, our definition of diversity and inclusion is affirming the uniqueness of, um. And differences. Differences among persons, ideas, values, and ethnicities. Yeah. Uh, so to me, diversity is bigger than a bread box. It's not. You don't put it into this little narrow. I mean, even I'm a, uh, I'm a person of color, and I've been black a long time. So I'm not saying that you can just ignore that, the differences among people, but all of that brings it into. How are you going to be inclusive with it? I always say you can have apples, oranges, bananas, but until you mix it up, you don't have a fruit salad. I'm sorry. Until you make some inclusion, until you can show me how you're affirming that uniqueness that brings the difference. And anytime you bring differences, I believe, Phil, that you bring complexity. I don't think it makes it easier. I think it makes it more complex. But giving care is complex. We work with complex people. We're not going to simplify it. That is why nursing, to me is so important is because of the complexity of the system. Because we need to understand that the people we care for are complex. They come from systems that are complex. And the care that we so skillfully provide has to be done in a powerful, strategic way and in a collaborative way of all that. We bring all the different groups, the social workers, the dietitians, all of us. It has to be a coordinated effort, whether in the home or whether in the hospital.

Speaker A: Yeah, yeah. And how does that sense of belonging, that collaboration, you know, how does that affect retention, safety, and potentially leadership development? Ah.

Speaker B: Uh, I believe that the reason that nurses sometimes, especially the new ones, leave so early is that the atmosphere, the culture of the units, where they work, the atmosphere and the culture of the hospital, where they work, where they don't. They, they have to prove themselves, where they feel they're constantly on notice, where they don't feel like anyone's got their back, where they don't feel like anyone's affirming them, where they can't see a career pathway, where they're looked at because of their color, where they're looked at because of their height. I mean, there is still this culture of, let's see if this person can fit in. Let's test, uh, let, let's. We know that this nurse came because we were short on staff, but let's see if we can test if we want them to be part of this, this unit. Uh, I can't, I couldn't believe it when I saw it. It's like you're dying for assistance and help and yet you're testing the person at the same time. So there's this, this, this piece. We have to learn about how we work with other people. And the system, the health care system has to put a high priority on that, has to say that we care about how you work together, we care about how you treat the families as they enter. We care about how you're taking care of yourself. We care about that because we know that there's no quality care without you receiving quality support. And well being is a major part of what we deliver here. That's what we need to do in terms of the healthcare systems that we're running.

Speaker A: Yeah, yeah. And that just brings us back to sustainability. You know, people do not stay in systems where they are unseen or unheard or asked to give more than the system is willing to support. And so I wouldn't be a true student of Dr. Malone if I didn't ask you this question because I learned from you to always lead them with hope. So we, with all the pressure facing nurses and the healthcare workforce, what gives you hope?

Speaker B: The nurses that are out there. I mean, like, I think there are almost 5 million of us now in the country. I am so amazed at what we do. I am so impressed. Uh, it's just mind boggling the work we do. And it's not in isolation. I don't want to give you the idea that nurses do it all because that would be, uh, the wrong perception. The hope is about the collaboration. It's about the coordination. It's about how we can come together, understanding who we serve. And that's the other. That's the patient, that's the family, that's the community understanding that it's a gift to be able to do that, that it means that when you wake up in the morning, you don't say, why am I here? You know why you're here. You're here to serve. Bill Withers talks about a song about using me up. And I, I believe in it. I'm a nurse. I want you to use me up. That's my life story. So when they say, what do you want on your tombstone? I said, bev Malone was used up.

Speaker A: Yes, go on and use the. I, uh, love that. Oh, man. Please, please, please tell every nurse that you know to listen to this podcast. And Dr. Malone, if. If a healthcare organization wanted to make one meaningful move this month to better support nurses as healers and leaders, what should it do?

Speaker B: One thing that they could do is to bring the nurses in and listen to their stories and listen to what they're sharing and their recommendations, the policy recommendations, the clinical recommendations. Build me a system where we can make it better and invite nurses to join you in making that system safer, that system, um, more reliable, that system more accessible, that system more cost effective. Invite nurses into decision making and let them know that the care that they're delivering is the bloodstream. It's the heart of the organizations.

Speaker A: And that is a hopeful and practical place to land because it asks leaders to move from admiration to action. Really concrete action. Dr. Malone, this podcast is called Turn on the Lights because we're trying to help leaders see something that may be hidden in plain sight. So here's the question. What does the nursing workforce help us see about healthcare systems we, we have and the health care systems we need?

Speaker B: One of the things that nurses believe in is keeping people healthy. The healthcare system we need is one with a greater focus on prevention, on promotion of health, on an understanding that the journey is there for all of us. The life, that life journey. And that providers, nurses and other collaborators, my physician colleagues, my, my dentists, my. All of that is the more that we can combine and provide roadmaps for families and communities of how to navigate for older adults, how to navigate that. That's really what it's about. Can we come together and organize in a way that says, this is your map to keeping yourself as healthy as possible? Mr. Community, Ms. Community, Ms. Individual. And we are the navigators. I believe nurses are magnificent navigators of health.

Speaker A: Wow. Dr. Malone, thank you. You know, what I'm taking away from this conversation is that nursing is not peripheral to the future of healthcare. Nursing is one of the places where the future is already being revealed. So much of that is evident just in your work and your leadership. Nurses are showing us what patients need, what families carry, what communities experience, and what systems have not yet been willing to redesign. And if we're serious about the workforce we need, we have to do more than thank nurses. We have to listen to them, support them, prepare them, trust them, and invite them to lead.

Speaker B: Uh, the only other piece that I would add to what you said, Phil, is there needs to be these career pathways so that you're investing in the nurses, and they can see that, that there's a reason that I'm here, I have an opportunity to progress. Whether that's a licensed practical nurse walking in the door, who wants to become a registered nurse, whether that's someone who's an associate degree nurse, who wants to become a master level prepared nurse and actually work as a clinician, how to do that as an advanced practice nurse. It's really about, are, uh, you willing to invest in the work? Do you understand that you don't exist without the workforce? Yeah. And can you take that workforce methodology and reduce it to the individual, to the person, to the nurse, instead of talking about it as workforce? Sort of, um, a bland kind of mob blob of a thing. The individuality and the ability to promote them and support them, the people that are really providing the services that, um, not even AI can provide. It should be. One of the things somebody told me was that AI is about doing hands off care so nurses can do more hands on care. That's who we are. We are the hands on people.

Speaker A: Wow. Hands, um, on people. Well, Dr. Malone, I knew I was excited for this conversation, and now I know you've touched the lives of so many more people with your wisdom, with your experiences, with your advocacy. Just thank you, thank you, thank you for helping us turn on the lights around this important, important issue. And just thank you for all that you do and the ways that you show up to support not only nurses, but IHI as well. We thank you for your leadership. Thank you, my friend. After hearing from Dr. Malone, I wanted to connect this conversation to IHI's work in patient safety, workforce safety, well being, and systems that make safe and humane care possible. For this IHI Spotlight, we'll hear from Patricia McGaffigan, who helps connect Dr. Malone's message to the leadership conditions required to support nurses and care teams.

Speaker C: Hi, everyone. I'm Patricia McGathigan. I'm a nurse and a senior advisor for safety at ihi, where I also Serve as president of our certification board for professionals in patient safety. For most of my career, I've been working at the intersection of patient and workforce safety and well being and leadership and governance and quality, and helping create the conditions where patients and those who care for them are safe and can thrive. Beverly's conversation centered us on the role of nurses as leaders and as healers. And it helps us see that nursing has been and always has been about more than just staffing. And I speak about nurses in the same light. And I would say this for the healthcare workforce, but especially for nurses. And my truth is that nurses are healthcare's indomitable improvers and innovators and we are the stewards of transformation for healthcare. We sit at that very critical interest, intersection between patients and families and the health care system and have an ability to be able to see what could arise that could help advance patient and workforce safety and well being and where the roadblocks might be. And that's one of the reasons why our, um, nursing profession has been so central to advancing healthcare. And I talk about this a lot. I believe that nurses are architects and designers of systems in which patients and families and those who care for them can be free from harm. I think if leaders want to move from thinking about recognizing the workforce and nurses, um, from the lens of gratitude, they need to move to action. And I have a few thoughts about what they can start doing that will make a difference. I think first of all is to recognize that we have to stop asking nurses to be shock absorbers for broken systems. We've got a lot of complexity, a lot of challenges in those systems and need to embrace and invite nurses in to help redesign them, but for leaders themselves. And this is a lot of the work that I see that we do in safety that is kind of reflective and builds upon Bev's comments is getting out there and rounding in the units and in the care environments and asking questions to be able to understand what's a typical day look like for you today? How are things going? What might be getting in the way of what's making for a good day? What are you seeing? Is there anything I should know about that is really central to or even peripheral to how we could make sure that every patient has the best care and that the workforce is as safe as possible and able to focus on their care? And one of the reasons why I think this matters deeply is because for many, in many cases, we do things to nurses instead of with them. And that's the essence of what we talk about in our work at ia, the people who are closest to the work, and by the way, the people who are recipients of that work, including patients and families, need to be partners in designing and improving those systems. And not just so we can have people that are surviving their work, but so we have people that are able to thrive in their work. This is a performance strategy for organizations to bring out the best in everything that they can do for the workforce so people can come to work and give 2000% every day. I think that IHI has learned a lot from nurses and care teams about the conditions to make care safe. We, um, have, uh, constantly integrated those who are at the front lines of a challenge or an opportunity into our work at ihi. We recently, a couple of years ago, did a project on care model redesign through the lens of nurses. And we were able to build nurses into the planning of what that care redesign could look like. In fact, many of the initiatives focused on virtual nursing, which is so important to how we're able to transform care and bring care to patients and communities, uh, that otherwise might not receive that, uh, but being able to also discipline. How we think about some of this work matters deeply because we're able to partner with the workforce who has designed ideas and test of change, and they can rapidly implement some of those ideas and so see what's working, to see if a change is an improvement, to be able to identify whether we should adopt a change or adapt a change or maybe abandon a change. And that insight helps us move much more quickly, especially in a time when the speed of change is just astronomical in healthcare. And it enables us to be able to do so with greater confidence and build a degree of belief that the changes that we're making are indeed changes we could pursue. We had a chance to immortalize some of this in a, um, monograph on transforming care delivery. But a lot of the work that we have also been able to immortalize, that IHI has able to advance right now and has been working on, is in the National Action Plan for Patient Safety. And that is built upon the shoulders of people who have been out there who have taught us what safety and best care and care excellence looks like and how to realize that in the daily work of everyone across the healthcare enterprise. There are a couple of great resources that I think our listeners could benefit from that builds upon what Bev uh has spoken about. Certainly our joy and work resources, uh, help people understand how to make those connections in the conversation with the workforce, with nurses, to know what makes for a good day to know what might be getting in the way of making a good day, but helps us lift up the performance performance of care teams collectively as well as for individuals when they know that they're hearing or the organization is hearing what matters and is responding to what matters in ways that are able to, um, you know, bring out the best in the conditions in which people are working. I think we start to see a lot of thriving. The other resource that I might recommend is the monograph that we created as a result of our innovative care delivery nurse led solutions that would be especially interesting and I think it's of great relevance because some of the ideas like virtual nursing are right at the heart and soul of what so many organizations are trying to do and implement across the continuum of care. And I think it's an absolutely outstanding resource for people to understand how to discipline their assessment and testing of alternate care delivery options at a time when we really need nurses to be out there driving this work and doing so with mindfulness about how to do good tests of change.

Speaker A: What I'm taking away from this conversation is that honoring nurses requires more than gratitude. It requires systems that support their leadership, protect their dignity, and recognize the full humanity of the people who make care possible. You helped us see that nurses are not only carrying the work with care, they are shaping the future of care. Thank you so much for helping us Turn on the Lights around that. Turn on the Lights is a production of the Institute for Healthcare Improvement. My thanks to the Outcomes Rocket production team, our, our colleagues across ihi, and most of all to you for listening. If this conversation gave you something new to consider, please follow Turn on the Lights wherever you listen and leave us a, uh, review. It helps more people find the podcast and become a part of the conversation. For questions, ideas or guest suggestions, email us@podcasti.org that's podcast@ihi.org I'm Philip McAdoo. Until next time, see clearly improve boldly.