Difficult Conversations Podcast
Lessons I Learned as an ICU Physician
Episode 148 | June 22, 2021
Taking Care Of Our Own - True Nursing Leadership
Associate Vice President of Women and Infant Health Services at Virginia Hospital Center
Welcome to Difficult Conversations with Dr. Anthony Orsini. Often, I have drawn parallels between the doctor patient relationship and the business leader to employee relationship. For success, both require good communication and trust. Nowhere do these two worlds interconnect more then when it comes to nursing leadership. With all the talk about the problems facing physicians, it’s the nurses who are the face of healthcare. They are the ones in the trenches, holding hands and healing twenty-four seven. Nursing leadership is more important than ever which is why I am super excited to have someone I believe embodies the essence of what leadership is all about. Today, my guest is Dena Carey, Associate Vice President of Women and Infant Health Services at Virginia Hospital Center. As a Med Surg and NICU trained nurse, Dena has focused her latest role to build a team of nurse leaders that are engaged, respected, and dedicated to building a team of staff focused on one goal: delivering the best patient care and experience to the families they serve. As always, Dr. Orsini keeps his promise about two things, that you will feel inspired, and you will have learned valuable lessons to be a better and more compassionate communicator.
We start by hearing Dena’s journey. She talks about Virginia Hospital Center being a gem and a unicorn, and what it has done for her career. On the topic of patient experience, Dena explains that engaged employees are necessary for a good patient experience, and how the people doing the actual work need to be recognized and appreciated every day. She also shares the key to keeping employees happy, the importance of being open and honest, and how she makes sure every day that everybody on her team feels like they have a voice and a valued member of the team. She shares fantastic advice telling us there’s nothing better than a leader going out of their door to talk to the staff because that’s where you’re going to get the real information. We find out how Dena navigated the stress that was put on the nurses and everyone at the hospital during COVID and how motivating and inspiring people is so important to create relationships and promote teamwork. She tells us how she kept herself, and her leaders, sane and positive. Dena shares great advice for young nurse who want to become leaders, and why recognizing people is super important in preventing professional burnout. If you enjoyed this podcast, please hit follow, and download all the previous episodes. Go ahead and download this episode now!
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Dena Carey (1s):
You have to find your passion. My passion is people. I love my people and I love that my people love to do what they do. And so if I can have them in a place where they are doing what they love to do and they’re being loved for it, our patients are making out our patients are getting the best care. Cuz I have the right people taking care of the right type of patients being led by the right leaders. And it just makes so much sense.
Welcome to Difficult Conversations: Lessons I learned as an ICU physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and president and CEO of The Orsini Way. As a frequent keynote speaker and author, Dr. Orsini has been training healthcare professionals and business leaders how to navigate through the most difficult dialogues. Each week you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better this is the podcast for you.
Dr. Anthony Orsini (1m 20s):
I am honored today that the Orsini Way has partnered with The Finley project to bring you this episode of Difficult Conversations: Lessons I learned as an ICU Physician. The Finley Project is a nonprofit organization committed to providing care for mothers who have experienced the unimaginable, the loss of an infant. It was created by the founder Noelle Moore, whose sweet daughter Finley died in 2013. It was at that time that Noelle realized that there was a large gap between leaving the hospital without your baby and the time when you get home, that led her to start The Finley Project. That Finley Project is the nation’s only seven part, a holistic program that helps mothers after infant loss, by supporting them physically and emotionally.
Dr. Anthony Orsini (2m 4s):
They provide such things as mental health counseling, funeral arrangements, support, grocery gift cards, professional house cleaning, professional massage therapy and support group placement. The Finley Project has helped hundreds of women across the country. And I can tell you that I have seen personally how The Finley Project has literally saved the lives of mothers who lost their infant. If you are interested in learning more or referring a family or donating to this amazing cause please go to The Finley project.org. The Finley Project believes that no family should walk out of a hospital without support. Welcome to another episode of Difficult Conversations lessons I learned as an ICU physician.
Dr. Anthony Orsini (2m 44s):
This is the Dr. Anthony Orsini. I’ll be your host again this week, you know, I’ve often have drawn parallels between the doctor patient relationship and the business leader to employee team member relationship. For success, both require good communication and trust. Nowhere do these two worlds interconnect more than when it comes to nursing leadership. There are approximately 4 million registered nurses in the United States right now, and another million licensed practical nurses. And with all the talk about physicians and the problems they face, it is the nurses who are undoubtedly the face of healthcare. They are the ones in the trenches, holding hands and healing 24 7.
Dr. Anthony Orsini (3m 24s):
So nursing leadership is more important than ever. And today I am thrilled to have someone who I believe embodies the essence of what nursing leadership and leadership in general is all about today. My guest is Dena Carey. Dena is the Associate Vice President of Women and Infant Health Services at Virginia hospital Center in Arlington, Virginia. She has been a nurse for 15 years and has been in leadership for over half of her career. As a Med Surg and NICU trained nurse, Dena has focused her latest role to build a team of nurse leaders that are engaged, respected, and dedicated to building a team of staff focused on one goal, delivering the best patient care and experience to the families they serve.
Dr. Anthony Orsini (4m 6s):
In July of 2019, Dena was named to the Washington business journal, 40 under 40 business leaders. She is a frequent speaker on Nursing leadership among other topics. As we all know, leaders are rarely successful that they don’t have good communication skills. That’s why I am especially excited to have Dena Carey as my guest today, or a welcome Dena. Thank you so much for taking time out of your busy day to speak to us.
Dena Carey (4m 31s):
Thank you so much for having me what an honor and exciting moment to spend the next couple of minutes with you just talking about the things that I think we both love.
Dr. Anthony Orsini (4m 41s):
Yeah, last time we spoke was a, a few weeks ago and the conversation went so smoothly. I always say sometimes I was like, I should just hit record because it was great. So hopefully we can copy how great that was, but this is a topic that is near and dear to my heart and communication in general, but COVID and everything else that’s been happening right now. And we’re going to get into all of that later, but I’m excited to hear about, you know, all about that, but first let’s start off just telling your story to my audience, your journey, how you got, where you are. I want to hear about that top 40 to 40. That’s a pretty cool too. So you can maybe finish up with that. So, but you know, who’s Dena Carey.
Dena Carey (5m 22s):
Yeah. Well, Dena Carey is a woman who came from Philipsburg, New Jersey. New Jersey, absolutely Jersey girl here through and through. And so I was always the leader. I was always the outgoing one. I was always outspoken. Everyone always knew what Dena was thinking. And I think that has rang true throughout my entire career. I was the little girl who dissected everything I knew from early age that I wanted to do something in blood and guts and gory. And I think that’s kind of funny. I also grew with a mom who did hair on dead people because they’re is a funeral home right down the street from her beauty shop.
Dena Carey (6m 8s):
And I would go with her to be with her while she did the hair on these dead people. And I liked dead people. I was, I wasn’t scared of that. I wasn’t nervous around them. I held their hand. I would talk to them and I became comfortable in those situations. And as I grew and matured and went through high school, my first job was a secretary in a med surg unit. And I remember the one night I had a moment. I spent hours with this patient. I worked night shift or worked hours with this patient. And she was telling me the names of the wheels on her IV pole, and who they were.
Dena Carey (6m 49s):
And they wear these animals. We talked about them all night and the nurses were like, you’re a really good at creating this relationship with patients and getting them to trust you. And she had a great night. She didn’t fall. She didn’t have any issues. She took all her medicines and they were like, can you come back tomorrow? And it was at that point that I realized health care was my calling. That nursing was my calling, and I want it to be on the other side of that desk with the patients in the room. So I went to James Madison University in Virginia, and I started to study health sciences and did all my prerequisites to enter nursing school.
Dena Carey (7m 30s):
As a second degree, after my four years of JMU, I went out to Bellarmine university in Kentucky. They had a 18 month accelerated program and went through nursing school and really just fell in love with nursing. As you can imagine, I came out as a med surg nurse. I was taking care of five and six and seven patients within six months of being on the floor. I was asked to be in charge of night shift. And I, of course was like, of course, you know, Dena always wants to be in charge. So I gladly accepted that honor and not realizing what responsibility I had over a 25 bed med surg unit night shift five and six patients are at a time admissions coming in and out, but I embraced it and I really liked it.
Dena Carey (8m 17s):
And the seasoned nurses were so excited that somebody else wanted to be in charge. And I always pride myself that my shifts ran smoothly. People knew what was going on. I kept people close knit, helping each other, working together, and people want it to work when I was in charge. And that was cool. And so as I kind of went through it, I was starting to get a little bit burnout cause our patients want it to be fixed, but they didn’t want to fix themselves. Adults don’t really want to fix themselves. They just want you to a quick fix them and then send them on their way. And so I was trying to figure out where was my real calling and I’ve always been drawn to kids babies.
Dena Carey (8m 59s):
And so my friend worked in the NICU and she said, come see me, come hang out for lunch. So I did and I fell in love and I found my niche and I went into the NICU at UVA in Charlottesville, Virginia. I worked as a nurse there for six years. Within those six years, I was on committees. I was chair of committees. I listened to all of my colleagues, the physician’s, the fellow’s, the residents, the interns, the med students, the nursing students. I had one specific nurse practicum student and she really pushed me to my limits as a preceptor, as a teacher, as a mentor, I’m still friends with her today.
Dena Carey (9m 44s):
It was just incredible. I was also always the nurse you got assigned the dying patients, which not everybody always talks about and NICU patients do die. It’s part of what we do. It’s not a fun part of what we do, but it sure is an honor to be with these families during these really hard times. I also remember which physicians I wanted to be in those situations with. And those physicians were so good at communicating with these patients and how to really break this bad news. And I know you have a whole book on breaking bad news, but it’s so true, you know, who can do it and who’s good at it.
Dena Carey (10m 26s):
And who’s not so good at it. And then the families struggle and nurses are left sometimes with picking up those pieces for that family. So after UVA and being in the NICU, I decided that my family and they wanted to be closer too all of our family in New Jersey and Northern Virginia. So we picked up and we moved to Northern Virginia and I was looking for the next step. I was looking for what’s next for Dena. I went to Johns Hopkins. I was traveling to Baltimore every day as a NICU nurse. And my husband was traveling to Washington DC and it was not working.
Dena Carey (11m 7s):
All we were doing was driving. So I said, I’m going to look for a position in Virginia. And I found this little gem in Arlington Virginia, a called Virginia Hospital Center. And when I found Virginia Hospital Center, I tell you, its a gem is not only a jem, It’s a unicorn and I’m not here to promote Virginia hospital center, but I am so fortunate to have chosen a place that has given me the opportunity to just explode as a leader and as a communicator and as a nurse leader that has been given the autonomy to make things happen. And that’s exactly what I did.
Dena Carey (11m 48s):
I came in as a clinical educator for the first year and I helped move our NICU from a level two to a level three and take on the sicker babies. At the same time we partnered with the children’s national medical center. They are neonatologists apartment. And I partnered with the chief of neonatology who came in to build the program with me. And when I say with me, that’s exactly what we did. And I think when people say, what makes you so successful is I’m willing to partner outside of nursing to bring the whole team together.
Dena Carey (12m 29s):
That dyad leadership model is so integral and to what I’ve been able to accomplish. And we were always on the same page. We had conflicts, of course we moved through them together. We would brainstorm together. We would collaborate together. We would show our teams. We were on the same page and we had the same vision for that NICU. And that NICU was to take it from a two to a three and to provide all levels of service from 23 weeks on for gestation. But we also knew our limits. We had two very large level four NICU in our Northern Virginia region. There was no reason for us to compete.
Dena Carey (13m 10s):
We’ll send our babies out when they need to go out to the level fours, but how can we keep our babies in the community where they were born and provide top notch, high level NICU care to keep these moms and babies together. And that’s exactly what we did. So after six years we went from a 14 bed NICU to a 28 bed NICU. Within the first year as I was the clinical educator, I then applied to be, the director was named the director. We continued to grow the program. I doubled my FTEs in nurses. So I went from a around 32 nurses.
Dena Carey (13m 50s):
So today they have over 65 nurses. There are a turnover rate is less than 9%.
Dr. Anthony Orsini (13m 57s):
That is a great statistic. And that’s amazing. And that leads me to really what this podcast is all about. Last time we spoke, you said something that, and I wrote it down. So we were talking about patient experience. We were talking about the happy employees, that turnover rate is amazing. And I’ve seen turnover rates as you know, really high, but you said engaged employees are necessary for a good patient experience. And so I wrote that down in quotes. Tell me about that. As a leader, you also spoke about the dyad leadership, where are you partnered with the doctor to build this NICU? But it seems to me that I think what makes you so successful is you’re actually partnering with the people on the ground too.
Dena Carey (14m 38s):
That’s exactly what I’ve focus on every single day. It’s the people that are doing the actual work that need to be recognized that need to be appreciated. That need to be heard. And every single morning, when I walk into my unit, I walk in with courage, with integrity, with competence, with confidence and a smile. I smile and I say hello to every single person, every single staff member that walks by or that I walk by, I say, good morning to Lamont who cleans our floors. Our floors are the shiniest floors in the hospital.
Dena Carey (15m 18s):
You can see a reflection of them and it’s because of Lamont and his continued dedication to make sure we have the cleanest facility to have a baby in. It’s because of the people that say hello back to you and recognize that your there with a smile and their going to be there with a smile as well, it’s contagious. And it means the world to your staff when you’re there to be personal and to be honest and open with them and to start their day off, right with good morning, how are you? It means so much. I truly believe how I show up is how they show up. So
Dr. Anthony Orsini (15m 58s):
If you’ve heard this podcast before, one of my favorite quotes, I have many, but one of my favorite quotes is that all of the Italian quote that says the fish rots from the head down and what you just said, there is something that is so deep and my beliefs and core is that the people on the ground, they take on their personality and the outlook of their leaders and in a world where there’s so many toxic leaders now I loved that you just said that. My other favorite quote is when your most passionate employees go silent, that’s when you’re in trouble. So other than smiling and being happy and speaking to everybody, what’s the key to keeping them happy that they don’t want to leave.
Dr. Anthony Orsini (16m 38s):
You know, people don’t leave jobs, they leave leaders so obviously there’s something going on right there, but the 9% turnover. So what do you think the secret is to the young, the charge nurses out there that really wants to learn?
Dena Carey (16m 56s):
Yeah. I think honest, open, transparent communication in multiple formats and multiple ways for your team. I think that is one of the biggest things that we can do is to be open and honest. I can’t tell you how my staff respond to me. When they ask me a question or I present them with a project or a problem. And I’m honest with them and say, I don’t have the answer. I don’t know how we’re going to fix this, but together we’re going to figure it out. And I’m here to make sure you have the resources that you need to figure this problem out or to change this process.
Dena Carey (17m 38s):
But we are going to do it together. You’re not going to be alone. I’m not going to let you fail. And I don’t expect you to let me fail and providing that 200% accountability is they know what my expectations are. We have a problem to solve. We have a project to complete, we need to do it together. And I’m here with you. And I expect you to be here with me too, and I think that that is so integral into what I do every day is making sure that everybody on the team feels like they want to have a voice, two their respected and three that I value them being part of our team here at Virginia hospital center, I’m very fortunate to work for a hospital and an organization that truly selects some of the highest performing highest achieving employees.
Dena Carey (18m 37s):
That’s an expectation coming here. We talk about it in the interview process. So I am very lucky. I’m very fortunate to work with high performers. Many of us are though. So how do you keep those high performers engaged? You have to keep challenging them. You have to keep giving them more to feed on, but you have to be cognizant when you’re asking them to stretch themselves. How far can you stretch them for how long? And are they in a place that they can accept being stretched and do it. And I think most of us, our, most of us stretched ourselves really thin to the max.
Dena Carey (19m 17s):
People always say, how did you do it? Or how do you do it Dena right now on the ABP of women and events, health, I have over almost 200 FTEs underneath me, you know, under my four directors under them or I’m getting my MBA from Virginia tech. I have two children. I have a puppy, which is a lot of work. And I’m like,
Dr. Anthony Orsini (19m 41s):
No, you really needed the ad that to your list.
Dena Carey (19m 44s):
Yeah, exactly. And so, you know, how do I do it all? I make time for it all. And I focus on my people. My people is what are most important? It gets the job done. And if I am not here, I know this place is running because they know what the expectations are. They know exactly what I want to see out of them because I show it to them. And I have continued to show it day in and day out.
Dr. Anthony Orsini (20m 13s):
And let them know that you care, you know, there’s going to be, and that leads into my next question, but there’s going to be times in everyone’s life, where they’re going through a crisis and they may be an employee who has been dedicated and the excellent employee and they have a family crisis and they need a few days off or they need somebody to a shoulder. It is a good leader that says my door’s always open, but actually keeps the door open that we see so many leaders to say, my door’s always open. And then, but when you come in and do you feel like you’re not being heard? And so everyone goes through difficult times and it’s really important that they know you care. Right?
Dena Carey (20m 50s):
And I think it’s interesting. I learned that the hard way of having my door’s always open, I need to go out of my door and see my people. I need to go out to the trenches. If you will, and see what they’re actually doing, what are they experiencing? I opened and started with my labor and delivery director. We started doing GYN surgeries here in our ORs. We have some unproductive time. We are trying to figure out how can we help the main OR who is exploding with surgery? How can we move things around and make our third OR really productive?
Dena Carey (21m 31s):
So we brought GYN surgeries here and to our OR bay, which allowed me to stabilize staffing for the OR, and open PACU. You said that was running full-time with a full-time staff. I go see my people in the PACU. They come in, they go to the PACU, they do their job and they go home. But I go see them in the PACU, I want to know what’s going on in the PACU. You, how was it going? This is a brand new for all of us. I’ve never been an OR nurse. I’ve never been a PACU nurse, but I care about what do they need. I gave them the autonomy to say, we need an ice machine. We need this supply. And we need our own supply of it. I can’t be running down the hallway every five minutes to get this.
Dena Carey (22m 14s):
I need my own supply. We make that happen. And so I truly am a leader who believes, yes, do I have an open door policy? I do. And do I expect my staff to come talk to me? If they have a concern or problem I do, but there’s nothing better than a leader going out of their door to talk to the staff on the other side, because that’s where you’re going to get the real information.
Dr. Anthony Orsini (22m 36s):
That’s fantastic advice. I think that’s really true of the military had something called ground truth in which that means, you know, you really want to know what’s going on the general has to go down in the trenches and as the people what do you need, you know, they have to be there and you hear some stories of these great generals and great leaders that came in and he had a meal with their troops and how much that meant to them. So that’s a great piece of advice. You said something about a stretching people that only when they are in a position to be stretched. Tell me about what happened during COVID because regardless of what we tried to do, we stretched everybody.
Dr. Anthony Orsini (23m 16s):
So how did you navigate the incredible stress that was put on nurses and everyone else at the hospital during COVID?
Dena Carey (23m 23s):
It all came back to the relationship and the trusting relationships that we have built prior to COVID. And we capitalized on that. I was honest and open with them and said, I’m as scared as you are. My office is literally right next to rooms, X, Y, and Z, where they were the negative pressure rooms. They were the room’s for our COVID patients. I was within 10 feet every day of our COVID positive moms. And I came to work every single day and I wore my mask and my eye protection. And I was right by their side.
Dena Carey (24m 3s):
I didn’t stop going through our safety huddles. I didn’t stop rounding on patients. I didn’t stop rounding on them. What are you scared of? What can I relieve for you to open communication? Our CMOs put out a briefing everyday about the changes that we all experienced. The first 60 to 90 days have COVID things were changing within 24 hours. It was so much to keep track of. I followed up every day for the first several months, and then it spaced itself out. But with the updates that came from the main hospital that came from the CMO and how did it relate to us and women and infant health.
Dena Carey (24m 44s):
Our patients aren’t sick, our patients are coming in to have this amazing experience that we’ve just completely changed. No visitation. What do you mean grandparents can’t come? What do you mean aunts and uncles and sisters and brothers can’t come? Siblings can’t come meet their baby brother or sister? ou know, this was a major change for our patient population. But I thought was interesting was in the very beginning, we did lose several staff nurses. That really, it was because they had to take care of their families. It was too much to manage. They didn’t maybe need to work or maybe they did, but it just wasn’t going to be here. That’s fine. We supported them.
Dena Carey (25m 25s):
We said, if you want a job after COVID come back, we were open and honest with our staff about why they left and said, you know, it’s too much for them to handle. It’s not because they don’t want to work here, but how can we further support you? How can we be in this together? And they really stepped up and I say, my retention rate and my turnover rates are low. And just the NICU. I would love to let you know that not just in the NICU, but overall, my turnover rates decreased 59% in total between my three departments from 2019 to 2020, we actually sustained staffing during COVID.
Dena Carey (26m 9s):
We are fully staffed on all three units. I don’t have one travel nurse In-house. It’s a lot to be proud of. And it’s not just me. It’s my leaders. I have hired and engaged four of the most fabulous directors’ that I can find. They match the personalities of the unit’s. They care for. And our labor and delivery is a lot like an ER postpartum and mother-baby is a lot like a med surge floor nursing and NICU as an ICU, they are three very unique specialty areas that I picked and chose who was going to be in those leadership roles that we’re gonna be engaging.
Dena Carey (26m 53s):
Were going to create those relationships with the staff that make the staff want to be there. It’s all about inspiring and motivating your people. And how do you motivate people? You set the expectation and you role model, those behaviors you want to see happen again. I tell all of my people and I have it posted on my computer monitor. I look at it every day, recognized behavior always gets repeated. Always, and that’s in personal life or not. When I’ve recognized my child for hanging in their backpack on the hook, when they walk in the door from school and say, thank you so much for putting your book bag away.
Dena Carey (27m 37s):
They do it the next day. And then they finally don’t need to be reminded of it. It’s no different with your people. If you recognize that you just told that safety story on huddle, like a boss, you did that. Awesome. Thank you for stepping up and sharing that with the team that’s going to get repeated. And so recognized behavior is just it’s at the forefront of inspiration and motivating you’re people,
Dr. Anthony Orsini (28m 6s):
Especially when that behavior promotes teamwork. And we see in the NICU, when the little things that really make a difference, you mentioned babies that are dying. When the nurse says to the nurse is dealing with their family and a very sick baby, let me feed your baby for you, or what could I do for you? And I can say that I’m very proud to be a neonatologist cause NICU’s in general do that, but there’s degrees. And there’s people when you promote that kind of leadership and everyone follows, that’s really where you get that success. We had Lori Gunther on who we both met or friends or a both speaking at this, a Synova conference in November is I’m looking forward to seeing you there. But Lori Gunther was talking about how Sonova is, which is an association for a nurse leaders have to do some debriefings.
Dr. Anthony Orsini (28m 49s):
And I believe she’s still doing them for nurse leaders. You mentioned your four amazing nurse leaders, but it was stressful for them to, so how did you keep yourself sane? How did you keep your leaders sane and positive? ’cause if the top the fishes head is out of control the rest is, is going to fall. How to control too.
Dena Carey (29m 9s):
Yeah. So I asked my leaders to take a hard look at their schedules and to make sure that they were taking time for themselves. And I said, your work is getting done. I need to know that you’re taking time for you. I want to see an adjustment in your schedule. I want to make sure that you feel supported and that you have time to take care of yourself and your family along with this family. And so they all chose to do it in a little different way. I chose to take off using my paid time off every other Monday off three day weekends. I don’t check my email. I don’t do anything but be home with my kids.
Dena Carey (29m 48s):
And you know, they had virtual school on Mondays. Oh, that was asynchronous. They didn’t have teachers. So I spend time with them and I made sure it was good quality time. I made a schedule for us that these are the things we, we are going to do together. When I say make a schedule, I’m a little bit ocd I’m a little bit type A, I did make a schedule. We did school from, you know, eight to 10. And then me and my daughter practice reading because she is still not reading because of COVID and not being in school. It’s hard to see her struggling, but we made time for it. We did a together and she wanted to do it together and they named it mommy Mondays.
Dena Carey (30m 29s):
And that was awesome for me. And that was really meaningful. And they noticed that I took off on Mondays to be home with them, especially being in school. I’m in school part-time, but it’s two nights a week, but I don’t get to be with them. And all that time off, I can’t tell you it was priceless. It was absolutely priceless time. And I made my leaders do that as well. And I think that also gave their assistant directors the opportunity to step up on the days that their leaders weren’t there they stepped up into that role to take on the unit and the management. And I reached out to them when there was issues or concerns or things that needed to be talked about that’s successful leadership, right there.
Dena Carey (31m 17s):
That’s succession planning. That’s exactly what we all have to focus on. If we don’t help our assistant directors step up in the times when our directors are either on vacation or out on maternity leave, we have no plan for when we move on, right? We’re all going to continue to grow, or hopefully we continue to grow. And if we’re continuing to grow and support each other, we have to have a succession plan. And, but we have to mentor and grow them. You can’t just throw them in to the fire. And I expect them to go to swim. And I expect that I, and I, I challenged them every day. Right now. One of my leaders is on maternity leave. And I had a very direct conversation with both of her assistant directors. And I said, we’re going to get through this together.
Dena Carey (31m 60s):
And this is your time to shine. This is your time to be great. And I want you to think about what does great look like a little sideways in their, for you. I love side. I love what she does for us. And we use her theory is a lot, but they both looked at me or were like, thank you so much for telling me it’s okay. I said, it’s okay. And you’re gonna make mistakes. You’re gonna make bad decisions, or we’re going to talk through it and we’re going to support each other through it. We’re going to learn from it and not know that again. But you also are going to do things that do work, and we’re going to celebrate those and lift you up because you are gonna be the next director here or at another place you are going to be.
Dena Carey (32m 40s):
So this is great practice.
Dr. Anthony Orsini (32m 42s):
I’m a firm believer in wherever you put the bar, people will go over it. And I think one of the things I see with successful leaders is that they raise the bar and people go over it. You know, the current NICU that I work in, the nurses there and some of the therapists do stuff that a lot of NICU don’t allow them to do. And they do it well. And the place runs like clockwork and my friends from New Jersey and from New York, when I used the word, we’ll say to me, how did that unit a, a 147 beds run like that? And I said, it is a prime example. When you raise the bar, people will go over it. But the opposite is true too. If you lower the bar, they are very happy to stay there too. One of my other favorite quotes is why would I hire smart people and then not listen to them?
Dr. Anthony Orsini (33m 27s):
That’s a Steve Jobs talk. So I love that. And I think that’s really what a true leadership is really all about. And so we have to take care of our leaders. We have to make sure everyone’s happy. And if they are happy, then they are engaged that they are engaged they take care of the patients, which is ultimately why we’re all here doing that. And that goes, whether things are going well or things aren’t going well. And so I think that’s a really great advice. So this is just an amazing talk and I interview, and there’s just so many good things that the young nurses who want to be in leadership. And by the way, we have a decent size audience out there that has nothing to do with healthcare that, you know, you want to be a boss.
Dr. Anthony Orsini (34m 12s):
We’re having Kristin Baird who is going to on and Cy Wakeman has been invited. I think she was coming on. Kristin Baird talks about how expensive it is for a nurse to replace a nurse and bad leadership we’ve said this many times, bad leadership is expensive. So making sure that you hire the best leaders, Dena, I’m going to ask you one more question before I asked you the final, tough question and all the time, what would be the one piece of advice that you would give to that young nurse who really wants to become a leader? Tell her, where do I go from being a second year med surg, RN, to being a leadership in nursing.
Dr. Anthony Orsini (34m 54s):
What do I have to do?
Dena Carey (34m 57s):
I always tell new nurses, find your passion, find your passion. What drives you? When I was in the NICU and I was a one-year in what drove me crazy was the things we put on baby’s skin without thinking about the long term effects of those things. There are stickers everywhere, there’s things in their nose. There’s things in their mouth. There’s tape on their face. There’s tape around their hand, on their feet. The IVs, you know, what’s more important losing the IV or keeping the IV, but there’s tape everywhere. And my passion became skin. I then became the skin rounder in the NICU.
Dena Carey (35m 40s):
Then I joined hospital-wide skin prevalence committee. I was the guru of skin and the NICU. I then became on the education council. I then became chair. I found my passion and I followed my passion to climb that ladder. And that was from the very beginning of my leadership career. But you have to find your passion. My passion is people. I love my people, and I love that my people love to do what they do. And so if I can have them in a place where they are doing what they love to do, and they’re being loved for it, our patients are making out our patients are getting the best care.
Dena Carey (36m 24s):
Cuz I have the right people taking care of the right type of patients being led by the right leaders. And it just makes so much sense.
Dr. Anthony Orsini (36m 34s):
And the elephant in the room here that has also tied into all of this is the very high rates of professional burnout among doctors and nurses is the latest number I saw a for nurse It is 60%. I couldn’t believe with a passion, a a a hundred percent. My passion has been communications. So people ask me, why did I talk about it in the book? But for some reason, I gravitated towards that, just like you have at the death and dying of NICU and how many people felt that at that moment, it’s a failure when it’s actually an opportunity to help the family when they need us the most. And you spent 10 years researching how to break bad news. And unfortunately got the nickname breaking bad news doctor, which I’m not so sure is a good title, but this is something that I’m really proud of because it’s something that I’ve taught.
Dr. Anthony Orsini (37m 19s):
So you agree with me, that’s the best way to break this professional burnout problem is that just get people to enjoy their work again.
Dena Carey (37m 26s):
I do. I really do. I think once they can find the joy in what they do and make sure that they have those personal connections with their patients and talk about them, talk about the success of what good care looks like. Share those stories of grateful patients. I read probably once a week, I read a letter written by families to our patient experience department, to our leaders that are rounding after the fact, I read it line by line. I announce who those star staff were, you know, in yesterday’s letter was a Maureen from the postpartum unit.
Dena Carey (38m 12s):
She was the angel of all angels for this family. And I want this staff to recognize her. I want them to walk down the hall and say, wow, Maureen, you really are awesome and pay attention to what Maureen does. And I want to get on there.
Dr. Anthony Orsini (38m 25s):
And I want to be on that letter of next week and to recognize people is so important. So great advice, Dena closing up, I warned you about this question. So what is the most difficult conversation that you’ve had in your life? And you can say type of conversation, and please give advice to people who are out there that needs, how do you navigate it or did not navigate a correctly and give them some advice on how to do that?
Dena Carey (38m 53s):
Well, I thought a lot about this question.
Dr. Anthony Orsini (38m 55s):
You know, some people, I forget to warn…
Dena Carey (38m 59s):
I am very lucky. I’ve had a lot of experiences with my life, honestly. And I think that in my current role, as an AVP over for different units, I think one of my most difficult moments in conversation is when I’m given a project that I’m not the expert in, and I have to threaten the comfort zones of all the other experts. Okay. That is often the most difficult conversation that I have to have.
Dena Carey (39m 42s):
I have to bring together pediatricians, OB’s, neonatologists nurses, lab directors, and role epic directors. So IT directors, for those of you who don’t know epic and get everybody on the same page and really understand the mission of what we’re trying to accomplish and ensure that they all know how much respect I have four them being the expert at the table. And I think that’s often the most difficult thing I have to do as an AVP. So maybe not your most traditional answer.
Dr. Anthony Orsini (40m 18s):
But that’s a great answer. I’ve found that also that you have to recognize that everyone wants to feel important. Everyone wants to be heard. And when we have that many people in the room, you know, some people would say stroke a little ego’s, but you kind of have to do that, right? Because the egos get in the way and everybody wants themselves to be heard, but they don’t want to listen to everybody else. I think that’s great advice. You got to get everybody on the same page and I mean, look, what’s happening in Washington, DC. Right now, I get nothing done because no one listens to each other. So we won’t get political, but that’s, I think our government should take your advice.
Dena Carey (40m 57s):
And I think that’s, what’s hard. We in health care often our, this is how we’ve always done it. This is how we’ve always done it. And to, and the threat that comfort is hard. It’s hard to do as a leader. And I know my reputation is often, if anybody can do it, Dena can do it. And often that’s hard to do so. It is hard. But I think like you said, listening and valuing your people, they will always join you.
Dr. Anthony Orsini (41m 34s):
Fantastic. Great words of advice, Dena, the way for people to get in touch with you, your email, or what’s the best way for people to get in touch with you. If they want to ask you a question or get some advice,
Dena Carey (41m 44s):
Either on LinkedIn, Dena, Carey, or feel free to email me. My work email is dCarey@virginiahospitalcenter.com. Their welcome to reach out. I love to mentor. I love to teach. I love to just share what we’re doing because it’s working
Dr. Anthony Orsini (41m 59s):
And your enthusiasm overflows. So we’ll put all that in the show notes, but Dina, thank you so much for being here. I promise my audience every week there’ll be inspired and the like you to learn communication and this certainly fit the bill. So thank you so much.
Dena Carey (42m 13s):
Absolutely. Thank you so much for reaching out. This was an honor and a pleasure and I’m so thrilled. Thank you.
Dr. Anthony Orsini (42m 19s):
Thank you. If you enjoyed this podcast, please go ahead and hit follow. It’s no longer subscribe. They are available on apple, Spotify, and Amazon and just about every other podcast platform. If you want to get in touch with me, you can reach me through the Orsini Way.Com. Thank you again and Dena. Thank you. We appreciate everything that you do. Well before we leave I want to thank you for listening to this episode of Difficult Conversations lessons I learned as an ICU physician. I want to thank The Finley Project for being such an amazing organization, please, everyone who’s listening to this episode go ahead visit the Finley Project.org see the amazing things they’re doing.
Dr. Anthony Orsini (43m 1s):
I’ve seen this organization literally saved the lives of mothers who lost infants. So to find out more, go through the Finley Project.org. Thank you. And I we’ll see you again on Tuesday.
1 (43m 11s):
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Dr. Anthony Orsini
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