SONSIEL_Karen Miguel: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Hiyam Nadel:
Welcome to the SONSIEL podcast, where we host interviews with the most transformational nurse scientists, innovators, entrepreneurs, and leaders. Through sharing their personal journeys, we create inspiration, provide guidance, and give you actionable ideas you can use to be a catalyst for change.
Hiyam Nadel:
Hello, everybody, this is Hiyam. Welcome back to SONSIEL podcast, and I’m excited to go to talk to Karen Miguel, who works at Mass General Hospital in Boston. Before I turn it over to her to introduce herself, we’re going to really dig deep into well-being and well-becoming. Karen, can you please introduce yourself?
Karen Miguel:
First, thanks so much. It’s a pleasure to be here. I really, it’s a great topic, it’s front and center at where we are, so thanks for inviting me on. Yes, my name is Karen Miguel. I’m a staff specialist for quality and safety and practice at the Mass General Hospital, and been a nurse for nearly four decades. And I always like to say I never really know how I ended up in this role, nothing I’ve ever planned from a long-term strategy perspective, but each step I take seems to open up another door and just give me some foundational basis for the work that I am most passionate about, one of them we’re talking about today.
Hiyam Nadel:
That’s fantastic, and I’m always curious as to what inspired you to go into healthcare, specifically nursing. Can you tell us your story about that?
Karen Miguel:
Sure, it goes back to like most little girl, most little girls in the sixties, influence of either things in TV or in their life, and they weren’t many choices back in the sixties that really felt little girls could do. And believe it or not, my mom is a nurse, 87 years old, and my, and her sister, my aunt, was also a nurse. So it really as role models listening to what their lives were and what they shared, it just, it fit naturally. I think in many instances we learn at an early age if we’re caregivers or receivers, and I certainly am a caregiver, so it felt natural and it felt right when I went into it.
Hiyam Nadel:
That’s a great story, a lot of influence there from your mom and aunt. Tell me when you first went into nursing. Tell me a little bit about your clinical background. What patient population were you most involved with?
Karen Miguel:
Sure, I found a passion in the intensive care unit. I spent some, nearly 18 years in a trauma surgical ICU, and the environment was rich for growth professionally, and most importantly, from a cultural perspective. It’s really where I reflect back on now and learned that this is what a working environment should be like. So leadership support, development, and empowerment for staff nurses. And the most important piece that I learned in that sort of area was the accountability, how much you were accountable for your role. And it really came from leaders’ ability to cultivate that empowerment staff. So intensive care unit really was where I learned who I was as a clinician. I love the intricacies of being managing all of the systems in a patient and more importantly, like the collaboration that went on with that. They were just, never just one person involved in the success of discharge from an ICU, but it was definitely a team-based sport. So yeah, that’s where I found myself.
Hiyam Nadel:
Yeah, it’s interesting because I think some units actually lend themselves more to that collaboration because it’s intense environment, you need each other, you actually rely on each other, so I could see that. And you mentioned that you are a staff specialist in quality and safety. Was that a natural evolution for you? Do you find that most nurses go to quality safety from the ICU background?
Karen Miguel:
Not necessarily, when I think about how I got to where I am today, it’s always been because somebody else saw something in me that they thought I could impact. And what happened naturally after the intensive care unit was really following the passion and the vision to continue to support improving practice at the bedside. I was always involved in practice committees from the first day I arrived into the nursing profession and continue to think about how do we make it easier for staff to do the right thing at the bedside. So my first step away from direct care was actually in a clinical resource manager role and looking at needs for products and technologies, working with clinicians and making decisions, but also being a liaison to the financial side of it. And I learned quite a bit in that role on need versus want, but then also of course, saving is never really a cost saving. So certainly working with frontline staff and empowering them to make decisions on products that would impact their, the improvement of their role was key. That role served its time for the most part and one of the opportunities that not was coming back to a staff-focused role in patient safety. And so I had a unique opportunity to begin the development of a patient safety sort of office in the Department of Radiology here at MGH. It was given to me by a great executive director who was a nurse at the time and visionary and certainly looking at what was going on in the world of patient safety, wanted to create this environment in radiology, which is one of the, it is the second largest department in the hospital, and from a staff perspective and very, very complex in its way, it’s almost its own little mini hospital. So many of the things that I developed as programs in that world is really what led me to where I am today. Always involved, always engaged in how, what makes a unit successful? How does the health of a unit impact patient outcomes? And learned a lot about that with a program that I had initiated with support of a few other key folks on improving teamwork and communication in our high-risk areas in radiology, mainly the interventional radiology areas. And so what you start to see is there are things that get in the way of staff every day, and if we can remove those obstacles, they tend to do their jobs more fluidly and they tend to enjoy their jobs a lot more. So we really worked hard on improving the particular process that revolves around the interventional radiology cases. So looking at standard communication, psychological safety, debriefing after events, and working with leadership, it was a strong recognition when leaders were engaged in this process there was a much better improvement and outcomes on patients, which I thought was resounding, and certainly, there’s a lot of literature right now on teamwork and communication. So it started to, I think, seal it for me, that culture is local, culture can eat strategy for lunch and we’ve heard that saying before. So certainly, certainly a very big important part of why I am where I am today, continuing to be in quality and safety. I think quality and safety is certainly about patients, but most importantly about staff.
Hiyam Nadel:
Interesting. And I would imagine that quality safety gives you broader perspective or broader view of a lot of the problems, but more importantly, the trends. So if there’s trending, if you’ve already developed one solution for one unit or place, you can apply to others when you see the trending.
Karen Miguel:
Correct, yeah, yeah.
Hiyam Nadel:
And I, you said something really interesting to me, which is when leadership is involved, we have better outcomes. Can you describe that for our listeners? What does leadership and involvement really mean? Are they at the front lines, rolling up their sleeves and being with their staff, listening to their staff? So if you can go into that, I’d be really interested.
Karen Miguel:
I think it’s multi-dimensional. It can be rolling up your sleeves and being there with staff. It can be also representative of what gets in staff’s way. You know what I started to see, and again, I reflect back on my years in the ICU, what worked was that when we had an issue and a complaint, the obstacle was attempted to be moved or permanently removed, and so they listened to staff. And I think the walkaway message for me was, if you take care of the staff, they’ll take care of the patients. And so the importance of leadership engagement can be multi-level. It’s not necessarily how they do it, but that there’s a perception from their staff that they matter. And years later, I learned a lot about Paul O’Neill, he was the CEO of Alcoa, the largest aluminum manufacturer in the world, and he asked his staff three questions on a regular basis. Do you have what you need to do your job and is it in working order? Are you treated with respect by everyone you work with? And are you thanked regularly? And so if you can apply those three things to an environment where leaders are listening, that’s their role, it’s to listen and to remove obstacles. I think there’s so much coal in today’s healthcare environment where mid-level leaders have an accountability to their staff on the units, but they also have the ear of the people they report to and assisted needs. And so I think they’re in probably one of the toughest places in healthcare right now, and to be successful is, you’ve really got to have a strong stamina and understand where your priorities are. But leadership to me is, really the, it’s the key to a unit success and certainly affecting the local culture that we see drives well-being and well across many of the not just healthcare but across many institutions and many different roles.
Hiyam Nadel:
That’s right, I 100% agree with you about the leadership and you’re a better leader if you really understand the listen to what your staff is going through. And I also love about, the fact that removing obstacles, we can’t give one, it is not a one-solution for burnout and well-being so that we need our resources and tools, but also we need to get to what is actually causing the burnout, we need to work on that. And I also love the idea of the leadership, we need to think about leadership because they are in a tough position. So how do we support leadership just as well so they can turn around and support their staff?
Karen Miguel:
Yeah.
Hiyam Nadel:
So if we can pivot a little bit, Karen, and just tell me about the work that you do. I have been with you when we’ve gone up to the units to listen to the staff. I always learn so much from you, but can you tell me about the work that you’re doing, not just with the staff in the hospital, but also with our new grads, for example, and all of that? I would love to hear more.
Karen Miguel:
Yeah, sure, so the pandemic, COVID, I think, has afforded a lot of opportunities that sometimes we underestimate, and one of them was the exposure of obstacles that are in the way of staff doing their roles. I think it shined light on a lot of it that had already been there. So many of the issues that we’re identifying that we equate to, increased burnout now on staff, have been there. There are some new ones, but many of them have been there. It’s just the last two and a half or three years has drained so many of our emotional wells that we don’t have the stamina to tolerate another sort of obstacle in our work or something that gets in my way of a good day. And so the small things that we used to be able to manage and blow off are now big things and they’re hard to get by. And many times, as we’re seeing with our staff through here, even at our own institution, it’s hard to come in, it’s actually hard to be present at work. And I think some of the work that we’ve been trying to do in a small collaborative within our own department, patient care services, as well as with a group at the hospital level, is to create time and space. And as you mentioned, we create time and space for staff to take the pause, recognize possibly where they are emotionally and what’s sort of bugging them, and once we can identify those things, we can actually work on them. And so in the height of all this, after we’ve won, we spent, oh, God, upwards of over 100 hours, closer to 150 hours of time, talking with staff and identifying really the burdens that they felt they were carrying and giving them time to grieve once in a century event that had been happening to all of us. The best part was our leadership’s embracing of the themes that had come out of all of those sessions and the development of staff-supported improvement groups. So six or seven improvement groups create, that were created had actually improved the way we were going to enter to our second wave. As you and I both know, working together, that really propelled us to want to continue these conversations. And so much of it was based on doing roving rounds to ask people what was getting in their way of them doing their jobs today versus what’s one good thing that’s happening for you today, and we started to develop this list of things people were asking and needing, but we put them all together and realize how hostile was so resource rich with so many things that staff didn’t even know how to tap into that we became conduit for sharing these resources, helping people access it, and learning that there’s a lot of different needs out there. Not everybody needs to learn how to meditate or take a deep breath, but there are people that have other ways that they want to fulfill or keep themselves feeling as they can function at their best. So one of the great things that we’ve been doing in expanding is thinking about, how can we prepare our new grads. We’ve got a big movement in healthcare, particularly in nursing of staff churning, and that basically means they’re changing jobs, they’re moving more frequently, they’re going to what they consider to be less stressful jobs. So there’s lots of vacancies things are getting filled with new grads. We’ve had the big quit, we’ve had early retirement, so we’ve had a lot of nurses leaving a few years before they wanted to. So here at the hospital, we’ve made a concerted effort to attract new graduate nurses. And one of the pieces that’s been very highly focused on by leadership, and in quality and safety is, again, getting back to that, take care of the staff, they take care of the patients. Do the new grads have the skill sets they need so that they can be in this profession for as long as somebody like me and you. I mean, like four decades. And honestly, the world is different in healthcare, and so it’s probably harder now to think about having a bedside position for 40 years, but what can we do to help them prepare for this? So we have started to impact that by getting involved in their development program. We have a transitions to professional practice, it’s a 12-month program. We touch base with them once a month and our education center brings in all different kinds of subject matter experts and topics to talk to, and they’ve now included self-care planning. So we talked to them about this journey of well-becoming because it’s not really ever a destination, it’s always an evolution of wellness. And how do I find ways to fill my cup? What works now might not be something that works years from now, but it’s still this exercise, this consistent way of putting and understanding when I’m empty, putting myself first, how do I make sure that I’m taking care of self first? So we started a curriculum, using a curriculum on not just sharing the resources, but trying to understand how to determine where you are. So using really some of the short centers, stress for estate, we looked at how do you look at the red, yellow, green. Where am I today? How do I know when my colleagues are and when I’m there, what does that look like? What do I need? How do I ask for it? And so really using that time with them to impart the importance of it and to leave them with a couple of exercises, a couple of different strategies, and then a whole bucket of resources. So I think it’s going well, we are, we’re basically trying our second, our part two. Nearly 600 new grads have come into our institution in the last 18 or so months, maybe a little bit less, not sure on the exact numbers, but we have, we’ve been invited now to, at a six-month mark, touch base with the folks that we initially engaged in, setting up a self-care plan and talking about it like what worked, what didn’t, and why not. And also starting to talk about what’s getting in their way of well-being on their units. And that actually has been a great … of information helping us understand maybe we can target some of these topics like grief and dying. It’s like just the immense amount of grief that families have in this concept of being around people that have to transition to death, it’s heavy. How do I manage that in my new career? We’re touching on things like not being treated respectfully at work. The lateral violence is there still and how do we maybe enlighten that, and areas such as crucial conversations, how do you have a difficult conversation with someone who’s challenged you so that it’s a win-win? And so some of these things have surfaced as opportunities that we’re kicking around and wondering if these belong in the well-being toolkit. So really excited about this program. I think the new grads is where it’s at. I think we have a lot of work and support that we need to do with our own full-time staff, and I think it’s just as important to catch them as they’re coming through the threshold of a new profession.
Hiyam Nadel:
Yes, and I’m very excited to see some of the outcomes as we look at them two years down the road or three years down the road, etc. Now, Karen, you mentioned that we both recognize that we are a well-resourced hospital, luckily. What is the one thing you want to leave the audience with, even if they’re not well-resourced? So, for example, going, having a team that’s very passionate about this, we all volunteered to do it, go up to the units and talk to the staff, and that didn’t really, it took our time, but I think we all enjoyed doing it, we wanted to do it. What is the one thing you would leave today for our audience that are maybe not in a well-resourced institution?
Karen Miguel:
Yeah, I think it’s pretty basic, Hiyam. It gets back to how to take care of the staff and they’ll take care of the patients. And so what does that one thing look like? It’s presence. It’s the ability to listen, and sometimes it’s just validating, validating their feelings, validating the day, validating the obstacles. Sometimes it’s action from leaders who can move obstacles. It isn’t, it isn’t, I don’t think leaders should be afraid to ask what’s in the way of you doing your job well, because there’s always this bottom-line fear that maybe they can’t move that obstacle. Just asking, and sometimes the acknowledgment of that is enough, and maybe it’s enough to be able to say, We’re going to keep working on that and I am going to be your advocate. I am going to be speaking about this issue. I am going to see if we can get more attention on this. And I think it’s presence, and as much as the leaders are overburdened now with so much weight from the top and sort of absorbing from the bottom, they are really the ones that we want to resource well and make them successful. How do we give them what they need to do their jobs well so that they can take care of their staff who ultimately, as I said, take care of the patients?
Hiyam Nadel:
That’s beautifully said, Karen. Honestly, I can talk to you all day long, but we are at the end of our session. I want to thank you very much for joining us today. And if any of our audience members wanted to reach out to you, could they do that?
Karen Miguel:
Oh, yes, absolutely, Hiyam. Sometimes I feel like a half an hour is never enough, and if people asked a question, I’m never short for a comment. So I would be very happy to talk with people, absolutely.
Hiyam Nadel:
And what is the best way to reach you through email?
Karen Miguel:
Yeah, I think that would be great. You can provide them my email, it’s fine.
Hiyam Nadel:
Perfect. Thank you so much and thank you everyone. I hope you enjoy the rest of your day.
Hiyam Nadel:
Thanks for tuning in to the SONSIEL podcast. If today’s podcast inspired you, we invite you to join our tribe or support our mission by visiting us at SONSIEL.org. That’s S O N S I E L.org.
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