This is Laura Dierda with the Becker's Healthcare
podcast. I'm thrilled today to be joined by
doctor Terry McDonnell, senior vice president and chief
nurse executive at Duke University Health System. Doctor
McDonnell, it's a pleasure to have you on
the podcast today.
It's a pleasure to be here with you,
Laura.
Now I'm looking forward to our discussion because
I know we're gonna dig a little bit
deeper into some of the interesting things you're
doing at Duke, regarding workforce, talent development, nurse
education, and more. But before we dive in
there, can you tell us a little bit
more about yourself and your background?
Sure.
I am an oncology nurse practitioner by training.
I've been taking care of GI oncology patients
for the last twenty some odd years.
Nursing is actually a second career for me.
Prior to nursing, I,
had time in education,
and, you know, I think all of our
experiences bring we carry with us to to
our work of today.
I've had the pleasure of being at Duke
for about the last year and a half.
Prior to that, I was out in Seattle
where I, served as the CNO, COO for
the Fred Hutchinson Cancer Center.
That's great to hear. And, you know,
really, really fascinating to have the kind of
career that you have in in terms of
looking at the education side and and really
a lot of experience. So,
first and foremost, can you tell me a
little bit about why the traditional approach to
nursing education isn't working anymore?
Well, I you know, it's interesting. I I
think it's multifactor.
We've got,
a generation
of learners
that have grown up with video, with rapid
information.
We've also got a generation
of the workforce that, you know, spent the
last part of their their intense education
in a pandemic.
So you take all of those factors together
and people just learn differently. They've got different
needs,
you know, and we're looking at how we
really ensure that people feel confident and competent
when they're starting their first jobs. We're on
much shorter trajectories as well. I mean, we're
looking at
taking people in early college programs. If you
look at what the Bloomberg grants are doing
around the country, they're partnering with local high
schools
to to take people from the community and
condense
into an early college type of program where
when they graduate,
they're ready to be in a healthcare workforce
in a CNA or a CMA or some
kind of a tech role.
That that's taking what traditionally
would have been probably six to eight years
of education
and shortening it down.
You know, we look at people that are
balancing a lot of things. They're not just
dedicating
all of their time to school,
but they're doing a broad variety of things.
And, you know, when you start a new
career,
there's automatically
a ramp up period.
But when you're in face to face,
you know, hands on patient care situations,
there's a level of intensity
and, you know, there's there's a level of,
I would say,
almost anxiety and fear
that can
take hold when you don't feel fully confident
in that situation.
And I think what we've done over the
last
decade or so, especially with our with our
new nurses,
is we've
taken them and we've not just slowly ramped
them up,
but we've brought them into high intensity
environments,
the ICUs,
acute care environments.
And we need to give those students or
those those those people who are transitioning into
practice
more of a ramp up period so that
they really feel like those skills are solidly
underneath them.
That makes a lot of sense. So, you
know, certainly
seems like a a great opportunity,
to to bring the newer clinicians in or
those students who are are really,
needed in the workforce, but as you mentioned,
haven't maybe had the the same time,
ramp up period or experience that traditional
nurses have. When you look especially at the
academic
medical center, setting, how is integrating that academic
and clinical training,
together
helping to solve that workforce shortage?
Well, we've got a unique opportunity. I mean,
when we can bring the school and the
the work environment closer together,
that allows us to to train people in
areas and get them hands on experience
in a much more controlled fashion in the
areas where they ultimately end up working.
So they don't go from a completely foreign
training ground
to the area where they're going to work
and try to learn
the environment, the culture, and all of the
elements of that new environment all over.
It it becomes a gradual ramp as part
of their education
And then when they're graduated and they're certified
and they're ready for practice,
their orientation
can be much smoother because they're familiar
with simple things like where things are, what
the culture of the unit is,
what the expectations are. And their transition to
practice can be much easier because they already
have that knowledge.
So then learning the skills and the specifics
of the the needs of the of patient
care,
medication administration,
wound care, all of those elements
that they need to be fully confident and
confident in,
those skills can be acquired in a in
a much more controlled
and we hope, you know, less anxiety provoking
environment.
That's fascinating to hear. You know, it certainly
seems like a really smart way to,
navigate
some of these challenges.
I think especially,
I'm curious why some of the early hands
on experience is critical to reducing,
you know, nurse burnout that we're hearing about
and improving retention as well.
Well, I I a
a a picture is worth a thousand words
for me. So if you imagine yourself,
as a new nurse
and you're on a unit and a patient
is under your care, and suddenly there are
subtle changes in that patient and they're getting
sicker,
and you need to then start to process.
You're taking vital signs. You're you're thinking to
call the resident or the intern or the
physician on call. You're you need to take
certain actions.
And if you don't feel
that you've got that
good solid base of knowledge and understanding underneath
you,
that can really invoke,
a feeling of fear and panic.
And no one ever wants to feel
that they don't have full confidence
and full control of a situation when they're
caring for another human being.
And when we think back to when we're
new in any situation, any of us, in
a new job, first day at work, first
day at school, that that pit of anxiety.
When you're a new nurse
and you're feeling that
daily
because you haven't had the opportunity to really,
really transition to practice
solidly and feel confident,
that tends to create
a condition of feeling burnt out.
You're constantly feeling anxious.
You don't feel like you've got everything you
need to be successful.
And that
ultimately what is leading a lot of our
staff to lead the profession.
They just don't feel well supported or confident
in the environment.
So by pulling it all together
and really supporting people through those early days
of their practice,
If if you don't have that anxious feeling
day in day out, you feel a little
bit better about coming to work. You feel
like you can handle more. You feel like
you can process more.
You feel more controlled.
That makes a lot of sense and, you
know, certainly
a great,
situation to be in if you are able
to have that sense of control and feel
a little bit more bandwidth to tackle the
challenging things that I know arise on a
daily basis for nurses and clinicians
across,
the health care organization.
Before we wrap up here, I'm curious
what,
this move
signals for the future of nursing at Duke
and nationwide.
Well, you know, at Duke, we're taking a
a very proactive approach. We we really wanna
support
our community,
so we wanna make sure that we're
offering the members of our community opportunities to
have not just jobs, but career paths at
Duke.
So when a CNA comes to to Duke
from one of our high schools,
when they've graduated,
we then have an opportunity to offer that
CNA a pathway to then become a registered
nurse
because we've got the academic partnerships right here
on-site.
So we can support someone financially and also
through course offerings
and program offerings for them to get their
education and their RN.
And the really neat thing is that we
also have the Graduate School of Nursing that's
right here on campus that we partner with.
So if someone wants to go on and
become a CRNA or an NP,
they can do that,
and they can do it without ever having
to leave Duke. We can support them
through
ensuring that they've got job flexibility,
that we can support them financially through scholarship,
through tuition reimbursement,
and but most importantly, we can we can
give them a professional
practice environment
that allows them that latitude to become fully
competent in the work that they're doing and
grow.
And I think that's the really unique opportunity
that we have here at Duke by bringing
undergraduate,
graduate, and the work environment all together under
one roof.
That's an amazing to hear. Doctor McDonald, thank
you so much for joining us on the
podcast today. This has been a really fun
and informative conversation, and I look forward to
connecting with you again soon.
Thanks so much, Laura. Have a great day.