1 00:00:00,240 --> 00:00:02,399 This is Laura Dierda with the Becker's Healthcare 2 00:00:02,399 --> 00:00:04,480 podcast. I'm thrilled today to be joined by 3 00:00:04,480 --> 00:00:07,120 doctor Terry McDonnell, senior vice president and chief 4 00:00:07,120 --> 00:00:09,839 nurse executive at Duke University Health System. Doctor 5 00:00:09,839 --> 00:00:11,119 McDonnell, it's a pleasure to have you on 6 00:00:11,119 --> 00:00:12,179 the podcast today. 7 00:00:12,714 --> 00:00:14,155 It's a pleasure to be here with you, 8 00:00:14,155 --> 00:00:14,655 Laura. 9 00:00:15,195 --> 00:00:16,954 Now I'm looking forward to our discussion because 10 00:00:16,954 --> 00:00:18,554 I know we're gonna dig a little bit 11 00:00:18,554 --> 00:00:21,195 deeper into some of the interesting things you're 12 00:00:21,195 --> 00:00:24,954 doing at Duke, regarding workforce, talent development, nurse 13 00:00:24,954 --> 00:00:27,189 education, and more. But before we dive in 14 00:00:27,189 --> 00:00:28,550 there, can you tell us a little bit 15 00:00:28,550 --> 00:00:30,089 more about yourself and your background? 16 00:00:31,029 --> 00:00:31,529 Sure. 17 00:00:31,989 --> 00:00:35,210 I am an oncology nurse practitioner by training. 18 00:00:35,590 --> 00:00:37,989 I've been taking care of GI oncology patients 19 00:00:37,989 --> 00:00:39,770 for the last twenty some odd years. 20 00:00:40,695 --> 00:00:43,195 Nursing is actually a second career for me. 21 00:00:43,734 --> 00:00:45,414 Prior to nursing, I, 22 00:00:45,975 --> 00:00:47,434 had time in education, 23 00:00:48,774 --> 00:00:50,695 and, you know, I think all of our 24 00:00:50,695 --> 00:00:54,049 experiences bring we carry with us to to 25 00:00:54,049 --> 00:00:55,189 our work of today. 26 00:00:55,969 --> 00:00:57,809 I've had the pleasure of being at Duke 27 00:00:57,809 --> 00:00:59,409 for about the last year and a half. 28 00:00:59,409 --> 00:01:01,270 Prior to that, I was out in Seattle 29 00:01:01,570 --> 00:01:04,530 where I, served as the CNO, COO for 30 00:01:04,530 --> 00:01:06,229 the Fred Hutchinson Cancer Center. 31 00:01:07,135 --> 00:01:08,754 That's great to hear. And, you know, 32 00:01:09,454 --> 00:01:12,015 really, really fascinating to have the kind of 33 00:01:12,015 --> 00:01:13,694 career that you have in in terms of 34 00:01:13,694 --> 00:01:16,174 looking at the education side and and really 35 00:01:16,174 --> 00:01:17,795 a lot of experience. So, 36 00:01:18,575 --> 00:01:20,094 first and foremost, can you tell me a 37 00:01:20,094 --> 00:01:22,200 little bit about why the traditional approach to 38 00:01:22,200 --> 00:01:24,299 nursing education isn't working anymore? 39 00:01:25,000 --> 00:01:26,760 Well, I you know, it's interesting. I I 40 00:01:26,760 --> 00:01:27,739 think it's multifactor. 41 00:01:28,519 --> 00:01:29,340 We've got, 42 00:01:29,719 --> 00:01:30,459 a generation 43 00:01:30,920 --> 00:01:31,659 of learners 44 00:01:32,519 --> 00:01:36,004 that have grown up with video, with rapid 45 00:01:36,004 --> 00:01:36,504 information. 46 00:01:37,125 --> 00:01:38,744 We've also got a generation 47 00:01:39,045 --> 00:01:41,604 of the workforce that, you know, spent the 48 00:01:41,604 --> 00:01:44,344 last part of their their intense education 49 00:01:45,125 --> 00:01:46,024 in a pandemic. 50 00:01:47,170 --> 00:01:49,750 So you take all of those factors together 51 00:01:49,890 --> 00:01:53,429 and people just learn differently. They've got different 52 00:01:53,489 --> 00:01:53,989 needs, 53 00:01:54,450 --> 00:01:57,170 you know, and we're looking at how we 54 00:01:57,170 --> 00:02:00,869 really ensure that people feel confident and competent 55 00:02:01,415 --> 00:02:03,974 when they're starting their first jobs. We're on 56 00:02:03,974 --> 00:02:06,454 much shorter trajectories as well. I mean, we're 57 00:02:06,454 --> 00:02:07,515 looking at 58 00:02:08,215 --> 00:02:11,014 taking people in early college programs. If you 59 00:02:11,014 --> 00:02:12,935 look at what the Bloomberg grants are doing 60 00:02:12,935 --> 00:02:15,574 around the country, they're partnering with local high 61 00:02:15,574 --> 00:02:16,074 schools 62 00:02:16,870 --> 00:02:19,290 to to take people from the community and 63 00:02:19,430 --> 00:02:19,930 condense 64 00:02:20,550 --> 00:02:23,189 into an early college type of program where 65 00:02:23,189 --> 00:02:24,090 when they graduate, 66 00:02:24,629 --> 00:02:26,870 they're ready to be in a healthcare workforce 67 00:02:26,870 --> 00:02:28,870 in a CNA or a CMA or some 68 00:02:28,870 --> 00:02:30,544 kind of a tech role. 69 00:02:31,004 --> 00:02:32,705 That that's taking what traditionally 70 00:02:34,125 --> 00:02:36,604 would have been probably six to eight years 71 00:02:36,604 --> 00:02:37,185 of education 72 00:02:37,805 --> 00:02:39,344 and shortening it down. 73 00:02:39,805 --> 00:02:41,564 You know, we look at people that are 74 00:02:41,564 --> 00:02:44,219 balancing a lot of things. They're not just 75 00:02:44,540 --> 00:02:45,040 dedicating 76 00:02:45,419 --> 00:02:47,280 all of their time to school, 77 00:02:47,740 --> 00:02:50,379 but they're doing a broad variety of things. 78 00:02:50,379 --> 00:02:52,620 And, you know, when you start a new 79 00:02:52,620 --> 00:02:53,120 career, 80 00:02:53,740 --> 00:02:54,719 there's automatically 81 00:02:55,580 --> 00:02:56,800 a ramp up period. 82 00:02:57,715 --> 00:03:00,694 But when you're in face to face, 83 00:03:01,155 --> 00:03:03,895 you know, hands on patient care situations, 84 00:03:04,754 --> 00:03:06,215 there's a level of intensity 85 00:03:07,235 --> 00:03:10,034 and, you know, there's there's a level of, 86 00:03:10,034 --> 00:03:11,014 I would say, 87 00:03:11,710 --> 00:03:13,729 almost anxiety and fear 88 00:03:14,189 --> 00:03:14,930 that can 89 00:03:15,629 --> 00:03:19,010 take hold when you don't feel fully confident 90 00:03:19,550 --> 00:03:20,610 in that situation. 91 00:03:21,469 --> 00:03:23,229 And I think what we've done over the 92 00:03:23,229 --> 00:03:23,729 last 93 00:03:24,784 --> 00:03:27,185 decade or so, especially with our with our 94 00:03:27,185 --> 00:03:27,925 new nurses, 95 00:03:28,784 --> 00:03:29,525 is we've 96 00:03:29,825 --> 00:03:33,025 taken them and we've not just slowly ramped 97 00:03:33,025 --> 00:03:33,685 them up, 98 00:03:34,064 --> 00:03:36,564 but we've brought them into high intensity 99 00:03:36,865 --> 00:03:37,365 environments, 100 00:03:37,905 --> 00:03:38,645 the ICUs, 101 00:03:39,930 --> 00:03:41,150 acute care environments. 102 00:03:42,729 --> 00:03:45,210 And we need to give those students or 103 00:03:45,210 --> 00:03:47,770 those those those people who are transitioning into 104 00:03:47,770 --> 00:03:48,270 practice 105 00:03:48,889 --> 00:03:50,889 more of a ramp up period so that 106 00:03:50,889 --> 00:03:53,229 they really feel like those skills are solidly 107 00:03:53,290 --> 00:03:54,270 underneath them. 108 00:03:55,114 --> 00:03:56,474 That makes a lot of sense. So, you 109 00:03:56,474 --> 00:03:57,215 know, certainly 110 00:03:57,674 --> 00:03:59,375 seems like a a great opportunity, 111 00:03:59,995 --> 00:04:03,114 to to bring the newer clinicians in or 112 00:04:03,114 --> 00:04:04,734 those students who are are really, 113 00:04:05,194 --> 00:04:07,450 needed in the workforce, but as you mentioned, 114 00:04:07,450 --> 00:04:09,629 haven't maybe had the the same time, 115 00:04:10,090 --> 00:04:12,750 ramp up period or experience that traditional 116 00:04:13,129 --> 00:04:15,770 nurses have. When you look especially at the 117 00:04:15,770 --> 00:04:16,270 academic 118 00:04:16,649 --> 00:04:20,410 medical center, setting, how is integrating that academic 119 00:04:20,410 --> 00:04:21,550 and clinical training, 120 00:04:22,134 --> 00:04:22,634 together 121 00:04:22,935 --> 00:04:24,954 helping to solve that workforce shortage? 122 00:04:25,974 --> 00:04:28,134 Well, we've got a unique opportunity. I mean, 123 00:04:28,134 --> 00:04:31,495 when we can bring the school and the 124 00:04:31,495 --> 00:04:33,354 the work environment closer together, 125 00:04:33,814 --> 00:04:36,819 that allows us to to train people in 126 00:04:36,819 --> 00:04:39,240 areas and get them hands on experience 127 00:04:40,100 --> 00:04:42,100 in a much more controlled fashion in the 128 00:04:42,100 --> 00:04:44,360 areas where they ultimately end up working. 129 00:04:45,060 --> 00:04:47,800 So they don't go from a completely foreign 130 00:04:48,355 --> 00:04:49,175 training ground 131 00:04:49,875 --> 00:04:51,634 to the area where they're going to work 132 00:04:51,634 --> 00:04:52,774 and try to learn 133 00:04:53,154 --> 00:04:55,555 the environment, the culture, and all of the 134 00:04:55,555 --> 00:04:58,055 elements of that new environment all over. 135 00:04:58,435 --> 00:05:00,595 It it becomes a gradual ramp as part 136 00:05:00,595 --> 00:05:01,415 of their education 137 00:05:01,800 --> 00:05:04,680 And then when they're graduated and they're certified 138 00:05:04,680 --> 00:05:06,139 and they're ready for practice, 139 00:05:06,599 --> 00:05:07,419 their orientation 140 00:05:07,879 --> 00:05:10,779 can be much smoother because they're familiar 141 00:05:11,479 --> 00:05:14,759 with simple things like where things are, what 142 00:05:14,759 --> 00:05:16,779 the culture of the unit is, 143 00:05:17,345 --> 00:05:20,545 what the expectations are. And their transition to 144 00:05:20,545 --> 00:05:23,024 practice can be much easier because they already 145 00:05:23,024 --> 00:05:24,165 have that knowledge. 146 00:05:24,625 --> 00:05:27,285 So then learning the skills and the specifics 147 00:05:28,305 --> 00:05:30,964 of the the needs of the of patient 148 00:05:31,024 --> 00:05:31,524 care, 149 00:05:32,040 --> 00:05:33,019 medication administration, 150 00:05:34,680 --> 00:05:36,300 wound care, all of those elements 151 00:05:36,759 --> 00:05:39,000 that they need to be fully confident and 152 00:05:39,000 --> 00:05:40,060 confident in, 153 00:05:40,519 --> 00:05:43,079 those skills can be acquired in a in 154 00:05:43,079 --> 00:05:44,459 a much more controlled 155 00:05:45,144 --> 00:05:48,125 and we hope, you know, less anxiety provoking 156 00:05:48,185 --> 00:05:48,685 environment. 157 00:05:49,865 --> 00:05:52,185 That's fascinating to hear. You know, it certainly 158 00:05:52,185 --> 00:05:54,365 seems like a really smart way to, 159 00:05:54,904 --> 00:05:55,404 navigate 160 00:05:55,944 --> 00:05:57,004 some of these challenges. 161 00:05:57,464 --> 00:05:58,365 I think especially, 162 00:05:59,144 --> 00:06:01,439 I'm curious why some of the early hands 163 00:06:01,439 --> 00:06:03,459 on experience is critical to reducing, 164 00:06:04,480 --> 00:06:06,879 you know, nurse burnout that we're hearing about 165 00:06:06,879 --> 00:06:08,819 and improving retention as well. 166 00:06:09,839 --> 00:06:11,459 Well, I I a 167 00:06:11,839 --> 00:06:13,519 a a picture is worth a thousand words 168 00:06:13,519 --> 00:06:15,939 for me. So if you imagine yourself, 169 00:06:17,384 --> 00:06:18,444 as a new nurse 170 00:06:19,384 --> 00:06:22,044 and you're on a unit and a patient 171 00:06:22,105 --> 00:06:24,745 is under your care, and suddenly there are 172 00:06:24,745 --> 00:06:27,225 subtle changes in that patient and they're getting 173 00:06:27,225 --> 00:06:27,725 sicker, 174 00:06:28,264 --> 00:06:31,404 and you need to then start to process. 175 00:06:31,980 --> 00:06:34,620 You're taking vital signs. You're you're thinking to 176 00:06:34,620 --> 00:06:36,300 call the resident or the intern or the 177 00:06:36,300 --> 00:06:39,420 physician on call. You're you need to take 178 00:06:39,420 --> 00:06:40,480 certain actions. 179 00:06:41,100 --> 00:06:42,800 And if you don't feel 180 00:06:43,339 --> 00:06:44,720 that you've got that 181 00:06:45,495 --> 00:06:48,714 good solid base of knowledge and understanding underneath 182 00:06:48,774 --> 00:06:49,274 you, 183 00:06:49,814 --> 00:06:51,514 that can really invoke, 184 00:06:52,375 --> 00:06:53,995 a feeling of fear and panic. 185 00:06:54,375 --> 00:06:56,555 And no one ever wants to feel 186 00:06:57,349 --> 00:06:59,449 that they don't have full confidence 187 00:07:00,149 --> 00:07:02,149 and full control of a situation when they're 188 00:07:02,149 --> 00:07:03,849 caring for another human being. 189 00:07:04,389 --> 00:07:07,029 And when we think back to when we're 190 00:07:07,029 --> 00:07:09,750 new in any situation, any of us, in 191 00:07:09,750 --> 00:07:11,909 a new job, first day at work, first 192 00:07:11,909 --> 00:07:14,525 day at school, that that pit of anxiety. 193 00:07:15,384 --> 00:07:17,004 When you're a new nurse 194 00:07:17,384 --> 00:07:18,605 and you're feeling that 195 00:07:19,225 --> 00:07:19,725 daily 196 00:07:20,425 --> 00:07:23,545 because you haven't had the opportunity to really, 197 00:07:23,545 --> 00:07:25,085 really transition to practice 198 00:07:25,625 --> 00:07:27,245 solidly and feel confident, 199 00:07:28,050 --> 00:07:29,750 that tends to create 200 00:07:30,370 --> 00:07:32,310 a condition of feeling burnt out. 201 00:07:32,769 --> 00:07:34,629 You're constantly feeling anxious. 202 00:07:35,250 --> 00:07:38,290 You don't feel like you've got everything you 203 00:07:38,290 --> 00:07:39,430 need to be successful. 204 00:07:39,995 --> 00:07:40,654 And that 205 00:07:41,194 --> 00:07:43,035 ultimately what is leading a lot of our 206 00:07:43,035 --> 00:07:44,574 staff to lead the profession. 207 00:07:44,955 --> 00:07:48,175 They just don't feel well supported or confident 208 00:07:48,314 --> 00:07:48,975 in the environment. 209 00:07:49,915 --> 00:07:51,855 So by pulling it all together 210 00:07:52,235 --> 00:07:54,475 and really supporting people through those early days 211 00:07:54,475 --> 00:07:55,295 of their practice, 212 00:07:56,160 --> 00:07:59,300 If if you don't have that anxious feeling 213 00:07:59,439 --> 00:08:01,680 day in day out, you feel a little 214 00:08:01,680 --> 00:08:03,680 bit better about coming to work. You feel 215 00:08:03,680 --> 00:08:05,279 like you can handle more. You feel like 216 00:08:05,279 --> 00:08:06,660 you can process more. 217 00:08:07,120 --> 00:08:08,339 You feel more controlled. 218 00:08:09,555 --> 00:08:11,074 That makes a lot of sense and, you 219 00:08:11,074 --> 00:08:11,735 know, certainly 220 00:08:12,194 --> 00:08:12,834 a great, 221 00:08:13,954 --> 00:08:15,555 situation to be in if you are able 222 00:08:15,555 --> 00:08:17,954 to have that sense of control and feel 223 00:08:17,954 --> 00:08:20,514 a little bit more bandwidth to tackle the 224 00:08:20,514 --> 00:08:22,194 challenging things that I know arise on a 225 00:08:22,194 --> 00:08:24,134 daily basis for nurses and clinicians 226 00:08:24,879 --> 00:08:25,379 across, 227 00:08:25,680 --> 00:08:26,740 the health care organization. 228 00:08:27,600 --> 00:08:29,540 Before we wrap up here, I'm curious 229 00:08:29,920 --> 00:08:30,400 what, 230 00:08:31,040 --> 00:08:31,860 this move 231 00:08:32,240 --> 00:08:34,160 signals for the future of nursing at Duke 232 00:08:34,160 --> 00:08:34,899 and nationwide. 233 00:08:36,320 --> 00:08:38,720 Well, you know, at Duke, we're taking a 234 00:08:38,720 --> 00:08:41,924 a very proactive approach. We we really wanna 235 00:08:41,924 --> 00:08:42,424 support 236 00:08:42,804 --> 00:08:43,544 our community, 237 00:08:44,325 --> 00:08:46,825 so we wanna make sure that we're 238 00:08:47,764 --> 00:08:50,644 offering the members of our community opportunities to 239 00:08:50,644 --> 00:08:53,365 have not just jobs, but career paths at 240 00:08:53,365 --> 00:08:53,865 Duke. 241 00:08:54,480 --> 00:08:58,080 So when a CNA comes to to Duke 242 00:08:58,080 --> 00:08:59,620 from one of our high schools, 243 00:09:00,320 --> 00:09:01,379 when they've graduated, 244 00:09:02,000 --> 00:09:04,639 we then have an opportunity to offer that 245 00:09:04,639 --> 00:09:07,600 CNA a pathway to then become a registered 246 00:09:07,600 --> 00:09:08,100 nurse 247 00:09:08,504 --> 00:09:12,045 because we've got the academic partnerships right here 248 00:09:12,105 --> 00:09:12,605 on-site. 249 00:09:13,144 --> 00:09:16,445 So we can support someone financially and also 250 00:09:16,504 --> 00:09:17,725 through course offerings 251 00:09:18,345 --> 00:09:20,745 and program offerings for them to get their 252 00:09:20,745 --> 00:09:22,205 education and their RN. 253 00:09:22,839 --> 00:09:24,759 And the really neat thing is that we 254 00:09:24,759 --> 00:09:27,000 also have the Graduate School of Nursing that's 255 00:09:27,000 --> 00:09:29,159 right here on campus that we partner with. 256 00:09:29,159 --> 00:09:30,679 So if someone wants to go on and 257 00:09:30,679 --> 00:09:32,779 become a CRNA or an NP, 258 00:09:33,320 --> 00:09:34,539 they can do that, 259 00:09:34,955 --> 00:09:36,955 and they can do it without ever having 260 00:09:36,955 --> 00:09:39,615 to leave Duke. We can support them 261 00:09:40,075 --> 00:09:40,575 through 262 00:09:41,274 --> 00:09:43,134 ensuring that they've got job flexibility, 263 00:09:44,235 --> 00:09:47,455 that we can support them financially through scholarship, 264 00:09:47,914 --> 00:09:49,294 through tuition reimbursement, 265 00:09:50,360 --> 00:09:52,600 and but most importantly, we can we can 266 00:09:52,600 --> 00:09:53,500 give them a professional 267 00:09:53,960 --> 00:09:54,940 practice environment 268 00:09:55,399 --> 00:09:58,120 that allows them that latitude to become fully 269 00:09:58,120 --> 00:10:00,440 competent in the work that they're doing and 270 00:10:00,440 --> 00:10:00,940 grow. 271 00:10:01,480 --> 00:10:03,899 And I think that's the really unique opportunity 272 00:10:03,960 --> 00:10:06,394 that we have here at Duke by bringing 273 00:10:06,615 --> 00:10:07,115 undergraduate, 274 00:10:07,574 --> 00:10:10,134 graduate, and the work environment all together under 275 00:10:10,134 --> 00:10:10,875 one roof. 276 00:10:11,735 --> 00:10:14,294 That's an amazing to hear. Doctor McDonald, thank 277 00:10:14,294 --> 00:10:15,495 you so much for joining us on the 278 00:10:15,495 --> 00:10:17,254 podcast today. This has been a really fun 279 00:10:17,254 --> 00:10:19,334 and informative conversation, and I look forward to 280 00:10:19,334 --> 00:10:20,794 connecting with you again soon. 281 00:10:21,219 --> 00:10:23,159 Thanks so much, Laura. Have a great day.