SCCM Resource Library-Moving Mentorship From Academic to Practical

Video Transcription

Hello, and welcome to today's webcast, A Multiprofessional Approach to Building and Retaining Teams. My name is Dawn Herman.  I'm the Associate Director of Accredited Continuing Education at the Society of Critical Care Medicine in Mount Prospect, Illinois. I'll be moderating today's webcast.  A recording of this webcast will be available within five to seven business days. To access the recording, log into mysccm.org, navigate to the My Learning tab, and click  on the Multiprofessional Approach to Building and Retaining Teams course. You'll find an evaluation and recording in the course section. Thanks for joining us.  A few housekeeping items before we get started. There will be a Q&A at the end of the presentations.  To submit your questions throughout the presentation, type into the question box located on your control panel.  Please note the disclaimer stating that the content to follow is for educational purposes only. And now I'd like to introduce you to our speakers for today.  Andrew Mabey is Executive Director, Advanced Practice Providers at Grady Health Systems in Atlanta, Georgia.  Marina Rabinovich is a Clinical Pharmacy Specialist at Grady Health System in Atlanta, Georgia,  and Barbara McLean is a Critical Care Program Specialist at Grady Health Care System in Atlanta, Georgia. And now I'd like to turn it over to Barbara to start our presentation.  Thank you very much, Dawn. And thank you to the Society of Critical Care Medicine for helping us to address this really important and timely perspective.  You might notice that all three of us are at Grady Hospital, and we all three are part of a team that's always evolving.  And I think one of our purposes today is really to talk about how we build effective teams and how we build effective teams in critical care.  You might notice that we are from different professions. Andrew is an APP, and he's the Director of the APP Service. Marina Rabinovich is our Lead Critical Care Pharmacist.  And I'm a Critical Care Clinical Specialist. I'm also a Nurse Practitioner, not practicing in that way. And we work together building effective teams within critical care.  So very important as we share our perspectives and our points of view about how we build teams to really appreciate that teamwork is more than just a statement that we've got  a great team. Teamwork isn't saying that I have a leader who dictates to all of us and we're all reporters. Teamwork is more than just coordination and communication skills.  It actually is a collaborative mindset, a collaborative methodology that creates value and respect and trust for all members of the team with equal value, equal trust, and equal  respect. And that commitment to building those effective relationships significantly and profoundly  enhances the way in which we communicate and actually can improve our quality patient care. So it is really quite important to remember that simply saying that you have a team is  not actually team building. It's a first step and it's a great step, but it's not actually the end result or the result we're all striving for.  Building a team, actual true teamwork will improve our patient outcomes. So one of the things that I'm very grateful to the Society, and I've long been working  on our language, is that when you hear the term multidisciplinary teams, we always perceive  as registered dietitians and chaplains, social workers, nurses, nurse practitioners, PharmDs, et cetera.  When we hear the word multidisciplinary, we think that means to include all of us. But typically when the word multidisciplinary is spoken, what that means is cardiology,  neurology, nephrology, pulmonology, right? You get the picture. That's why the change is to talk about multiprofessional or interprofessional teams.  Because when we say interprofessional or multiprofessional, that includes everyone, all disciplines of physician specialization and everyone who is practicing in critical care.  We have one discipline. We have one discipline that's healthcare. And for us, we have one discipline, and that's critical care.  With many professionals who participate in that practice, one goal, the care and safety of our patients.  And that's what we're here to talk about, is how we're building teams, how our teams are reflected.  And always to ask you to reflect honestly, does your expertise, diversity, and status difference, and membership of individuals who come and go because they're consultants,  all of which make an effective team? Does that organization within your practice actually benefit you as a team, or does it  hinder your team effectiveness because it's a top-down strategy or a bottom-up strategy rather than an equal collaborative methodology?  So I think one of the most important things, and I hope that's part of what you're going to learn from this today, is about changing our language from exclusion to inclusion in  order to help us provide better ways that we can communicate and that we can collaborate. It's really easy to say we do it. It's not so easy to actually do it.  And to remind ourselves that always in the end, there is a hierarchy of practice and a patient responsibility is to the person who ultimately signs the orders on the chart.  We have a way to build effective teams, effective education to share our vision, to communicate  effectively, to value all of our roles, to appreciate and understand the benefit of all of our roles.  I always really enjoy giving a quote from Dr. Mantaus from Critical Care that's really quite old, 2011, but I love one of the things that he said, and I'll just highlight that.  I mistakenly treated other team members as reporters, there to provide me with information so I could make the most of decisions.  And while this modus operandi might be expected from a just graduated trainee, eager to assert  his or her new skills and directive discretion, it simultaneously disrespects and fails to leverage the talents and energies of all of our teammates.  So I'm very happy and very proud to actually be able to just remind you that none of us is as smart as all of us.  Talent wins games, but teamwork and intelligence wins championships. And many ideas grow better when transplanted into someone else's mind.  And now I'm very honored and very happy to introduce you to one of my excellent colleagues, Andrew Mady, who is the Executive Director of Advanced Practice Providers.  Take it away, Drew. Hey, how are you guys doing today? And my title from ground zero really speaks volumes to my journey and what I'm here to  kind of talk about today, because I truly did start from ground zero, meaning I was a nurse, I was a student, a student nurse, then working with Grady, and then I was an  extern, and then I was an APP, and then I was a program director, and then an executive director, all very quickly in relative terms.  And I think that, and I think for myself, I don't even think I had an idea that this was my pathway. And actually, you know, Barbara is an amazing friend and mentor.  And actually, her idea was, it turned out to be my idea in that I was going to be a leader at Grady and help Grady start this APP program.  Now, if you don't know about Grady, it is a level one trauma center smack dab in the middle of Atlanta.  And if you know about level one trauma centers, traditionally, they rely heavily on resident workforce.  And, you know, through the progression of physician workforce and the or the lack thereof and the resident work rules that have been incorporated over the past few years, decade,  there's not as many physicians. And so, and Grady is growing as an institution. We're about to, you know, blow up to 154 more beds.  So that being said, there's just not enough residents to take care of patients. And those are unique environments to operate within. And we do have two schools of medicine here.  And I tell you all this to kind of paint the picture of complexity and interprofessional,  disciplinary, all the above relationships that you have to achieve in order to be successful. But it all starts with an idea and the rubber meets the road with the destination.  And in a hospital, we all have a destination to take care of patients. Now you have to know your audience and other people in professions have different ideas  on how to get to that destination. So I think a lot of times my job is to meet people where they're at and try to help them see or, you know, contribute to their destination.  Just like when you hit Apple Maps or Google Maps, I don't want to iOS judge people. But they give you a bunch of different ways to get to the same destination.  Maybe you don't want to take a highway. Maybe you want to avoid traffic. Maybe you want to go this direction because you want to stop at a restaurant.  So you have to know where that person's trying to go, not only where that person's trying to go, but how they're trying to get there.  I say that all to say that human capital is important as the money. And you can't just like right now, I have to hire an additional 60 APPs, right?  I got all the money in the world to hire these people. However, if nobody wants to work for this group or this institution, then it means nothing.  If I don't have physicians that make this a good place to work, it's worth nothing. Same with nursing and any other support staff.  We have to work together to make this thing achievable and believable. And when you start new services, you have to not only convince people inside your hospital,  but the people you're actually hiring to leave a storied facility potentially to come work for you.  And that is not straightforward in something that requires a lot of what I say, meeting people where they're at. And a lot of that centered around trust.  Like, you know, a lot of times when I interview people, I get 15 minutes, sometimes from a pre interview to an hour and a half to three hours when I interview them.  And I have to trust them at the end of that interview to some extent and vice versa. It's a tough job, but we all have to do it.  You know, in a hospital, we have meetings galore, but we have to not only earn the trust of people we know, but the people we're trying to get to know.  And a lot of times that I think that's undervalued because you know somebody and that's their job to turn this epic access on today because my employee, something happened with HR.  Sometimes we take those relationships for granted and you still have to be kind and meet people with where they're at in order to make things move forward.  And one thing about myself, relative fast track, right, to leadership is just because your experience or pathway doesn't look like someone else's doesn't mean you're not worthy.  You know, you got it and you always hear it and it's such a cliche and that you got to dream big.  Well, I mean, in healthcare, wherever you decide you want to work or whatever your pathway is, you do have to dream big.  Luck is where prep preparation meets opportunity, but you can't win the lottery if you don't buy a ticket. You cannot, you know, build a program if you don't first try and start it.  You can't fail something that you haven't tried. So I really, you know, I'm going here and there, but I think a lot of what this slide  talks about is ideas are built on trusting yourself and others as well as others trusting you in order to get where you need to go.  And that doesn't mean you have to be an administrator for 30 years in order to get the job. And also, and like I tell people, I would rather hire somebody who's kind and willing  to learn than somebody who knows everything and is not kind. And even as like an APP, which is a highly technical position, I would rather have somebody  who's nice and can learn the job in a few months that, you know, at least get relatively proficient in a few months than somebody who's coming in swinging and knocking down  all the dominoes that we've built as a team. And some of you may be familiar with the virtuous cycle. It's like the positive connotation to a snowball effect, right?  And so we think of a snowball effect is like things spinning out of control. It's going downhill. It's going to explode and hit somebody.  Well, a virtuous cycle is like the opposite of that, right? It's like things building in a good way.  You know, in 2018, my first six APPs arrived in June and July, three each month for different services. And now we've hired 79 advanced practice providers and I need 110, 120.  And we're hiring every, you know, every so often. And you know, there's a lot of units that I'm supposed to staff or I'm ultimately responsible  for staffing. And a lot of people in my, you know, colleagues in my field be like, how are you hiring all these people? I can't find anybody.  And I tell my staff, the reason why we're able to hire these people is because you guys build good relationships with students and colleagues and you refer them.  And luckily, Grady's name rings bells across state lines. We've been really able to attract some interesting talent.  But like I said, none of that means anything. And there is no virtuous cycle, unless that part you don't, we don't pay attention to  all the things we talked about in that first slide, because you've got to build upon something. And a lot of that is ideas and trust.  And moving on to the next slide, when we talk about maintenance and growth, is you have to grow leaders from within.  I mean, I was kind of the only person that was the leader for quite a while, for a relative good reason. My team was young, but we grew people from within.  And now I have leads and multiple leads in each department that are now becoming more proficient in managing those departments.  And not just internally, but working with physicians, medical directors, and consultants, as well as nursing leaders, and really trying to empower them to solve problems on their  own. Because as a leader, you know, you can be, you know, I always tell people, whether I'm here 80 hours a week, or 36 hours a week, or 40, or whatever, people are going to be  the same amount of upset. It's the quality of engagement that you create with each individual, each time is how successful you will be.  And there's going to be lulls, but you got to push through it with your staff, and your mentees, in order to build things and use the past to predict the future.  For instance, I'm in a situation right now where one of my teams is having some consternation with a new leader. Well, we've had the same problem in a previous department.  So using that as an example, and using patience, and saying, hey, listen, just keep engaging.  Let's figure out like, just because this person did it that way, doesn't mean you have to do it that way. But here's an example.  What's a version of this that we could instill within your department that may be helpful and meaningful for people to look at you as the leader in the department, not just  somebody who makes the schedule? So teaching frontline employees, including myself, how to be patient is very tough, but you have to lead by example.  And I think that's one way that you can build relationships too. Sometimes problems aren't going to be solved over an email, no matter how many sentences you put in it.  You have to pick up the phone, you have to set up a meeting, figure that thing out face  to face, so that you guys can move things forward. Emotional intelligence, right? As a frontline employee, I mean, a lot of, you get a lot of feedback, you get your reviews,  your annual reviews, you have nurses, people write complaints on you, you know, whether it's nursing, or RLs, or safety events associated with your name, or you hear things in staff  meetings, because I'm saying it, or the lead is saying it. But the further, I think that the further you get from the frontline, the less feedback that you actually get.  So you have to rely, what I try to teach my staff is, is you got to rely on the non-verbals.  So for instance, if you're a new employee, and you're passing, you're presenting a patient to an attending, and they're kind of looking in other directions, and they're not paying  attention, my guess is that you've probably said too much. So seek feedback out. So use the non-verbals, emotional intelligence, to really figure out, read the room, and try  and move things forward in a way that doesn't require somebody holding your hand. And luckily, if you do have somebody to mentor you and hold your hand, that's great, because  you got to have resources to feedback. Lean into uncomfortable situations. If something uncomfortable is going on, you may have to wait a bit to address it, but  write it down in your to-do list, and make sure you check that off before the week's end. You know, a physician told me, there's bad residents, and then there's residents who  have to-do lists.  And so I think that's, you know, extrapolated to our profession, too. We got to hold ourselves accountable to what we need to do for our staff.  We already talked about being genuine, and really in there about creating a balanced lifestyle and having people trust you. And that's where the benevolence comes into it.  People trust that, you know, maybe I don't understand what Drew's saying, I'm a fool, but I know he's trying to do the right thing.  I'm going to give him the benefit of the doubt, because in the past, he's shown himself to be respectful, timely, and do what he says.  So the fruits of the labor, the big picture, these are a lot of things we talked about. A lot of times, you know, hey, when I came to this institution, things were done this  way for 100 years. We have to change that view. And it's done by utilizing all the things that we just talked about. I'm running out of time, so I'm going to speed things forward.  But you've got to, we talk about engagement, not only doing it, but making it meaningful. So, you know, as a leader, you have to meet one-on-one with your direct reports.  No questions. They have to meet with their direct reports, no questions asked. But then also, you have to meet the ones you're removed from to figure out to make their voices  heard, especially somebody who's quiet, seek that person out, make them, you know, engage with them and have a conversation so that you can move things forward.  And this cannot be done without personal well-being and job satisfaction. And that goes along with creating a work-life balance.  Like what I was talking about before, you could be here 80 hours a week, and the problems are still going to be there.  You have to empower your staff, your direct reports to move things forward and give them the resources.  So, I know I've said a lot, and I've talked fast, but I know that Marina, my colleague who is next, and that is my colleague, that is somebody I work on, on many levels, and  my APPs work with her staff on many levels to make things move forward, is up next. So, Marina, I'm going to hand it off to you, and thank you so much. Thanks, Drew.  And I do remember Drew starting from ground zero, as a sick nurse, and me being a young MNQ pharmacist. So, we'll go way back.  But thanks for the leading into the My Session, and I'm going to try and talk about retention and team building from a pharmacist perspective.  The clinical pharmacy services have been around for some time, so it's not necessarily a new  concept, but with the wide variety of beneficial activities performed by critical care, clinical  pharmacists, and the benefits of pharmacists' participation on the SU team, that's been extensively reviewed and supported by published studies, and even a position statement from  several national organizations, including SCCM. However, there's still very little guidance on how the critical care clinical pharmacist role can be optimized and justified  on the interprofessional team. And the visibility of realistic success of the multi-professional  critical care team is still contingent on the support of administrators and executives. And I feel like it's definitely much, we feel it much more on the pharmacist side of  things than maybe other professions. And I'll explain why. So just some of the national pharmacy workforce transition, a little fact before I get into more of a personal experiences  and such. So as I mentioned, you know, despite the apparent benefit of clinical pharmacy  services on patient care, these types of services are not provided for all ICU patients. And as a  matter of fact, only about 70% of ICUs have direct clinical pharmacist services with, and that's with limited weekend coverage and weekday evening and night coverage.  Also clinical, critical care clinical pharmacist, pharmacy practice model is often very, often very  substantially among different ICUs. And clinical pharmacists may have numerous responsibilities,  including patient care, obviously, as well as administrative teachings, scholarly responsibilities.  And that's all coupled with relatively high pharmacist to patient ratios. So as a result,  many pharmacists report high degree of burnout and stress, which is one of the common barriers  to retention. And then just nationally, it does seem like the pharmacist vacancy and turnover  rate is increasing over the last decade or so. And the pharmacist school enrollment and number  of students or graduating students that would like to pursue postgraduate residency training  to become qualified critical care pharmacist is actually decreasing. So there's definitely  trends that, you know, may not be great. But anecdotally, in my experience, while the pharmacist  turnover rate has increased, I'd say that in within the critical care world, pharmacy world,  these trends are probably not as high. And most clinical critical care pharmacists tend to stay  in their jobs, and they're relatively satisfied with their jobs. And then they do tend to stay  in those positions for a long period of time. Just to give you a little bit of an overview of where  I came from, and how kind of Grady pharmacy services have evolved. We started our clinical  pharmacy services in 1986, with only five clinical pharmacists, with only one in the critical care  setting, the surgical ICU, since we're a level one trauma center, that seemed to be the most, the  place with highest acuity. And then obviously, emergency medicine, we grew our program to up to  35 clinical pharmacists, including outpatient services as well. So that's like, what 10  pharmacists for a decade for 10 years, so one a year or so. And really, the main ability to grow  our services was due to expansion of other services within the hospital. So we, in 2002, when we  started our critical care pharmacy residency, we had two critical care pharmacists, one in the  SICU, and one in the NICU. Now we have six. So in 2023, we have six critical care pharmacists, one  in the NICU, one in the SICU, or two in the SICU, one in the burn, one in the in the neuro, I'm  sorry, and then one in CVICU. So we grew, but our ratios remain pretty much the same, we're still  about 1 to 20, 30 patients per pharmacist, because we're, we've expanded our ICUs and number of beds,  but the degree of expanding clinical pharmacy has been much slower. The positive trend among our  pharmacy services, the retention, though, if you notice, you know, out of 35 clinical pharmacists,  we have a Grady, 22 have trained at Grady, among the critical care pharmacists, five of them trained  at Grady, and at least half of us have been at Grady for over 10 years. So there's definitely positive  trends. And a lot of it has to do with our collaboration with other professions, physicians,  nurse practitioners, nurses, dieticians, respiratory therapists, and such. So the team approach plays a  huge role in clinical pharmacists retention, critical care setting, or even all other settings as well.  But the drivers for pharmacists turnover, or intent for turnover is are still very real. And there and the  biggest struggle that clinical pharmacists have is ability to add on positions to justify positions, and  their presence on the ICU team, despite what's, you know, published in the literature and such. So because  there, it's so difficult to justify our positions and our presence on the ICU teams, there's delayed  recruitment and you know, availability of these jobs. So which adds on just extra responsibilities for the  pharmacists that are already there. So all of the responsibility that normally would be spread out among  multiple people are basically just handed over to that one pharmacist. So that kind of puts a little more  stress on there as on to the burnout. Organizational commitment is one of the other reasons is where if, you  know, is the organization accepting of the personal goals and values, which will dictate the loyalty of  that pharmacist or that employee to the organization. And then all of that will feed into job  satisfaction, which is viewed differently by many different people and professions. Overall, it's a sense of  affection an employee has for the job situation, like their environment, people they work with, relationship,  coworkers. And that's a really big one. Because again, a lot of times we as a, as a pharmacist, I will, you know, I  will tolerate the amount of work or the long hours if I'm happy with my environment, the people that I work with, the  coworkers, and so on. Career commitment is also a big one for pharmacists. As a profession, their attitude towards  their profession and motivation to work is something one of the biggest strengths that we have. But the one that's  probably the most important to us is the perceived organizational support is, which is the extent to which pharmacists  perceived that, you know, that we perceive as the pharmacist, or I perceive that the organization values my  contribution and cares about our well being. So that's where we've kind of feel like, if that's present, again, the job  satisfaction is definitely there in the work climate would be positive. So, in a way, there's a lot of pharmacy workforce model  of practice model gaps. And with the ongoing shortages of other healthcare providers, nurses, physicians, and other staff, the  pharmacist service roles may be expanding. And they will have to take on more responsibilities for education, coordinating care,  and the quality improvement activities. But as I mentioned earlier, justifying clinical pharmacy services, including critical  care remains a huge problem nationally. So there's definitely a lot of opportunity here to close some of these gaps or to optimize  pharmacy practice model in order to, for us to be able to participate in a multi professional team. And some of the reasons for why  it's difficult to justify clinical pharmacy services, is the fact that we can't build for our services, we have no universal pharmacy  practice model. So some organizations of pharmacists could be doing a lot of distribution, medication distribution activities, and on top  of patient care activities, and non patient care activities. And in other institutions, pharmacists are only responsible for patient  care and teaching and research. So it's really variable. There's not a standardized method to characterize productivity for pharmacists. And  then very limited methods to track value of pharmacists direct and indirect patient care. So some of the ways to optimize this, the  pharmacy practice model and to hopefully, in the future, increase the number of pharmacists present on the healthcare teams, multi  professional teams is to really continue to focus on the research on measurement of ICU patient outcomes, and evaluation of pharmacists  impact on those outcomes, trying to develop more of a universally accepted metric for clinical pharmacists productivity, and standardizing  pharmacist to patient ratios and staffing models. So that's a big one, there's really not a guidance as to how many patients per pharmacist is  appropriate. As I mentioned, currently, for us, we're covering about 20 to 30 patients on a given day. So, and these are ICU very high acuity  patients. Leveraging regulatory requirements and fee for service models is a big one. We've been fighting for clinician status for a while. And  that acquiring that provider status where we're actually able to bill for services would significantly improve our ability to justify our roles and  positions. And then another one that's helped us a lot is requiring clinical pharmacists on multi professional teams to meet accreditation standards.  Examples would be to get certified for burn center to be certified, they're required, there's a clinical pharmacist on the team. Same thing with  transplant. I think trauma is moving that way. So having that, this is something that we can do as a society as a team is to try to advocate for this. And I am so  fortunate and, you know, grateful to say that all of the providers that I work with have advocated for pharmacy, clinical pharmacy services from day one, and they  would go and fight for us. So this is definitely something that we're fortunate and we see happening, but there's still room for improvement there. And the next  couple slides, I know, I'm running out of time. So, but the next couple slides are really very much, to me, kind of common sense and standard of practice in the way of what to do to be able to sustain a  successful model for recruitment and retention. And from a pharmacist perspective, again, since I can only really speak on behalf of the pharmacist, for us, it's positive work environment culture. It's having that team feeling, being  valued, being appreciated and respected by the team and all the professions on the team. And creating that supportive, collegial and respectful work environment is very crucial.  Mentorship programs and professional development are extremely important in order to be able to retain and grow pharmacists and any other clinical providers. And job satisfaction, again, is very dependent on an individual, I feel like. But for us, if we do have that positive work environment and culture, the job satisfaction usually goes along with that.  And lastly, the last few things are really just, like I said, pretty standard as far as recruitment process and effective onboarding. And a work-life balance is going to be a big one because I keep going back to, we don't have any guidance to what is appropriate pharmacist to patient ratio or other provider to patient ratio.  So it's not well documented. And at some point, the burnout is real and compassion fatigue is real. So we do want to focus on the work-life balance and figuring out how to work within the organization so that we can, we're able to keep our pharmacists and retain them for a long time and not lose them to other health care organizations or industry where work-life balance is down.  So that's definitely much more flexible. So I think I'm running out of time, but I do want to thank everyone for listening in and hand it over back to Barbara.  Thank you so much, Marina. I, again, I'm going to remind everyone, I'm really grateful to be part of this team. And Marina and I have done a lot of projects together. We've been leads on, co-leads on multiple projects.  And she certainly has opened up pathways for me within the Division of Critical Care Pharmacy and really being connected to her as well as Drew opening that up with the APPs.  So I'm really going to talk about something a little bit different now, because I think one thing is we all are aware that we have recruitment retention issues, that we have an aging workforce and nursing, that we have a reduced enrollment in medical school.  I think we have a significant increase in enrollment in advanced practice provider, probably not so significant in our pharmacy programs.  But I really want to talk about how do we actually bring the rubber to the road? How do we actually bring value to our team, create trust and collegiality?  And I do believe that one of those ways is with multi-professional approach to educating our team. So when we think about that multi-professional relationship.  So the reason that we need these interprofessional education, right? Remember, is that we've got to have a point of view that is a communication point of view.  That does not mean that we are not valuing every individual's profession and that in the end, we are not saying that the person whose name goes on the order is ultimately taking responsibility.  But what we are talking about is the trust, respect and value that has to be in place for individuals to feel like they're part of a team.  Feeling like you're part of a team is a major aspect in retention. Many individuals talk about not feeling valued, which is why they've left their profession, their organization.  So a really important perspective is how do we build that team? How do we remember not to work in silos?  And when we're talking about critical care practice, very simply changing one word, not my patient or patient.  Just that simple word, which says, what are we doing today for our patient?  Changes the way individuals feel in terms of respect and trust and value and in terms of accountability and responsibility.  It's also really important because it actually helps to facilitate other team members contributions.  So really relating that to nursing. Frequently, there might be a program where we might invite physicians.  The nurses are running it or the pharmacy's are running it or the APP's are running it. It might be the perspective. What is it that they can really teach me? I'm a physician.  And granted, the education, the program is very difficult and very encompassing, but we do all have something to teach each other.  Sometimes when we have physicians teaching in a nursing course, nurses will say, why is there a physician?  Even at our national meeting, the American Association of Critical Care Nursing.  Sometimes when there's a physician on the panel, the comments will be, why is a physician teaching us?  He's teaching us because he has something to share. I'm teaching you because I have something to share. Every member of our clinical team can contribute.  And if we're embracing teamwork as a core value, we want to create a sense of safety. There's always a fear of judgment. Residents have a fear of judgment.  APP's have a fear of judgment. Pharmacists have a fear of judgment. Physicians have a fear of judgment and nurses have a fear of judgment.  What their fear might be is probably quite different. But for nurses, the fear is, what if I say something dumb or wrong?  How are people going to perceive me? Better for me to be quiet, which then decreases their value on the team and changes what the cooperation is as we move forward.  So it really changes if we think about a we, our patient. It reduces the us versus them approach that has historically been part of how we practice.  So a key for this is building trust and respect, value and communication. And there are many ways to do that. There are obviously many ways to do that.  But the way I'm talking about is really related to multi-professional education.  And by really integrating all these different types of learning and all of the different professions in their value-laden proposition.  And that when we have a day-long symposium, we have three physicians, two pharmacists, two nurses and APP.  That individuals come for the whole day from every practice. They come and stay for the whole day, which is a very silent way of communicating how we value each other's information.  And that that's a really important commitment to us. That's a lot of change. And what can it actually help us achieve?  Well, first of all, starting in schooling, multi-professional education brings our students together.  So shared med school classes with pharmacists and nurses and nurse practitioners and dieticians, etc.  We're sharing classes and that brings us together for shared learning experience and helps us to develop a collaborative methodology.  That helps us ultimately to build a safer and more patient centered and oriented health care system.  If we are actually improving that collegiality, that actually can increase morale. That can actually help us retain our experienced staff.  And it also allows us to better share all of our knowledge and our resources, our experience and understanding of our roles and work intensity.  So that there's some understanding that when a bedside nurse says, I just can't take this patient.  It's not because they don't want to do the work, but because they have two other patients on CRT and continuous IV insulin and four to six vasopressors and they're intubated and they just don't know how they can provide safe care.  So if we have a better form of communication, we can understand that we can assist each other. We can reduce some of that workload and we can increase our value of mentorship.  Now, I know there's a lot of discussion now and I think there was an article or there was a webinar coming up about the value of mentorship in critical care,  and I'm quite sure all of us feel that's a significant value. But mentorship doesn't always have to be physician to physician, nurse practitioner to nurse practitioner,  but could be a value of mentorship in all of the multiple professions and the value that that  brings us when we talk about education. I think it is really important to know that about 55% of  staff feel don't really feel comfortable speaking up even when they think that there's a problem  with patient care. That's known as psychological safety. I think if we really talk about desiring  to recruit and retain individuals as part of collaborative and functional healthcare teams,  our number one commitment from bottom up, from top down, and every way sideways, we have to build  psychologic safety. So a lot of different studies, I've listed them here. Some of them are older.  There are newer treaties that look at how we're developing our teams and how we are creating  psychological safety, but it is really important to appreciate that non-physicians oftentimes are  uncomfortable with speaking up about their concerns because they fear that they will be  belittled, because they fear blame, retaliation, punishment. 50% of nurses, this is currently,  50% of nurses report that nurse input is not well received in their units or on rounds. All right, so let's really be aware. I can't do a job without the whole team,  and you can't do a job without me as a nurse on your team. So we have to figure a way that we develop this collaborative, trustworthy communication model. One of the ways to do that  is to really create an environment where everyone's opinion is valued. If you are concerned  that the opinions are not as valuable as they could be, then we actually do multi-professional  education. But it's always an important question to ask, to ask yourself, to ask the people that  you work with. Is this environment that we have created that you're working in, is it safe from  blame or are you just surviving? And do you suffer from FOSO? Okay, so obviously I took that from  FOMO, fear of missing out, but I call it FOSO, fear of speaking up. Do our colleagues suffer  from fear of speaking out? Now we can think about simple methods to evaluate psychological safety  and asking in anonymous ways. If you make a mistake, is it not really held against you?  Do you get an RL? Do you get punished? Do you get sanctioned? Or do you sit together in a team and  say, this could have been a problem. Let's talk about how we can avoid this. Let's learn from  this problem. Let's make things better. Or does it just go to a reporting system that then may or may  not be deployed in a way that actually helps you solve problems? Are you able to bring those up?  Are you able to discuss tough issues? Do you debrief every day? Do you debrief about conflict, not just  patient care, but conflict? And do you do that in a way that's accepting? Do people on your team  reject others for being different? Is it safe to take a risk, to speak out, to speak up? Is it easy  to ask each other for help across the professions? Is it easy to ask for help? And is it clear to each  one of our team members that no one is going to act in a way that deliberately undermines another's efforts? And do I feel, physician, nurse practitioner, pharmacist, bedside nurse,  chaplain, social worker, dietician, do I feel that my unique skills and talents are valued  and utilized? So creating this is an important concept. It's really what helps us define how we're going to move forward. And so always creating a methodology that all opinions and  ideas are welcome to encourage each other, to share failures, to recognize mistakes,  utilize them to grow your team, to meet together as a team, to learn together as a team, to create  a safety zone. So by the way, it's always the leader who sets that tone. So we know that in our critical care teams, it's primarily our physicians are the leaders. Our physicians  are the leaders and they set the tone. Setting the tone means developing this strategy of trust  and respect, seeking feedback, looking for help. So I want to give you just some informal and  formal ways to make that happen. And to go back to my colleague and actually the individual who  I thought wrote so beautifully about developing teams, that strong leaders can, but don't need to dominate team discourse. Consensual leadership cultivates psychological safety.  That promotes positive transactive memories. That is a major retention benefit. So debrief  difficult patients at the end of the week. Try for the end of the shift. Give 10 minutes to discuss  and support. Talk about conflict. Talk about resolution. Don't go home at night feeling angry with another member of your team because you had discourse. Always try to debrief,  always try to debrief. Morbidity, mortality with all the teams should be involved. So when we have M&M rounds, it's a very hush hush. It's only a specific group. It's not all the  members of the team who were involved with that patient, but we can all benefit from learning and  understanding what went right, what went wrong. Daily rounds where all opinions are included and  valued and in no particular order. Not the resident first and at the end or do you have  anything to add as a nurse? Do you have anything to add? Some days maybe the nurse should be first.  Some days the nurse practitioner. Other days the pharmacist. One of our senior staff said  she was assigned a topic for a daily educational bite in the ICU during rounds. She was so nervous,  but when she did it kind of changed her the way she viewed herself and her contribution. One of  our medical students spent the day in the SICU being precepted by a senior staff nurse and he  was like at the end of the day he said I had no idea what nurses actually do and my mother was  an ICU nurse. I had no real idea. I listened to what she said, but when I lived that day  I really changed my mind about what nurses were doing. So really important to elicit these simple  bedside tools to elicit the observations of others. I'm sorry and just really encourage others to speak up to value what they've said so that there's a transactive memory  that is really significant in terms of recruitment and retention and helps us to promote that team culture. That we're all discovering this together. That we're sharing  our inquiry together. Oh the resident said I'm going to look that up and research. I'm going to  hear about what that research is. I may not always understand what's being said or maybe I understand  it fully, but the value of it is so incredibly important. That all of our team members are  encouraged to bring their latest learning to the team for consideration and statements aren't like  you just attended too many programs. You're offering this input, but it's because you went  to too many programs. No, thank you for that input. We're going to take that into consideration, but we're ultimately going to look at the reflection of all of the information. But  ultimately, of course, the decision making is on the leader and whoever that leader of the team is.  The physician, the APP, together the leader makes the ultimate decision, but all opinions are valued.  And by the way, Drew did a really nice job of reminding us that we have decades, if not centuries,  of embedded cultural hierarchy that we have to overcome. If we really believe we want to recruit  and retain teams, we have to overcome our cultural hierarchy. So again, components of this successful  team education is that we create an environment that's non-punitive, that's very safe, that everyone  feels psychologically safe to offer opinions, to offer their perspective. I might ask you something  about hemodynamics and you may view that I've stepped outside of my boundary because I'm a nurse,  but I know a lot about hemodynamics. So please value what I have to say. It doesn't mean you're  going to change your mind, but you're valuing what I'm offering and reminding ourselves that we have  some very clear and well-known decision-making procedures that actually promote transactional  memory. Things like code stroke, code sepsis, code trauma, code blue, where individuals know their  responsibility and everybody's role and responsibility is being valued. So I think again, I go  back to Mounthouse, who just reminds us that the leader is who is setting that tone. That in the  patient interest, the value of the team actually is a component that is discussed every single day.  You might assume it, you might think everyone knows it, but you have to discuss it every single day.  And then we move to more formalized system learning. That's an exposure, like exposure to  new resident orientation, having invited lectures with all professions invited to attend, and also  to present so that we have a good understanding of what we do. Having a multi-professional in your  units, a multi-professional journal club with articles that affect team practice. Why is it that  we're doing proning? What does this mean? How does that recruit the lung? How does that recruit the  nurse? How does that recruit the APP, the PharmD, and the physician? Wine and cheese outings with  article review. And then one of the things I think is really important is to look at the methodology  of the fundamentals portal. To look at the fundamentals in critical care, which by the way,  not that long ago, 1996, was for physicians only. And how that's grown to incorporate all members  of the team, both speaking and attending, and how that approach has really helped us to achieve  a better team practice. And ultimately, of course, simulation, which allows us to actually act out  our roles and responsibilities when managing our patients. So again, I've really mentioned  all these things before, just that sessions are designed and delivered by very diverse faculty  members. And that we don't actually sit on the phone texting or sleeping or leaving when a team  member is not one that you believe is equal to your level. We actually accept that everyone is  equal to our level and that everyone has something to offer. So I do want to remind you about these  stunning examples of multi-professional education, ACLS, FCCLs, and all of its children, ENLS,  from SCCM and the American College of Cardiology, building these models. And I'm going to tell you,  in 1999, I said 1996, I was the first nurse, actually, who actually was one of the first  nurses, I should say, was awarded a certificate of successful completion in the fundamentals of  critical care support course. Prior to that, you as a nurse could audit. And at that time, they wanted to give nurses a different test. And I said, we're attending the same course,  I want the same test as a physician. And I think that we need to actually offer the same test,  which of course, as you know, we do now, wasn't because of me, but because of the vision of the  society. So really important to remind ourselves that nowhere in our hospital or high functional  team is more important than in the ICU. Particularly when there's crisis, we have to know  each other, we have to trust each other, we have to respect each other, we have to have a vision  about how we're going to grow our team. Because growing a team of trust and respect and value is my belief is the number one way for us to recruit and retain our colleagues.  So learning and understanding those values is an important component of multi-professional curriculum. And we should begin it as early as possible. Creating your team. We're all  taking a risk. All of us are taking a risk all the time, but it will improve our recruitment  and retention. You heard Marina talk about it. You heard Drew talk about it. You hear your own  staff talk about it. We all want to feel valued. We all want to feel that we're contributing. We  all come to work every day, believing that we have something to offer to our patients that's  going to improve outcome. We're all trying to build trust. We need true respect, true value,  true voices. We share our learning together. We have intentional communication, intentional  inclusion, real places at the table, not affirmative action. Real places at the table, real recognition.  Because that helps us be better informed. So I'm going to close with a little statement  from somebody who I think actually has a moral and ethical imperative about building teams. And  that would be Ted Lasso. Who knew this was going to happen? He said, please do me this favor,  William, when he's speaking to his team after they've lost the championship. Lift your heads  up and look around this practice of critical care. Of course, he said football, critical care. Look  at everybody else here. I want you to be grateful because you're going through this moment with all  these other folks. And because I promise you, there's something worse out there than being sad,  and that's being alone and being sad. And there ain't no one in this critical care practice  alone. Thank you so very much. I'm going to turn it back over to Dawn. Appreciate your time and attention.  Thank you, Barbara, Andrew, and Marina for your presentations today. Please, if you have any  questions, put them in the question box and we will get those out to the faculty as they're  bringing up their cameras. I think this question can go to each of you. And so can you each kind  of from your perspectives, can you speak to some of the changes you have noticed that you can  attribute to this collaborative environment that you each spoke to? And Barbara, would you like to  go first? Can you just say the little last part, changes? Sure. So can you speak to some of the  changes you noticed that you can attribute to this collaborative environment that you have been  talking about during the past hour? Well, I would say I'll go to something that Marina, myself,  and our Chief of Endocrinology, Dr. Guillermo Impieres, worked on, and that was recognizing  that we had significant profound sentinel events with hypoglycemia with patients who were receiving  IV insulin. So with Dr. Impieres' urging, Marina and I co-led a project for tight glycemic management  utilizing insulin and using an external cloud-based software methodology that we have integrated now  into every single intensive care unit, the PACU, the OR, and our very busy emergency room which  sees somewhere between 350 and 450 patients per day. We have now reduced incidents of hypoglycemia  in patients who are on continuous IV insulin across all of those areas to less than 0.01 percent.  Okay, I want to make sure you heard me, 0.01 percent, not 1 percent, 0.01 percent. And that was something that was a really phenomenal commitment. I think I would speak for Marina  and I, we felt really honored to be together and to be mobilizing that project together and  incorporating many other people into it, but it made a huge difference in terms of patients  and it makes a huge difference in terms of teams. And if we have time at the end, I'm going to share  something else with you. Perfect. Andrew and Marina, how do you guys deal with the high  turnover and large number of inexperienced staff members? Well, I think the good news is for me,  I have not lost, I've lost one person this whole year out of my, you know, 50, 60 people, but  times haven't always been so well and it is a cycle, so I assume, you know, that could change on  a dime. Now, there was a time where we did have a decent amount of turnover and I think, you know,  actually, you know, a lot of people get those HR surveys and they kind of, you know, kind of briefly  gloss over them. Well, I specifically addressed the points in the HR survey that I felt that I  could work on, which was engaging employees in a meaningful way because they answer the question by,  you know, I'm engaged, something to that effect. So, we worked on engagement with employees  specifically through different avenues, as well as it got the leads higher at functioning at a  higher level, which also helped and I think it's really, so it's really helped with my turnover and  from a how do you hire people to keep up with it. I'm on an indefinite kind of hiring runway, so I feel like there's always somebody coming down the pipeline. So, if  people want to see light at the end of the tunnel and they'll kind of help you through the  rough patches if they know there's something on the other end. So, you as a leader, you always  have to stay ahead of the curve and try and find a way to do that, even when it's not there. And Marina, do you have any additional thoughts on that question?  Sure, yeah. I'm kind of like similar to Drew. Fortunately, I haven't had a lot of turnover in the clinical pharmacy department, in the critical care department. If anything, we're  having a hard time keeping, we'd love to keep our people that we train. So, we train our residents  in a way that we'd want them to be impactful and effective members of a multi-professional team and  we put a lot of effort and time into them and we'd love to keep them so that we could expand  services on different teams. And like I mentioned in my talk, that we just have a hard time  being able to justify extra positions. So, for me, that's more of a struggle  as far as being qualified and the turnover, what we see more of is on our pharmacy  technician level, where we really have a hard time keeping our pharmacy taxed. And that really  affects our ability to provide effective care to patients down the line. So, it is still a struggle.  So, yeah, clinical pharmacy is great. We do have low turnover, but if we can't deliver  medications from point A to point B in a timely manner, in the correct way, then we're not going  to be able to provide optimal patient care. So, right now, our focus is mostly on retaining recruitment of qualified staff and retaining them or creating positive culture, creating  mentorship programs for them and kind of training, maybe career advancement opportunities and letters where they can kind of see some potential and have developed more of a  commitment and loyalty to their organization as well. So, those are the things where we would work  to focus on. And so, this concludes, unfortunately, we're running a little over time today.  So, this concludes our Q&A. And again, I'd like to thank Barbara, Andrew and Marina and thank the  audience for attending. Again, we did record this webcast. The recording will be available  for registered attendees within five to seven business days. To access the recording, log into  mysccm.org, navigate to the My Learning tab and click on the multi-professional approach  to building and retaining teams course. You'll find the evaluation recording in the course section.  Please join us for our next LEAD webcast on August 18th at 1 p.m. Central Time. And also,  be sure to check out the LEAD podcast on our website listed here. This concludes our presentation for today and thank you again for everyone for joining us and have a great weekend.  Thank you for the society. We all are really grateful that we were invited. Thank you so much.

Video Summary

The webcast was titled "A Multiprofessional Approach to Building and Retaining Teams." The speakers included Barbara McLean, a Critical Care Program Specialist, Andrew Mabey, Executive Director of Advanced Practice Providers, and Marina Rabinovich, a Clinical Pharmacy Specialist. They discussed the importance of teamwork and collaboration in healthcare settings, particularly in critical care.<br /><br />The speakers emphasized the need to create a collaborative mindset, where all team members feel valued, respected, and trusted. They stressed that building effective teams requires more than just coordination and communication skills. It requires a commitment to creating a collaborative environment that enhances patient care.<br /><br />They also discussed the challenges of recruiting and retaining staff, particularly in critical care, where turnover rates can be high. They highlighted the importance of creating a positive work environment, providing mentorship and professional development opportunities, and promoting work-life balance.<br /><br />The speakers also emphasized the role of multi-professional education in fostering collaboration and teamwork. They discussed the importance of bringing together professionals from different disciplines to learn from each other and value each other's perspectives.<br /><br />They shared examples of successful multi-professional education programs and highlighted the benefits of such programs, including improved patient outcomes, increased morale, and better utilization of resources.<br /><br />Overall, the speakers stressed the importance of creating a collaborative and inclusive environment in healthcare settings to build and retain effective teams. They emphasized the value of communication, trust, and mutual respect in enhancing patient care and improving staff satisfaction.

Asset Subtitle

Professional Development and Education, 2023

Asset Caption

Mentorship within critical care is essential for the transfer of specialized knowledge and expertise. Critical care practitioners require mentorship to acquire not only technical skills but also clinical decision-making abilities that come with experience. Developed by SCCM’s Leadership, Empowerment, and Development (LEAD) Program, this webcast:
Describes the roles of mentors and mentees in formalized mentor-mentee relationships
Discusses methods to individualize mentorship based on the goals and experience of the mentee
Reviews ways to adapt the mentor-mentee relationship as a mentee transitions from training to clinical practice
1 hour of free accredited continuing education credit is available for this webcast through August 31, 2024. Visit sccm.org/store for details.

Meta Tag

Content Type Webcast

Knowledge Area Professional Development and Education

Membership Level Professional

Membership Level Select

Tag Leadership Empowerment and Development LEAD

Year 2023

Keywords

Multiprofessional Approach

Building Teams

Retaining Teams

Teamwork in Healthcare

Collaboration in Critical Care

Collaborative Mindset

Effective Team Building

Recruiting and Retaining Staff

Positive Work Environment

Multi-professional Education

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