Rebecca:
And what I say about COVID is that it’s finally proving that innovation is needed in moments of crisis. The way we’ve done business has to stop. And if there’s ever a time for nurses to come out stronger, it’s during this pandemic where we can finally own the innovations that we have put in place to save patients’ lives.

Nacole:
It’s our season finale, everyone, and you just heard from Rebecca Love. Rebecca made me see myself in a new way, as an innovator. Those 27 workarounds I do every shift? They matter. Those 27 workarounds you do on your shift? They matter too. I came out of this conversation believing that nursing is full of potential and possibility. We’ve proven it during COVID. We’ve proven that we can make the shift.

Nacole:
My name is Nacole Riccaboni. I’m a critical care nurse working in Florida and your host for SHIFT Talk. Just a couple of housekeeping notes, and we’re going to jump right in. This podcast is brought to you by SHIFT, a new community for nurses ready to make a change. SHIFT is sponsored by the Robert Wood Johnson Foundation. My interview with Rebecca was recorded in mid-July, keep that in mind, as things with COVID might have changed. Let’s dig in.

Rebecca:
Nacole, it’s such a pleasure to be here with you, and thanks for taking the time. And nurse innovation history, with regards to having it documented, really was something that has never been done until recent years. And I think the best way that I can highlight this for you is that Johnson and Johnson has been a big proponent of Nurse Innovation. And I got to know them when we launched the program that we built, the first Nurse Innovation and Entrepreneurship program over at Northeastern back in 2016. And J and J came to us around 2017 and said, Hey, you know what? We’re looking to pivot our 15-year campaign of like thanking nurses to something different. Because although it’s had some success about driving nurses into nursing and helping with retention, you know that statistics are still really struggling right now. Like 50% of our new grads leave the bedside within two years of practice.

Nacole:
That’s so true.

Rebecca:
It’s ridiculous. It’s ridiculous. And so they knew the messaging wasn’t working. And so what they came across was the program, and the whole idea of it was what is Nurse Innovation, which is really how has nursing throughout healthcare really transformed the business of healthcare, but also the impact that nurses have had on patients’ care? So J and J, after finding our program, started to study the history of nurse innovation, and what they couldn’t find were any of these stories. So they hired an expert in the deep web to get out there and had to go and search and pull these stories that had never been documented. So I don’t know about you, Nacole, but when I was in nursing school, the only nurse people ever talked about really was Florence Nightingale. Right?

Nacole:
Yeah. And that was kind of it. You heard about anybody else after that.

Rebecca:
You never did. And it was like, okay, so she made this 200 years ago, and really nothing historic has ever happened since in our profession.

Nacole:
Nothing has ever happened that’s important, ever since her. For sure, yeah.

Rebecca:
Which is ridiculous, because you know that’s not true, but that’s what happened in nursing. Nobody ever documented our impact. And so when they went back and they hired this deep web developer to go in and search and find these stories, then they started to come out. On the nurses of how they treated polio, the expression of how they found out that sunlight was so important to newborns, to prevent jaundice. This was all led and discovered by nursing. And nobody had captured those stories.

Nacole:
Oh, I didn’t know that.

Rebecca:
Yeah, it’s amazing. There’s these amazing things and impact that we had. The entire treatment of how we treated HIV patients, in terms of not locking them away into rooms and not have anybody touch them, really was led by nurses to transform that. And then also, I don’t know if you know of Fatu Kekula, who came out of the Ebola crisis, but she was a nurse student right on the front lines of Ebola, her family contracted Ebola, everybody was very sick. She created the infection protocols, so that she could care for all of these people who were coming down with it, with garbage bags and duct tape. Like, it’s just remarkable. what nurses have done.

Nacole:
Wow that’s so crafty.

Rebecca:
Yeah. You’re going to love her. One day, I’m going to have to connect the two of you guys. But the whole idea is like that we’ve had all these impacts, but nobody ever documented them. We as nurses never thought to say, Hey, stand up and get credit for the impact that we had on healthcare. And that’s the idea of what Nurse Innovation is about, is how do we start documenting a legacy of nursing that’s had an impact, so that we can empower the profession to be seen as more than what we are, which right now, a lot of us, you can speak to Nacole, sort of feel like we’re, you know, sort of plugged in this play that we’re a support system. We sort of are the calvary, but not necessarily the leaders in healthcare. And that fundamentally, I think, needs to change.

Nacole:
Oh, for sure. I didn’t even know all about those stories. That’s really great.

Rebecca:
Well, and I think, you know, you probably, I mean, you’re, you’re on the front lines yourself and you’re seeing it every day, right? Like how many times have we been at the bedside, that we’ve MacGyvered a solution, that you knew if we could scale it, we’d save thousands of peoples of lives, right? Like, but we’re told often like, Hey, that’s great, but just sort of stay in your lane. And you have a job where tasks — we’re given a lot of tasks to do. And that, to me, is what frustrates me the most about nursing. We come up with these great solutions, we come up with these great ideas, but largely our job is given to us to accomplish tasks. And if we accomplish those tasks, it’s great. But at the same time, there’s no way to sort of change that process in any kind of real systematic way.

Nacole:
Now you mentioned workarounds. Do you consider workarounds to be viewed as a good thing? And are they recognized as nursing innovations? Yes or no?

Rebecca:
So I love workarounds. But you and I know that workarounds in healthcare, especially by nurses, are considered a bad thing.

Nacole:
I know.

Rebecca:
It’s like, one of those terrible things. We are told two things as nurses, right? We’re told to do two things to make sure that we never do — which is one, you never want to harm a patient, and two, we never want to kill a patient. Right?

Nacole:
For sure.

Rebecca:
Yeah. So you’re petrified to do anything differently. So we follow protocol, we follow procedure, but then we realize, most of this protocol, most of the procedure, a lot of these machines that we’re working with, were never designed to actually do what we need them to do more efficiently. So we create a workaround to manage that system. And what happens is, unlike places like Google or Amazon, where workarounds are like, Oh my gosh, that’s a better user experience. You get a promotion! We’re sort of slapped on the hand, because we went outside of the protocol. But what happens is, is that many of these systems were implemented, and they create more work for us as opposed to less. And the only way we can manage our job is to get everything done that we need to do, all of those tasks are assigned, we’ve learned as nurses to be really good at working around. I don’t know if you know this statistic, but an average nurse does about 27 workarounds per shift, which is insanity.

Nacole:
Yeah I believe it.

Rebecca:
Insanity.

Nacole:
There’s so many tasks that you have to do. You have to find a way of getting this all accomplished in a certain time frame. So the workarounds are kind of what get you where you need to be. But no one ever asked nurses like, is this feasible? Is this going to work?

Rebecca:
Yes. And so when it does, we all sort of throw up our hands and say, you know what? This just doesn’t work right for us. And you think about how much lost efficiency and time and resources, that if they had stopped and asked the nurses from the beginning, like how much more impact or how much better that product could have been to driving the outcomes. And I know it’s a convoluted system. I understand that a lot is really put between medical device manufacturers and hospital systems. And there’s a whole challenge on IP and all of this stuff. But the reality is, what’s been missing in this link for a very long time, is the engagement with nurses on the front lines so that they can create the solutions to the problems they’re seeing that will eventually, and in all honesty, save patient’s lives.

Nacole:
Even at my own institution, there are times where they kind of implement a new protocol or a system. It’ll be out, and about two weeks later, a nurse has a way of it working in their favor. I just don’t understand why they don’t ask the nurses, Is this feasible or doable? Before they implement a protocol. I mean, they’re the ones that are initiating the service, are doing the work. They should be a part of the kind of implementation and the protocol creative process, in my opinion.

Rebecca:
I totally agree. And do you know what? I think for the first time ever in the history of nursing, so we started sort of the program of Nurse Innovation back in 2015, simply on an idea. I had started a company, and a friend of mine said, Rebecca, you need to go to a hackathon. And at that time I had no idea, like many of us in nursing, what a hackathon was, but it was being held at a major medical school. And largely just to give you a little bit of background, it’s a three day event where people come together, pose problems and create solutions. It’s awesome. I showed up at this event, and I remember walking around the room, and it was filled with medical students and doctors and engineers and scientists and the CEO of the hospital.

Nacole:
Oh fancy.

Rebecca:
That was my response. And I kept walking around the room like, Oh my gosh, where’s the nurses? And I realized there were no nurses in that room. And to that point, like, what you just said, it’s fancy, and it was intimidating. I thought to myself, Oh, this is, this is where the decision makers are. I’m not supposed to be here as a nurse. And so, I think we’ve been there a lot, but my experience in that weekend was that the door would open and in would walk – So you get these mentors, and they come into the room, and they walk in and they ask you questions about your problem and your solution fit. And all these heads of hospitals, the head of all these cool startups or major companies would walk in. And they said, okay, well, we’ll just get the nurses to do it. And I would be like, well, actually it doesn’t work that way.

Nacole:
It doesn’t work that way, it’s not doable.

Rebecca:
And they’d say, well, Rebecca, why not? And in the course that weekend, more people asked me my opinion and were like, Oh my gosh, I never knew this. Like the CEO of the hospitals. Like I had never, never knew that this is how it worked on the floor. And what I learned was that nurses had such relevant and valuable information, that if they were exposed to those kinds of events, what could that mean for the future of healthcare? And that’s when the whole initiative kicked off, that I knew I had to have a nurse hackathon. And my life changed because I just held onto that vision and finally found — after just probably like you, Nacole, being turned down, doors slammed in my face phone calls hung up on — finally found somebody who said, I love this idea and why don’t you run one. And that was the beginning. That was the beginning in 2016, 2015. Nobody, if you look back historically, nobody was talking back about nurse innovators or entrepreneurship, really back in 2015, maybe less than a handful of articles mentioned those three words in the same article, but really none in the same sentence. So it’s been an interesting path since 2016 to 2020, where we have seen rapid change in this space, with directors of innovation being appointed. The first one, Hiyam Nadel, in the history of Massachusetts General Hospital. Nancy Albert, over at Cleveland Clinic, who’s now the Chief Nursing Officer of Research and Innovation at Cleveland Clinic. There’s new titles coming forward, and incredible healthcare systems that didn’t exist before.

Nacole:
Now, are you seeing more nurses at the hackathons that you’ve kind of been in attendance?

Rebecca:
So Nacole, as you know, right now our whole life is COVID, right? So we did something pretty remarkable, I think. The week after Nurse’s Week in May, I went to Johnson and Johnson, and I went to Microsoft and I said, We need to do a hackathon for nurses on the front lines. Because all I’m hearing about is how the technology, the programming, everything that’s setting up, that we used to operate in, is not working for us at the bedside. And they came forward, and in the course of four weeks, we pulled together a global hackathon that we had over a thousand participants register. What was remarkable about that? Even with Microsoft’s support, about 70% of our registrants were nurses. They came from all over the world. And so they leaned in, and you would just have been blown away by the solutions that they came up with. Everything from dealing with COVID within schools and tracking systems that they wanted to put forward, to the situations of the ICUs and the nurses and the being no family in the centers, so that you could actually have programming in place so that families could talk to patients without a nurse having to stand there and use a cell phone, to everything from data management, they just tackled problems that we didn’t even know existed, that they were facing at the front lines.

Nacole:
Because if you’re not on the front lines, you don’t really know the barriers that these nurses face each and every shift. You have to have someone that’s kind of in the trenches to explain to you kind of what those barriers are and to give you those kinds of opportunities to find out what’s working for their group and their community.

Rebecca:
And you see it right? Like I’m sure that, you know, as you’re experiencing this, the reality is it’s that entire blockade of where comes the bottlenecks. People assume they know what our job is. People assume they understand what the biggest challenges are, but I’ll give you an example. Our first, we ran a hackathon with J and J back in, November of 2019. And J and J was really nervous if we didn’t give sort of structured areas. And I said, you know what? I really want this to be as open. I want nurses to show up with as many problems as they did. So what happens at a hackathon is the first night, people stand up and they pose the problem that they’re facing. They don’t have a solution, but they know this is a problem. So here is a nurse who stands up and says, Hey, I work night shifts. And I can’t see anything. The only way I can see things is when I turn on the light and wake up the patient.

Nacole:
That is so true. I work night shifts. It’s like, you have to have, like, a flashlight on you all the time.

Rebecca:
So that is exactly like what we realized. If we had put the guard rails up, we would never have realized that 50% of every nursing shift is spent in the dark. So this team came up with a solution on creating this new kind of portable device that nurses could wear that’s bright enough to focus with, they can see on them. They called the team Night Vision. They’re total rock stars and have totally come up with this idea over the course of the weekend. They’re one of the few people that came out of a hackathon, turned it over and actually have started a business in it. And it’s this team of rockstar nurses. They don’t live by each other, they didn’t know each other, they live on opposite ends of the country, but they are solving the problem that faces 50% of us every single day. And we would never have known that if they had, I mean, talk about a problem that is glaring us in the face. Nurses are working in the dark, they can’t see, can we come up with a better solution?

Nacole:
I worked night shift for six years and I just, my husband’s like, you always have five flashlights. I was like, I have to have them. Because you don’t want to turn the light on to wake the patient up, but you have to see your pumps. You have to see what’s going on. That is amazing.

Rebecca:
So these are the things that hackathons come up with, these pain points that you’re like, Oh my God, did we really miss that? Did we really? Have the nurses really been working in the dark since the existence of time. And we’d never thought to come up with a better solution than turning on the light switch.

Nacole:
I remember starting my shift and everyone was like, do you have flashlight? So now we all carry them everywhere. But that is a great thing that you can just bring a problem. That would be my only apprehension if I went, where I would have to have a solution. But if you’re saying you can come with a problem only and work it out there, that is amazing.

Rebecca:
That’s what it is. And this is, it’s just to experience… Why I love hackathons is they’re so empowering. You come in here and you get to pose — So if your problem is exactly like what you’re saying, you know, working in the dark or doing these things. You come with the problem that’s driving you crazy. You don’t have the solution. You form a team with all of these people. And through the course of 56 hours, you come up with a solution. And you feel like you can change the world. And I think that’s why I love hackathons.

Nacole:
They are changing the world!

Rebecca:
They do, they do.

Nacole:
That is amazing. I mean, there’s so many gripes and issues nurses have, if we could all come together as a team and get these solutions, and this is a great, great, great platform for that. What a good idea.

Rebecca:
Well, you know what? I mean, I didn’t come up with hackathons, right? You can think Google and Amazon for that. But for one reason that we never used them in healthcare and they didn’t think to invite nurses. That’s, I just connected the dots. I think in life, that’s just what I do, is just connect dots. Like how can we make nurses get access to the things and the resources they need that nobody ever thought to connect them with? And that drives me insane, from a perspective of what our profession is about. Because we as nurses, never, if you want to change healthcare, you want to save patient’s life, you should engage with nurses. Because there’s nobody out there with like truer intentions. Our whole life as nurses, it’s about putting the patient first. If you want to save health care, you want to change it, you should be engaging with nurses every step of the way. And that’s what Nurse Innovation is about. But for a lot, people are like, Oh, nurses. Like I think, and you tell me this, Nacole, but what drives me crazy is we as a profession constantly say, Hey, we’re just a nurse. We downplay what we do.

Nacole:
Yes we do. We downplay our skill set all the time. All the time.

Rebecca:
If we don’t start changing that dynamic? We’ve almost turned nurse into itself as an adjective. It just sort of describes what we do, but it doesn’t. Because I think we need to start showing to the world that what we do is we have knowledge, expertise, and incredible skill sets that accomplish more to transform healthcare and to really manage the most complex situations in any healthcare system. Because we have that 360 view. We understand administration, we understand the bedside, we understand the technology. That the truth is we’re not necessarily an expert in any one domain, except that we’re an expert of understanding where all of those systems fit. And that has never been quantified for value. And I think that’s, fundamentally, we know that healthcare is a business. And because we, as nurses, can’t charge for any of our activities, that it’s basically billed, you know, to the physician who bills for our services. Because it is the business of healthcare, nurses historically have been seen as a cost structure to healthcare systems, which means that we get hit with the first cuts, the first lack of resources, because we are seen as a cost structure, not as a revenue maker for healthcare systems, and why we fundamentally are blocked with so many of the things that we try to take forward to do transformation.

Nacole:
I completely agree with that. That’s so true. So well said. Now, in terms of that structure, in terms of nursing innovation, do you feel that the COVID process, the thing that these nurses are going through, these workarounds are being recognized as a good thing or a bad thing?

Rebecca:
So COVID, as terrible as it is to the world, there has been something in some of the leading healthcare systems that I never thought would happen. And I’m hearing from girlfriends of mine, from chief nursing officers from around the country. What we know in COVID is that everything that we thought we knew about respiratory illnesses or disease and infection control has largely been wrong, right? Like all those protocols and processes that we had in place, we’ve had to throw out the window with COVID because they weren’t working. And I’m talking about simple things, like that that we used to put patients in high fowler’s to help increase oxygenation. And now, we’re proning them on their stomach to breathe. This is counter to everything we used to do. So there’s a whole bunch of such examples along these situations, but what has been fundamentally also different is, nursing leaders are telling me that these collaborative teams, so they started to bring in physicians and nurses and OTs and PTs and everything to collaborate. And I’m hearing from these nursing administrators that their physician colleagues are saying, Oh my gosh, the nurses have such knowledge. Like I had no idea that this was a barrier. Like if I asked to do this kind of protocol this way, or this hang, this kind of medication at this point that they would not, that it would complicate their workflow, and that they came up with these better solutions to actually creating answers to some of these really big barriers. Their insights were so valuable that suddenly things are changing. And for the first time, and sort of to go back to that J and J example. J and J decided to run another campaign, right, to document, to create another video about nurses on the frontline during COVID and this innovation. Where three years ago, they had to hire an expert in the deep web, what Linda Benton told me was actually, they just did a simple Google search. And this time, nurse innovation started to pop up everywhere. Like for the first time ever, I received an email from like Cleveland Clinic who said, Look at what our nurses came up with. This is how they created extended tubing, so that you could put IV pumps. Stanford Healthcare just came out, and because of COVID, Stanford Healthcare just created entire nursing innovation center because of COVID. Because they saw the impact that nurses were leading.

Nacole:
Now in the whole kind of post-COVID kind of era, how could we make it normal to acknowledge nurse’s contributions in terms of patient care?

Rebecca:
The truth is, is that it’s all about creating a system that does things differently to recognize nurses in a process. And I don’t know if you’re aware of this, but one of the biggest challenges that we faced is always in healthcare systems. Physicians always had, they always had these contracts in place, that if a physician developed something, the hospital would create a collaborative IP contract with them to help them develop their idea. None of this existed for nursing. And so I can tell you, I have all of these nurses who came up with ideas. One of the examples came from one of our first hackathons. She developed a new form of a Luer lock that, I don’t know what the, over the course of the weekend, what she was, she was this IV nurse. And she realized that the Luer lock kept coming undone in pediatric patients, because it had only been designed for adults, right? She had had almost all these near misses of babies and young children almost bleeding out because the Luer lock started coming out of place. So over the course of the weekend, she re-hacked the Luer lock. And what we found out is that patent hadn’t actually been touched since 1916. So a hundred years ago that patent hadn’t been addressed right? So she goes to her nursing manager, she goes to the chief nursing officer, like I’m going to develop this. They’re all like, fabulous, good luck, go do it. They, she gets a story in the Boston Globe, and suddenly she gets a letter from her healthcare system, like we own the IP of that idea. So any system that you work for, even though they say this, they basically have this contract in place that says, Hey, it’s our idea. If you come up with this idea from the experience beyond the front lines, we technically own it. Now, they had always had processes in place like this for physicians, but they never thought to say, Oh, well, maybe nurses have some good ideas, until this happened. So I think fundamentally one of the first things that we got to do is we got to start recognizing that nurses are probably going to come up with some great solutions and similar kind of programs have to be put in place. So how do we protect that? And then two, what’s the biggest challenge for me when I was dealing with this, when I started to talk about innovation or entrepreneurship, I was starting my company. I felt like I had, was thrown out of the nursing profession. The way that nursing was built, and the way that it had the institutions that exist, have a very specific definition of what nursing should be in my opinion. It’s like academia, become a nurse practitioner, publish and do nursing research. And that’s what you’re defined in, in this model.

Nacole:
And that’s kind of, yeah, you only have about four or five lanes to pick from.

Rebecca:
You do. And so when you go outside of that, they weren’t really supportive of saying, Oh, wait, you have this idea, or you want to start a company or you want to do X, Y, and Z. And so I think what happened was after I transitioned on from Northeastern, I went for a walk. And in those two years that I was at Northeastern, I got to start meeting nurses that I had never heard of. Did you, for example, like Molly McCarthy, she’s the Chief Nursing Officer of Microsoft. Did you even know Microsoft had a Chief Nursing Officer?

Nacole:
I did not. And in what context? That’s amazing. I did not know that.

Rebecca:
No, not only does Microsoft have a CNO, but so does IBM. Right? And then also, so does Medtronic. And so do all of these companies that exist out there. Nurses have these rockstar positions. Like I have two nurses that are senior directors at Deloitte as consultants, these roles that I never knew of. And what I started to learn was all these nurses stopped identifying as nurses because — not Microsoft and those that actually got a chief nursing officer title — but all these nurses who had sort of left that traditional path, went out there and started creating it. But I had met all of them. And that’s why it came to me that I needed to start a nursing society that sort of supports others that walked on a different path, but they’re measured by their peers based on the impact that they’ve made. I don’t care what your degree is. I don’t care what background you have, but if you just have made an impact, then we want you part of our tribe, because we’re about action. I’m tired of policy. Like I’m tired of nurses only owning policy, and that never gets adopted. I want to own action.

Nacole:
It never gets adopted. They have all these great ideas. They have all these binders, they have great presentations, but it never gets facilitated into something actionable, and that’s so sad.

Rebecca:
You got it. And they only talk to each other.

Nacole:
And, you know, they have the support of their community, but it never gets turned into anything. And that can be really disappointing.

Rebecca:
It is. And that’s, to me where we have created this hierarchy within nursing, that we talk to each other, but what we’ve done a really poor job of is talking to the rest of the world about what the value of nurses brings. So SONSIEL is all about that. It’s all about representing these nurses, these rock star nurses who walked on the edge of life, didn’t follow the traditional path, and the impacts that they’re making. And one of the examples of that is we wrote a book. And this publisher had come to me and said, Rebecca, write a book about yourself. And I’m like, how boring. Nobody wants a story of myself.

Nacole:
It’s not going to be boring.

Rebecca:
So boring. But I was like, let’s write a story of, can I get all these nurses who walked the life differently? And they’re like, Rebecca, that’s like, you know, that’s too many. We’ve never worked with that many authors. And I was like, just give me a chance. So I send a message to all of these nurses that I know in the world. And I said, look, I want to put together a story about your book, three to five pages, tell your life story of what you wish you told yourself 20 years ago. So in the course of three months, we collected 47 stories, and the publisher published the book. It’s the Rebel Nurse Handbook. And it’s all of these stories of these nurses that just had life differently. And it’s just, they make you laugh. They make you cry. And we have associate degree nurses. We have, you know, we have nurses…

Nacole:
I love that. I’ve learned so much from different levels of nursing. Oh, that’s so great.

Rebecca:
Yes. So that’s, I think Nacole, like what, you know, you have, I mean, you’re the definition of a nurse who has seen life differently and who has done nursing differently and done it incredibly well. What you’ve done to represent and create a voice in a space. None of us were taught that in nursing. So when you hear, like, what can you tell from, you know, you’ve lived this, so what, what things have you done that you just knew you had to do? And even though most people would have told you not to do it. And I think that’s how, I’ve lived my life. Like what, what were those for you?

Nacole:
When I’m always scared to do something, or I have butterflies in my stomach, that’s just my personal kind of signal to just keep going. Cause you have to be uncomfortable to get anything done that’s progressive and new. You’re going to be uncomfortable. It’s going to be something that you’re going to second guess yourself constantly. And as long as you have a good support system and great mentors and professional organizations, like the one that you mentioned that you were a part of, you’re going to be okay.

Rebecca:
And so what was your first jump? Like what was your first jump where you had those butterflies, And everybody around you seemed to point you in that other direction, all the no’s, all the This isn’t gonna work, where was it that you just made your first leap?

Nacole:
Oh, when I was in graduate school, I was kind of doing my kind of nurse practitioner progression. And I wanted to open up a homeless clinic, and I’m kind of in the process of kind of working out the ins and outs of that. But everyone was like, Yeah, but you’re a nurse practitioner, you know, you’re just going to, you know, work at a hospital. You’re doing acute care. Just kind of stay in that lane and keep doing that. Why are you stepping over to this business side and doing this other stuff? And I said, well, I’m going to get my MBA. And they’re like, but why you’re a nurse or you’re, you’re doing too much. You have your fingers in too many things. Because again, if you’re a nurse, you’re just a nurse. You shouldn’t be doing or focusing on anything else other than that. And I just felt like, well, I don’t consider that to be an inappropriate kind of, antithesis of what I consider a nurse to be. We take care of many people, not necessarily only in the hospital. And I just kept thinking that way. Like I want to help people in general, not just people in the hospital or people in clinics, I want to help everyone. And how can I do that?

Rebecca:
I love that I have always felt, and people ask me, Rebecca, what’s the one thing that somebody would have told you before? And I said, I wish somebody would have stopped me after I became a nurse and said, you should have gone and got an MBA.

Nacole:
Oh really?

Rebecca:
I actually wrote an article MSN versus MBA, because fundamentally I think that an RN with an MBA degree is an unstoppable degree. I completely agree. It is the only degree in my opinion, that broke down the walls between male and female in work environments. And it is the degree that is breaking down, nursing’s vertical within a healthcare. Once you get that MBA degree, and I hear this. So Hiyam Nadel, who I had mentioned before, who’s now the first Director of Innovation ever in the history of Massachusetts General Hospital to oversee the nurse innovation. She said to me, Until I got my MBA, she said, I had all the same ideas, but once I got my MBA, everybody’s like, That is so smart.

Nacole:
You’re able to articulate your ideas on a different level. I don’t even know how to explain it, but people listen to you more because you’re able to use, I guess, their jargon and articulate the idea on a level that they can understand.

Rebecca:
Exactly. And so what I always say is what we miss in nursing school — healthcare is the business, and what we are taught in nursing schools, we are taught empathy and we are taught, I think, I feel, I believe. When you get an MBA, you’re taught finance, strategy, and operations. So when you go in, and what me crazy as a nurse before I started my own company and learning what this meant was, and going to a hackathon and realizing I had to show a financial impact, which had never been taught to me anywhere in nursing school. So I would go to my boss and I would say, I really feel that if we made this change, we’d save patient’s lives, or it would help with surgery. And they’d say, That’s great that you feel that way. I’d be like no, no. I really think, I really believe it. I don’t know what else to say. And then, so I don’t know if you were ever in those boats, but that drove me crazy. Cause you would fundamentally… And I was taught as a nurse, that’s all I needed. Use your nursing intuition, use it, listen to it. I would go and tell them my nurse intuition and radar bells are going off like rock stars. But just to your point, I didn’t know the jargon. And what I should have said was, The truth is, is if we operationalize the procedure this way, we’re going to save this many minutes in the OR that’s going to translate to this kind of revenue, because I’m going to get six more patients into the OR every day, driving the financial bottom line into the OR. Nobody ever taught us this. And the truth is how are we going to advance as a profession, if we can’t even speak the language of what we’re doing, if it’s coming down to dollars? So I hear from people like, Hey, Rebecca, you know, not everybody is an innovator and not everybody is an entrepreneur that’s a nurse. And I think everybody inherently, I go back and I push back. They are, they want to make it better.

Nacole:
I think it’s inside them. They just haven’t unlocked that part of their personality quite yet.

Rebecca:
Yes. And I say, you know what? To me, the definition of an innovator, an entrepreneur, is somebody who just wants to make something better. Every person in history, when you look at innovation and it comes at this moment, and it’s happening now, right? Like COVID is a catalyst for huge change and huge innovation happening. And we see this throughout history. And what I say about COVID is that it’s finally proving that innovation is needed in moments of crisis. Research and the way we’ve done business has to stop. And if there’s ever a time for nurses to come out stronger, it’s during this pandemic where we can finally own the innovations that we have put in place to save patients’ lives. And also, as you’re hearing, and you’re seeing on the front lines, for rightly or wrongly nurses are finally saying, go practice at the top of your license. And we’re the ones the only ones being sent into the patients’ rooms, right? Like the doctors and the medical students, they’re staying in the hallways, and they’re saying, Hey, that’s because we believe in your full scope of practice, go practice.

Nacole:
They’re like, Do that thing. Go ahead.

Rebecca:
Go ahead and go on in there. You got it. We support that.

Nacole:
You got it.

Rebecca:
And I think we need to make sure that past COVID we still own that. And we sit there and say, if it was good enough for us during COVID, because you guys didn’t want to cross the threshold and gave us the right to practice, it’s not only good enough, it’s time to build on it. So that’s exactly some of those things.

Nacole:
Now, what is your vision for the future of nursing?

Rebecca:
So I look at the world, and it’s sort of like, I see it, it’s sort of like this globe of like clear jello, it’s a mold, like it already exists. And I’m just trying to pivot it to refract and sort of send some rainbows in there. Cause I know that I’m not going to be able to change it all. I’m not going to be able to give the voice and elevate the profession all by myself or with all these other nurses around us, because it’s going to take more than that. But the vision that I see is connecting with people like you, and others who recognize that the definition of what nursing was does not have to be what it is going forward. And I fundamentally believe that the 200 years behind us in a sense sort of defined us, but that the 200 years going forward, if we don’t redefine what this profession looks like, I don’t know if anybody’s going to choose our profession. As we mentioned before, you know, 50% of our new grads are leaving the bedside within two years of practice. It’s the largest exodus of any profession in the world. And nobody talks about it. Why are we burning out? We just always assume there’s going to be more nurses. I don’t think that’s true. I don’t know if I’m going to tell my daughter that she should go and become a nurse. And I know you have two babies at home as well. Like, are we going to tell them that they should be nurses? My mother told me to be a nurse, and that’s why I became a nurse. And the reality is, now that I’ve lived the experience of nursing now, I’ve had a lot of success. I think I’ve broken down and gone a different path, and I love what I do and everything now. But the reality is, is it was hard. It was really hard. And I think, I guess to your question, the future for me is we need to start redefining what nursing looks like, and what we look like to the world, so that our impact, our value is to be quantifiable, not only in the way of, of people saying this is great, you made somebody feel better, but that we have a financial impact into the world. And that we also have a seat at the table to transform and hold positions at a much different level. And fundamentally what I like to see, is nobody ever stopped to think about what nursing careers look like. So the first day of our career can look very much like the last day of our career. And a lot of career nurses, 30 years in, they’re pretty much doing the same thing from the first day to their last day, right? We never created a career ladder. So let’s say that you spent two years on a med surg floor, and then you could step into an ICU and then you could step into a training program. This doesn’t exist in the world of nursing. We basically say, Hey, if you want to do something different, go back and become an NP, right? Or become an educator. And that’s the only way to do something different. That to me is a fundamental failure of our profession. That unlike other professions, like when you start out, you start out as a, you know, you start out as assistant, you move up to an associate, you move up to a director, eventually you become a VP, like there’s career progression. We don’t have that in the world of nursing. And I think fundamentally, we’ve got to start changing that so that people can see that differently.

Nacole:
Rebecca, thank you so much for letting me interview you. It was so great. I learned so much from you.

Rebecca:
Well, Nacole, I feel like I just talking to you, I see a difference for our future. And it’s talking to nurses like you, who in those moments where those butterflies hit and you know that it’s easier to stay where you are than to do things differently. And you took that jump off the edge. That’s what we need in this profession. It’s these kind of nurses. And I know that you have an amazing relationship with your husband and your kids, who are like, Hey, you know, you just keep going. My situation sometimes was a little different than that. And often that happens, right? It’s people that, you know, like how you take that risk of yourself to take that leap of faith and think it’s going to be okay, when everything else is telling you, it’s not the right time or the right moment. The reality is history is never the right moment. The right time to challenge the status quo? There is never going to be a perfect time. And if there’s one thing that I could leave with every nurse out there, is there is nobody better to bet on than yourself. It is only way to go forward. And we need more of you. I need more of you. We need, nursing needs more of you to bet on yourself. And we got you. Like, not everybody else is, but I’m telling you, whatever you want to go out and do, go do it. Because we support you. And go do it. We need you. So this has been awesome. Thanks so much for having me Nacole. This has been fabulous, and I can’t wait to see you in the future.

Nacole:
Thank you so much. Thanks for listening to SHIFT Talk. This podcast is brought to you by SHIFT, a new community for nurses ready to make a change. SHIFT is sponsored by the Robert Wood Johnson Foundation. The views expressed in this podcast are of the guest and host only, and do not reflect the views of the Robert Wood Johnson Foundation. Today’s episode was our season finale. Thanks for listening this season, and for going on this wonderful, wonderful journey with me. But don’t worry, you’ll soon be hearing from us.

Nacole:
Follow us on Instagram at shiftnursing, and head over to our website, shiftnursing.com, to learn about what’s next for this amazing community. One last note, please, please subscribe, rate and review Shift Talk wherever you get your podcasts We’ll be back soon with an incredible Season 2. Until next time, stay safe and keep being awesome!