Renee DeSilva 00:00
Welcome back to the table. I’m Renee DeSilva, CEO of the Health Management Academy and your host. This week I welcome Tammy Daniel, who is the Senior Vice President and Chief Nursing Officer at Baptist Health Florida, as everyone in healthcare is aware of the challenges facing the nursing workforce are numerous and multifaceted. Simply hiring in the traditional sense out of this crisis is really not an option. I appreciate Tammy’s insights and supporting existing nurses on their professional and leadership journeys, as well as finding innovative ways to grow the pipeline. Here are my takeaways from the conversation. First, I always ask about the early forces that influenced their interest in health care. And I loved Tami’s response. There’s a clear blend of teaching and strong female presence in her life, including her grandmother’s wonderful advice. Your joy is yours. Don’t let others take that away. Next, under Tamizh leadership, Baptists has taken a very intentional approach to early career leadership development opportunities. This includes an internal nurse manager Academy and upskilling existing talent for more specialized technical roles. As I noted before, these workforce challenges require a higher level of creativity and innovation. And I believe Baptists is reimagining the work and the correct ways. And finally, I continue to have great conversations with my guests about leadership and to me was no exception. We discussed the role of mentors and recognizing gifts and helping others to understand blind spots what I call the power of the nudge. I also enjoy Tami’s reflections on daring her management and communication styles based on audience and responsibilities and the fact that leaders can’t afford to show up in fixed ways. So with that, join us at the table. Hi, Tammy, welcome to the table.

Tammy Daniel 01:52
Good afternoon. I’m thrilled to be here. Thank you for the opportunity.

Renee DeSilva 01:56
Absolutely very happy to have you. Before we dive in, I’d love to start by learning a little bit more about you give us a sense of some of the early forces that shaped your career and interest in health care.

Tammy Daniel 02:08
Well, if you go back far enough, I would have told you I wanted to be a teacher. And as a small young girl, I spent a lot of time thinking about that. And, and playing school like we probably all did, when we were younger, my sister probably had the most spelling tests given to her than anyone in the world. But as I got a bit older and transitioned in my life, I realized that I had a deep interest in the sciences, and the interest in our how our body connected with all of that, and being able to help people be better and faster. And just related to health a lot more. And so I also watched my mother who was a single parent really working paycheck to paycheck and, and really struggling. And I often thought as a younger girl, like I did not want to be dependent on anyone else. I wanted to be able to fill my career with something that was self sustaining. And so medicine and healthcare really found me and I found it together. So I think that was what really inspired me. And my interest in my career was really how can I feel like I’m doing something that is connected with where I want to be in my life, and I could be self sufficient. My grandmother lived to be 102. And she always told me, Don’t ever let anyone take your joy from you, your joy is yours. And I feel like healthcare gives me so much joy. Because it allows me to be what I really want to be. And it allows me to function in an environment that helps me excel. So that’s that’s really how I my early forces shaped my career.

Renee DeSilva 03:50
It certainly sounds like you had a number of powerful women in your life and drew a lot from that inspiration. You’re now leading Baptist Health as the chief nursing executive. Did you shoot for that role early in your career? Or as you mentioned a moment ago, did the path unfold a bit more organically?

Tammy Daniel 04:08
It really unfolded a bit more organically. I can admittedly say that when I was any involved with anything in the past with a team or a group of people. I did have the desire to really be the lead of the team or the captain of the team because I felt like I was a problem solver and I was there solution oriented. And so I that kind of does propel you to be a leader, but as a CNO that was really something that other people saw on me more than I saw on myself. And they encouraged me to get uncomfortable in certain situations and step outside of that I know how to do this and get into the house. You asked me to do something I’m gonna say yes and figure it out. And as I was able to do that more and more doors opened and and people encouraged me along the way. So I would say that it was really things that other people and mentors saw in me and encouraged me to do as a nurse executive and one of my positions earlier in my career, I had assistants, you know, that would come on site and round with me. And she would always round in areas that she knew were challenging for people to be in compliance, and such as documentation about restraints or things that we struggle with across the health systems across the country. And she would deep dive into those areas with me, every time she would come in round I would new is going to be okay, what is she going to challenge me on today, that really fostered me to be more in tune with how I could make changes that make a difference. And that was challenges that she put in front of me, I often anticipated and she she told me at one point, she said, you’re really good at solving problems. And you’re, you have a talent for that. And so that always encouraged me.

Renee DeSilva 06:00
Yes, we’ll talk more about this. But it’s incredibly powerful, early in our careers, when people see skills in us that maybe we don’t see in ourselves, you talk a lot about the challenges, and of course, managing the nursing workforce is rife with them. And I think at this point, we have a clear sense for what they are. I do wonder, though, if there are one or two in particular that really keep you up at night, what would you point to?

Tammy Daniel 06:24
Well, I would actually point to I’m so grateful that I have an outstanding team that helped me be able to sleep well at night. To answer your question, though, I was speaking at a graduation not that long ago. And when we talked about where the new nurses were going to go and their first opportunities outside of school. And it was alarming to me that there were not a large majority, that we’re going to work inside the walls of our acute care hospitals. There were so many opportunities and so many things that they could get into as that first career option, that it alarmed me. And I’ve thought a lot about that since then, how are we going to build our workforce of the future, because you know, we’re all struggling with that. And encourage people to work in some of the most difficult settings and with the sickest patients, right within the walls of our hospital, we say healthcare is moving outside of the hospital, and we need people there. But we’re going to really need people inside the walls of the hospital where the sickest patients are where the tests and procedures are being done. And so that does keep me awake at night a bit. How are we keeping the healthcare environment attractive to all of our health care employees of the future and safe where they feel like they can work in an environment where they’re valued, where they’re contributing, and that they feel safe? Workplace Violence is on the forefront of everything in our communities? And so how do we make them feel that this is the place that you can learn a lot? And that it’s an exciting place to work? And then my second answer would be the other challenges that we all face, as you know, is finding the nurses that have that level of experience in the specialty area like your neuro or, or your Structural Heart program, the nurses that, you know, take a while to build those skill set up? And how do we keep those nurses in those departments and attracted to work in those fields?

Renee DeSilva 08:17
That certainly resonates. The other big one for me is just navigating the financial pressures, especially those tied to labor costs, which is typically upwards of 60%. So maybe talk a little bit about your lens on this both as a nurse and a caregiver as well as a senior executive.

Tammy Daniel 08:35
Yes – I feel like we have to be more creative than we’ve ever been before. Because we’re not going to fill these funding, fix these financial pressures if we continue to do things the way we are right now. So, you know, things that we’ve implemented are very different. We, for many years, did not have LPN in the acute care environment. We have 120, working at the bedside on our medical surgical units right now in our Baptist Health System, and they’re staying and they love it. In fact, in July, we’re standing up our first SCRUB NURSE program where we’re training 18 of our LPN that have been in our system to become scrub nurses and or because we can’t fill our search tech positions. So I think the answer to how do we become more innovative to solve these financial problems in our workforce is it’s within our minds and our creativity of how do we fix these things? We’ve all stood up internal agencies and created our own programs to prevent the need for having so many expensive travelers, but how do we partner with our academic centers and do things differently? Right now we’re working on an international program with one of our academic centers here in Jacksonville, and to train nurses that have come to the United States from the Philippines to be more comfortable working in the US healthcare system. And so we’re partnering with them and scholars shipping some of then to, to learn those skills and then obviously would obtain employment with Baptist Health. So you really have to adapt to what you’re facing for the financial pressures, because they’re not going to go away. And you’ll see everyday if you read any literature that many healthcare organizations are downsizing, or rightsizing. So we’re going to have to learn to do more with what we have.

Renee DeSilva 10:25
I agree, I think a big piece of that is technology. And it’s hard to keep pace with the amount of change there. There is a ton of conversation around AI and automation, and whether that will help break through in clinical settings. I think we’re still in pretty early innings on that. How do you think about that issue?

Tammy Daniel 10:43
You know, it is interesting that you asked that question because we do want people to be more efficient and be able to function at top of their license. And having said that, every time you we roll out new technology, or give them the ability to do something faster, it takes them a long time to learn that new technology. Right. And so sometimes they’re resistant to even try it because it takes me too long to learn it. I just I’ll keep doing it the way I I always have. And so I think that part of my answer to that question is not only are there new tactile neck technologies, like handheld devices, and using your phone and voice to dictation, which is something that’s going to be coming out for nursing and even higher level, I think the thing as a nursing executive that we need to look at is how do we get them to utilize and adopt this new technology. And just this week, we stood up some units called Barton units. Because Clara Barton was a nurse theorist that really was on the innovative edge, she pushed a lot of new advances in health care early in her career. And so we’ve identified five units across our health system that we are going to be using those units that are high performing, to test our technology to as we roll something new out, there’ll be the first adopters to it. And they’ll work through the kinks and bugs and help us operationalize it to the highest effectiveness. And then they’ll be our super users and help us roll that out to the system. Because what we’ve seen so far is we rolled out epic and last July and some new handheld devices and devices that we want people to use to make it easier for them to barcode scan, they’re not using them as much as we would like. So these Barton units are to help us work out some of those kinks and reduce the amount of time it takes people to do the work that they do. Where do you have

Renee DeSilva 12:31
confidence in terms of technology’s ability to help people work at top of license and perhaps reduce some of the administrative burden?

Tammy Daniel 12:42
Yes, I mean, a lot of nurses will talk to you about virtual nursing and how they’re piloting it on certain units and what’s working and what’s not working. I think you have to not you have to do things with your team, not to your team. So by that, I mean, how do you bring them along with you as you’re rolling these things out, instead of throwing them at them and expecting them to absorb it. And so that’s something that we need to learn a lot better.

Renee DeSilva 13:09
This topic of where automation has been deployed in clinical settings to really move the needle is one that I’ve been asking a lot of executives about. And I think your sentiment is shared pretty broadly, that there may be some pockets, perhaps some pilots or experiments, but we are still in the very early days of anything really impacting at scale. So we’ll have to come back and track with you on what this Barton unit experiment has been able to accomplish with the benefit of some time in the rearview mirror.

Tammy Daniel 13:37
Absolutely. When I became a nurse executive, I realized because I worked through many of the leadership roles throughout my career, that the nurse manager is such a difficult role in our healthcare system, they have to be the CEO of their service line or their unit, they’re managing a budget, which they’re held, you know, to high standards, and yet they’re trying to keep their team members happy and satisfied. And so how do I be that middle manager and and is that a desirable position? So one of the things that I realized is we need to have people prepared for that role. Oftentimes, we pick our highest performers, and say, you’d be a really good leader, here you go. And then we watch them learn as I go and struggle and it’s really difficult. So we stood up a nurse manager Academy a few years ago, and we implemented a process where nurses that had an interest in leadership could apply for this six month program. And we would help them be selected to go through a mentoring. They are assigned a coach. They spend a couple of weeks each month going through didactic training and preparing for budget management, how to hold a crucial conversation, how to have that conversation with a patient and their family. We actually do some scenario based work on interviewing and then they do a lot of departmental shadowing and so as a leader, your ability to collaborate with your peers that are not nurses in the lab and respiratory in finance is really important. So they meet with each of those leaders and spend a half day learning what it’s like to walk a day in their shoes. And that way, as they transition into a nurse manager role, they have a lot of relationships early built, and they have a greater understanding of the other person on the other side of that phone that they’re, they’re speaking with. And we’ve, we’ve seen great success, we have had about 80% of our leaders that have gone through the nurse manager Academy, go into a nurse manager role. And we’ve only lost two of them over the last three years to leaving the health system for another reason. And so this ability to train people and be prepared. And then when an opening comes this last opening we had on one of our progressive care units in our neural service line, we actually had eight internal applicants apply for that nurse manager role, when in the past, I know some of those roles for managers would stay open for months, and it just was really difficult to find candidates. And so this ability to have the secession planning and having somebody ready in position and feeling comfortable that they didn’t have to struggle in this role is really been successful for us. And so we’ve been able to present this at magnet and a few other places, I’m happy to talk to nurse leaders about it, because it’s really a good program and you could places can stand it up with within their health system, and hopefully see the same success that we’ve had. But we really have to prepare our nurse managers they work a lot of hours, one of the things I looked at was, could we do a shortened work week for them? Because they’ll have 40 hours in and you know, it’ll be early Thursday. So can they work for 10s? Can they have a day off and a pay period because you know, they work so hard. And so we also stood up nurse manager Appreciation Day. So Nurses Week is every year, early in May. And so one of the things managers do is do everything else for their team member. So when do we have interest manager appreciation? So those are some of the things that we really have tried to do to build that position up because it’s so important for our future.

Renee DeSilva 17:18
agree, I agree. Let’s pivot a bit that and talk about leadership development more broadly. It’s interesting when I asked you what animated you as a child, you did mention that teaching was a big part of that. And so I’ve been impressed as I’ve gotten to know you a bit the way you’ve built out competencies internally, particularly to the nurse manager Academy. Can you bring that to life Ross a bit.

Tammy Daniel 17:41
Yes, you can get really tunnel vision staying within your walls and within your community and you think you’re doing everything the right way. But if we don’t stay connected with each other and share ideas and talk with our peers across the country, we won’t grow successfully. So the five nurses that we selected to send were from different locations across the health system. And I’ll tell you, honestly, when they got there, they started texting me right away about this is amazing. It’s so neat to be with people even post COVID to be able to travel, right. But to be able to be off site where you can be away from your busyness of your work and have an open mind and think in a think tank with people from across the country that are in similar roles was just an amazing opportunity. And they felt valued for being selected to go do that. So that’s one thing for retention and really grow your own people but give them opportunities to push themselves outside of their comfort zone to and then to talk to people across the country that were struggling with similar things just it gave them a sense of confidence to say, You know what, we’re not in this alone. But we are doing a lot of the things that other hospitals are doing, and things that they’re doing that we’re not we’re hearing about now. And we could bring these back. And we can implement them. And they all five came back and shared ideas that they had heard or things that were doing well that they shared with other people. I actually met one of the CEOs that was also sending managers to the catalyst program. And she’s told me that her nurse managers came back and said, the practice nurses are so excited. And so it made me feel really good that they were that engaged. So I just think building that momentum, it gave them confidence. It gave them the ability to come back and be problem solvers because they were given the task to develop a project on their unit that they could work through the catalyst program to implement. And so they each have now stood up a different program that they’re in the process of incorporating and they asked me I just spoke with them again last week, if we could send more people to this program and then I said well, what if we brought the catalyst program, um, health management academy to Baptist and had some way to do a large group setting and incorporate our nurses from managers from across the system and an environment where they’re networking with each other. Would you see the same value as going off site? And they said, well, they thought that they would, because our nurses are from six different hospitals, and they don’t always interact with each other. So it’s, again, it’s that networking that’s so important. I think that’s what it brings to the table.

Renee DeSilva 20:26
Yes. When we think about workforce challenges, I think the big piece that you’ve been pushing on is this notion that we need to create our own internal pools of talent, whether that’s the scrub nurse training that you mentioned a few moments ago, or a nurse manager readiness program, you want to have strong internal candidates that can step forward when the need arises. And I think that’s a shift in how the industry ought to be thinking about recruitment and retention. It’s powerful to hear some of these examples coming to life for you.

Tammy Daniel 20:57
Yes, it’s a confidence builder, and they came back. And they said to me, you know, we’re hearing from other places that some things haven’t worked there to like something, you pile it in, and you try it. And I said, you know, what, we have to learn to fail fast, right, try things and then move on, because not everything is going to be successful. And that’s okay, because people are afraid to fail. And so I think this gave them the opportunity to have more confidence.

Renee DeSilva 21:23
While you’ve invested significantly in building out these internal opportunities for leadership development, I know that you’ve complimented that with external programs as well. In fact, Baptists sent five nurse managers to the health management Academy’s nursing catalyst programs, idea labs, along with 15 other health systems. How do you think about the balance here of internal grooming, anchoring on the competencies and the unique challenges of each local environment, with the right moments to pepper in external perspectives into someone’s career path?

Tammy Daniel 21:57
Yes, I think that person that sees talents in you that they want you to explore and expound on. And like I said, there was a CFO that really pushed us because then she knew and her experiences where leaders struggled and pushed those things and, and challenged me to develop in those areas. And I think, you know, part of what we do as leaders is learn to adapt to the situation. And this person taught me the ability to use different leadership styles. When I went to Wharton, I had the opportunity to go to the J&J, Wharton fellowship. And it was really a pivotal moment for me, because what I really transferred from that opportunity was people ask you what your leadership style is. And the answer is, you might have a natural leadership style. But to be a true leader and be successful, you need to adapt to the situation, because sometimes you have to be a transformational leader. Sometimes you have to be a servant leader, or an influential leader, if you’re speaking to the board, and you’re trying to help them understand that this capital equipment is really, really important. And so I think where I had a mentor early in my career was the person who taught me that you have to be able to be adaptive and flexible. And as a leader, you have to be able to know who your audience is, and adjust your leadership style to who you’re talking to. Because if I’m talking to a group of our nurses that are closest to our patients at the bedside, and I’m going to be influencing them to try to use new technology, like we were just talking about using their phones to do barcode scanning, we’re going to be talking about transformation, but I’m going to be coming to it as a servant leader, I’m a nurse too. And I can walk a walk in their shoes, and they understand that I’m speaking to them in the way that relate to what their experiences are. And so my quick answer to your question is just really be flexible and adaptable. And your mentoring needs to be someone who sees where you have strengths and weaknesses and helps you develop in those weak areas.

Renee DeSilva 24:08
Absolutely, I had the pleasure of kicking off a few of our cohorts that were here in DC. And the ops, my observation was just the energy in the room was palpable. They were together, away from the demands of their their personal and professional lives. They had space to focus on the on the day to day, and there was a vibe and connection with other health systems that was really fun to watch. And I said to them in my opening, that as you look into the audience, there are future Chief Nurse executives, chief operating officers, CEOs in the room. And it’s just been a real boost for our internal team to just serve in this capacity, given just how bright and excited these these leaders are.

Tammy Daniel 24:52
Yes, and just the willingness to be uncomfortable, right to take that step. To be the person one of the things that have into me early in my career, I was a CV ICU nurse. So worked with open heart patients would go down to the O R and put them on the balloon pump if they were struggling in that area. And one night I came into work, I often work night shift. And we had a really unstable heart patient come back up to the floor. And I’ll never forget the CB surgeon, It was seven o’clock I was coming in. And he turned to me, and he looked at me and he said, Oh, my God, I’m so glad you’re here. And that was a pivotal moment in my career to think that, you know, you’re doing something that someone saw appreciates, and that you’re making a difference. So for someone like a surgeon to say that to a nurse, is a great opportunity and agreement, they can be great mentors for nurses, too.

Renee DeSilva 25:45
I agree. I want to come back a little bit to where we started. You talked about the influence of early leaders and mentors in your own career path, which I loved. Was there a key moment or a specific mentor that you felt created a leapfrog moment for you personally?

Tammy Daniel 26:02
You know, I’m so glad you asked that question, because we were talking about our career mobility opportunities. And so we have stood up a career mobility program where we are talking to people early in their careers, and including our leaders, talking to them about where their interests are, they may be working on a neuro ICU unit, but they really have always had an aspiration to get into the O R and work in the neuro our area. And so how do we help them get there. And you don’t know that unless you have these conversations with people, and opening up the opportunity for them to share where their interests are. And if you see someone on your team that just has that natural ability to explain things, they’re a great teacher, they, you know, they’re very articulate, and helping them to say, you know, I see that you have a knack for this, would you be interested in exploring that and more and becoming a super user or taking on this responsibility, and encouraging them to get in the clinical ladder program where they can do a few other things like stepping in to be a charge nurse, or do a presentation in front of a group and kind of helping them to get, like I said before, outside of that comfort zone and be willing to be willing to get uncomfortable, but supporting them along the way so that if it doesn’t go where you hoped it would go, they still feel supported. And they’re not intimidated to try things again. But you don’t have to have that conversation with people to know where their interests are. And then if they don’t naturally have a desire to go there, I wouldn’t give up on that nudge that you were talking about, you know, maybe take a pause back, but come back around, and you got to build the managers up to be able to have those skills to see those talents. And people too often go when we’re starting the application process for the nurse manager Academy, to the current nurse managers and say, Who do you want us to encourage you to apply? And who are your stars right now? And who are your quiet, quiet leaders that may not feel comfortable stepping forward without a nudge? And so you know, just keep keeping your eyes and ears open.

Renee DeSilva 28:16
I completely agree. What has been powerful for me along the way is this notion of it is helpful to know your gifts, but it’s sometimes even more impactful to know your blind spots. And I always talk to my team here about that feedback is a gift even if it’s hard to hear. And it sounds like you’ve experienced that and had benefited from that as well.

Tammy Daniel 28:39
Yes, I just want to add there, you brought up a great another great point, we and one of our nurse manager academies had the majority of our candidates were white females, and you know, 90% 89% of our workforce, our females and, and some people came back to me and said, I think we need to look at a diverse, more diverse group, as people apply. Maybe we need to encourage people to apply that are not applying. And so we dug into that a little bit deeper. And as I found some people that were really strong charge nurses that weren’t applying, I actually spoke to them. And a couple of people told me that they didn’t feel comfortable sticking their neck out there because they’ve tried for things before and were turned away. Or were told no, that they weren’t qualified, and they didn’t want to feel that hurt again. So they were they didn’t want to be vulnerable. And so helping them through that process is really important.

Renee DeSilva 29:33
I think that point is really important. I just love how you think about the benefit of not just applying, but asking for folks who are in the role who they see as as ready or capable or are having potential. I think it’s often these invisible talent pools and profiles that could be a big part of our future and will require us as leaders to really think about that a little bit differently. So we’ve covered a lot today, but if you could invite any two people to come continue this conversation at your table, who would you invite? And why?

Tammy Daniel 30:04
Two people I would invite by hospital CEO because we have a great relationship. And I think we could, you know, have a good sounding board of what, what things we’re working on together and the challenges that we’re facing, because my challenges are his challenges and vice versa. And then any two people, you know, I would, I would buy my grandmother at the table, I told you, she lived to be 102. But she had a limited amount of academic education, but was the wisest person that I can ever recall, you know, in my life knowing and so she always had a solution, and encouraged me to think a little bit differently. And so having her at the table of any conversation would be an inspiration to me. But I’ll tell you one thing someone told me early in my career, when you’re having a conversation, always have a patient at the table, even if it’s an invisible patient, because you need to be thinking about what you would say and how you would process the thought you’re having if there was a patient in the room.

Renee DeSilva 31:07
Thank you, Tammy. I think that’s a perfect place to land. I enjoyed our time today.

Tammy Daniel 31:12
Thank you for the opportunity. I’ve enjoyed it, too.

Renee DeSilva 31:15
Thanks for joining me at the table with Rene de Silva, a podcast brought to you by the Health Management Academy. I hope you enjoyed this episode. And if you did, subscribe, and drop us a review on Apple podcast, Spotify, or wherever you’re listening to this podcast now, for all of our episodes, including show notes and transcripts and more information about how you might join me at the table in the future, please head to H M academy.com/podcast. I look forward to having you back at my table next time. Talk to you again soon.