Alright, good afternoon everybody. Stephen Hartz here with the H&H Impact. This is our 13th podcast and we have an awesome speaker with with us today in Rosemary Worcester. Um, I’m gonna have Rosemary introduce herself because she’ll be able to tell you so much more about herself than I will. Rosemary, how are you today?

I’m great, Steve. Thanks so much for having me. Oh, it’s wonderful. I appreciate you taking the time. I know you’re super, super busy.

Oh, I’m really happy to be here. I, um, have been listening to the podcast. Um, I’ve learned a lot of things, and I’m feeling a little bit honored, frankly, to be here today with you. So yeah, well, thank you. Well, listen, Rosemary, um, tell us a little bit about your background.

I’d love to hear from like how you got into healthcare to where you are today and, and, uh, what makes you you. Wow, big question. Um, I actually got into healthcare by way of EMS, um, and many have, many of my colleagues have, um, but I, I wanted to be sort of that resource person. So like, who do people go to when, um, when they have a question, or, or as is in EMS, when there’s an emergency? And that really evolved into a love for both people and science.

And nursing was just the best convergence of those two. I considered medical school, and I thought, well, that might be a little bit too heavy on the science. And then I considered like sort of a social service career path, and that might have been a little bit too heavy on the people. So nursing really fit that bill for me. And won’t be surprised to hear I went pretty directly into emergency nursing.

I might have spent maybe 8 or 10 months in a cardiac surgery inpatient zone, but again, just gravitated towards the emergency department. And I think the appeal there is really being very comfortable with not knowing what’s next. And if there’s anything that has transferred through my entire career, even to- I’ve been a CNO, nurse exec type for 10 or 11 years. It is that theory. It is being comfortable with not knowing what’s next.

My career also, though, included, you know, kind of a sinewy way to where I am today. I was in leadership at the unit level, managed an emergency department that went from a very small community department into a Level 2 trauma center over my time in leadership there. And I also spent some time as a Magnet director at the health system level. And that’s really where I fell in love with, quote, the system, system, system-level work. And after that began my nurse exec, you know, path.

I was a VP at a campus level, then spent a number of years in nursing operations. So all of the sort of math and business behind how we deploy nursing, really with the patient at the center, because all of this relates to the patient. And then took my job here at Bayhealth as the System Chief Nurse Executive, uh, just about 4 years ago. Awesome. That’s a, that’s a heck of a journey.

I love how you came up with your approach to wanting to get into nursing. Like, you looked at all the different avenues and options and then chose that. And then ED nursing, emergency department nursing, is, uh, unlike any other. Um, you know, I think your philosophy of just being prepared for the unknown is huge. I think as we teach in leadership all the time, that’s constant, right?

You never know what’s going to happen. I would love to say we’re going to know what’s going to happen with our budgets and CMS and all these things, but it constantly changes. Um, and you know what’s interesting about that is I was talking recently with another CEO of a hospital, another executive, and we were talking about how the book for healthcare success, to be a good successful hospital, has been written, right? There’s tons of literature out there and ways to do that, but one of the biggest variables in that are your people, right? And we talk about, you never know what you’re going to get.

You try your very best, you do all you can, you train, you onboard, you do those things. But that’s a unique aspect of it. I would imagine as a nurse leader, and you’ve been doing this for some time, you have seen the gambit of different levels of nursing and involvement and desire. Can you talk a little bit about your experience with dealing with the people side and the leadership side of being a nurse leader? Oh, yeah.

This is just core to the work, whether you’re a chief nurse or a chief medical officer, wherever you are in leadership. One of the phrases that someone wise once said to me early in my leadership tenure was, our job now is to take care of the people who are taking care of the people. And again, that really stuck with me. And the take care of the people runs such a range, Steve. I mean, all the way from how do I create a work environment where people seek it out?

That’s sort of the holy grail. How do I make this work environment where I keep people, but also where I can hold people accountable? I can garner and foster ownership. I can sometimes handle difficult issues. Every, I think, leader, particularly nurse leader, will say how sensitive and challenging it is to shape the team.

Sometimes you have to uninvite people to your team. That can be difficult, but it’s a critical part. You know, so it really is about the people because the technical pieces you can certainly teach. And, you know, we know that when nurses graduate today, they’ve got a lot of the technical and they need us to be sort of teaching them about the people. But I find as a leader, you know, I’m going to double down every single time on the investment in that people side.

Um, I mentioned the nurses who are graduating today. There’s, um, there is a gap there. There’s a gap in, um, the, uh, new nurses. We call them nurse residents. That’s anybody really in their first year out of nursing school.

Um, in how to navigate the challenging people part of taking care of patients. It’s not task-based. And you have to modulate. You have to do the same thing in leadership. You have to modulate to those that you’re leading.

And then also, of course, to those on your team. Because I’m sure you and those listening can picture the faces of those people where they’ve really had to be like, what? I don’t understand. Help me understand you. You do things so differently.

But it’s really about having a spirit of curiosity around the people that you work with. You, you hit on so many great topics. I’m going to start with the first one that I, I really like. So Simon Sinek, uh, great leadership instructor, I really like him. He talks oftentimes about it’s not about being in charge, it’s about those in your charge, right?

It’s about being the person who’s taking care of the people who are taking care of the patients. Because as you get into leadership, very rarely are you very patient-centric, right? You’re not the one out there shooting up, uh, giving them vaccines or, you know, doing the tests and stuff like that. And so you’re taking care of those people to make sure they have what they need to, to be successful- the right resources, um, the right, uh, equipment, people, all of the aspects that go into it. And it’s not always easy.

I think, uh, as a leader, sometimes, you know, we’re not able to give all the information that we would love to be able to tell people, like, hey, this is the reason behind everything. And sometimes you’re able to do that because, you know, it’s right information at the right levels and stuff. But to get to that level, it requires a significant amount of trust. You know, you- when you can build transparency and build trust with your team, you have to do that. I think you hit another piece that I love is being curious.

Um, I, I love Ted Lasso. I enjoy the show very much, and he talks about that, about being curious, right? Talks about, you know, if you took the time to be curious, you’d have maybe ask the right questions. And I think that’s something that as leaders we don’t always do. You know, sometimes you get so hot and heavy with, I have to get this done, completed.

But sometimes just asking that question, you know, what is your barrier? What is the challenge that you’re facing here? I think the other thing that it’s hard because every day you’re doing your job, right? You as a nurse leader, you as a CNO, nurse managers, everybody is doing their job. And so trying to take that time to actively mentor those, um, that we’re trying to raise to that next level and get them there.

And it’s tough, you know. My mother was a nurse. My mother was an OB-GYN nurse. Back- she talks about being brought into the nursing realm by Nurse Cratchit and, uh, being taught by those older nurses. And then nowadays you’re having to teach people the soft skills of being nice, like being a little extra sensitive, uh, Quint Studer, uh, great gentleman.

I enjoy Quint. I love his book, The Great Employee Handbook, because he talks about it at those levels, right? At the leadership level, at the peer level, and at the patient level. But a lot- so much of it goes back to that being nice, being kind, listening to your patients, being curious, right? It’s at all levels.

And, uh, so that’s awesome. I, I love- I love your, your approach. It’s very covers everything, right? Because it’s not all one types. Oh, sure.

And, but you’ve hit on some really great, um, resources. So I have to just tell you, this is the second time today that someone’s referenced Simon Sinek. He’s just- it’s, it’s sort of the classics, almost like the, the Food, Water, Shelter in Maslow’s hierarchy of, of leadership. But, um, I’ll tell you, I spent a lot of time immersed in the Quint Studer work. I was working at one time for an organization that was really closely aligned, made major changes.

We had tremendous success in an emergency department in moving patient experience scores. And the typical pushback happens because we’re humans that says, hold on a second, I’m here to do a job in healthcare. I’m here to take care of the patient. Old school says you took care of the patient and that’s what you did. And if they didn’t like it, well, fine.

But that is not the case anymore. It’s shared. It’s a, how can we healthcare help you reach those goals that you want to reach instead of I’ve got this checklist and you’ve got to hit all these things, patient. It’s the same in leading people. How do I help you as a leader reach what your goals are while you’re here taking care of our patients?

Our patients have to be well cared for. That’s sort of just a given, and it’s a must. And frankly, you don’t get to pass go unless your quality is in order. But beyond that, it’s about really opening opportunities not for where you as the leader see everybody slotted, but how do I get you where you want to go? And then we’re all happier.

Um, absolutely. So you, you brought up a good thing, a good point. So our team has recently been doing some, some training on that. And, uh, you know, you get so into the weeds sometimes you forget about what you can do for your people. And, um, one of our groups that we work with, uh, it’s called 10X talks about your PPF, your personal, professional, and financial goals for your team, right?

And so understanding like, hey, personally, where do you want to be? You know, what’s your passion about? Where do you want to be education-wise? Where do you want to be family-wise? And then the professional side of it is where do you want to be growth-wise?

Like, do you want to be the future CNO? Do you want to be a CEO? Or I worked in a- with a NICU unit one time that was dealing with some cultural shifts, and the woman who was in charge of scheduling She, she had schedule, been there 35 years. We went in and I was interviewing her. I said, what do you really want to do?

She’s just, I only got into this to hold broken babies. I don’t want to do anything with leadership or schedules. I just want to be there to help families get through these tough times. I am fine at this level. And, and so it was sometimes being curious, asking the right questions.

I think those are huge aspects of, of taking care of people. I had- talk about quality for a second. So quality’s first and foremost. I think we all understand, especially if you’ve been in the game. I think some people at times lose sight of, you know, not necessarily the importance of quality, but how to, how to make it hit the road.

How do you build traction with it? And, you know, I, I will be honest, when I was a helicopter pilot in the Navy, when I started out, like, quality wasn’t my priority, right? What I would say, when you’re a young pilot and you’re learning your mission, my, my priority was to get the mission complete, right? Whatever it takes, mission complete, warheads on foreheads, get people to target, troops to target, whatever it may be. That was my priority.

So I didn’t understand quality, really understand quality, until I went to the Navy’s safety program, Safety Officer Training Program. And then all of a sudden my eyes were wide open, right? And fast forward, uh, probably 12 years after that, I was, uh, leading a search and rescue unit out of Whidbey Island, Washington, where we were doing about 70 trauma one medevacs a year on the civilian population. And quality became huge. And then I would go into hospitals and we started talking about how we in aviation manage working together as a team for quality, and specifically in the ED, because that’s who we were dealing with mostly.

But that led me to create a program called H-R-O-R-X, the Prescription for Safety Culture.- and huge, huge fan of HRO, huge fan of getting people to that quality side of it. So in my experience, I think everybody wants to get to the culture of quality. But I had an admiral, my former boss, one time tell me, hey, Steve, you know, you’re really not doing much on culture. It’s not culture you’re working on. I said, Admiral, I want to banter with you on that.

I disagree. He’s like, Steve, think about it. Are you changing somebody’s culture or are you changing behaviors of the people you’re working with to get them to the culture? And that made me take a second to pause because I was like, you really are. Oftentimes you’re changing a little behavior, like, hey, are you using a checklist?

You know, are you going through these little things that we’re going to change? Because culture takes time. We know, you know, I think science says it’s 36 months, up to 36 months to do a cultural shift. But you can change people’s behaviors today. You know, by starting to hold people accountable, you know, the, the level of trust.

Are we providing great procedures, protocols, practices, policies, all those type of things? I’d love to hear your thoughts on that. Well, you know, I- the first thing I thought of as soon as you said that was, um, you know, culture eats strategy every single time. Um, but you’re right. I- so two things I want to tell you about.

One is We’re having this conversation here at Bayhealth right now around the difference between accountability and ownership. And deep, if you think about it. So am I just accountable to the things that I need to do, or do I really own what’s happening here? And I think there’s a sweet moment in there when as leaders, we want owners. Yes, you have to be accountable, but accountability will come when you really own it.

So we’re having that fun conversation. But what you’re describing about Am I- and that just really hit me too, probably the way it hit you when you first heard that. Are you going after culture? Are you going after the behaviors that define the culture that you want? And I would call that micro moments.

So I have this theory of, of how micro moments tremendously impact the greater system. So think about it. And let me give you a kind of a simple, not really complex example. So let’s say we look at the front lobby and it’s 5 o’clock at night. And there’s a line of people waiting to come in, sign in, you know, register, get their badge so they can go see their loved ones.

And it’s like 7, 8 people deep. Well, if you’re that family member, you’re going to be like, oh, there’s a big line. And, you know, oof. But what if somebody, a public safety officer, a front desk volunteer, goes over to the line and says, hey, I’m going to get you all started. Let me get- let me collect your name so that by the time you get to the machine that’s going to register you and give you your sticker, you’ve got all your things handled and you can move right through.

That’s a micro moment. So now those, those family members are like, hey, that’s really great. They cared enough. Somebody came out, talked to me personally and, and, you know, made my experience better. It probably wasn’t faster.

But it may have been better. That’s a micro moment. That’s a behavior. I’m having a moment here because it’s those things that really stack up to create your culture. I think there’s one really important leadership piece about this, though, Stephen, that is model the way.

The executive leadership must be consistent. In their own performance on these things. There can’t be, you know, this sidebar of the executives that say this is a little silly and I don’t want to do it. No, no, and no. So an executive has to also go over to the line of people waiting to get in to see their loved ones and say, hey, can I collect your information quick?

Takes 5 minutes. Let me help you get through this line. So we underdo that sometimes. You know, I’ve worked with some tremendous mentors and leaders. I have infrequently seen executives who don’t model the way.

But darn, you know the ones that don’t, right? Doesn’t feel good. But it’s those micro-moments. No, those- I love that, micro-moments. You know, we, we talk about, uh, when we do training, we do a Leadership 101 training for new managers, new directors, you know, and, and you’ve seen a million times in healthcare, you know, hey, you were a great charge nurse, we’re going to make you the DON and good luck.

And by the way, next week, can you give me your budget and who you want to hire in the next 2 weeks? And it’s like- and zero orientation. Yeah, no orientation, no training. So we talk about like the little things, and it’s those little things, it’s those little moments, those opportunities to be nice, the smiles, to ask people how they’re doing. Um, I love that, that you say it.

And here’s the funny thing, you, you had a moment I’m following up with you. So I was in Costco this morning and the line was, you know, ridiculous as Costco could be on a Tuesday, of course. So they started doing something like that. They now have somebody who comes in with a finger reader and scans your basket. So when you get to the front, it’s already ready for you to go.

I was like, that’s amazing. But that was an example. Yes, I’ve had that exact experience in Costco. And let me tell you, I left. I didn’t care that I parked, you know, 2 zip codes away.

I didn’t care because that was so cool. Oh, I love it. Yeah, no, I love those. I, I love that. I love that.

Micro moments. That’s an awesome one. Well, that’s wonderful. I, uh, I love, I love the dialogue we’re having here, Rosie. Um, all right, so next, next topic.

We’re gonna switch into a little something. So when you think of nursing And sometimes this could be controversial because you brought up a point a little earlier ago where you said, you know, as a nurse, most nurses were trained, we take care of the patients. That’s my job, take care of the patients. You know what I’ve seen a lot, and I’ve seen it more in rural healthcare, that’s a big part of our focus, is you’ll go in and you’ll have challenges at times between maybe, say, the nursing staff and rev cycle or nursing staff and supply chain. And you might have experienced experiences in your past where, hey, we’re not collecting copays in the ED because that’s not my job as a nurse.

My job is to take care of patients. Or, um, I’m not scanning all the supplies in the ED because, hey, my job is to take care of the patients. I don’t have time to check the stickers or scan all this stuff. You know, you’ve been through the gamut. You’ve been, you know, the Mach 1 Mod Zero brand new nurse.

Now you’re in nursing leadership. You know, can you tell me how your thought process may or may not have changed over so many years when it comes to like, hey, how do we holistically look at being a better nurse, being a better provider, being a better admin? Because to me, you brought up a great point. Admin has to be willing to do it. Nursing has to be doing it.

Providers have to be able to do it. We all have to work together to make this big machine work. And from the nursing side, I’d love to hear your perspective.

That’s a really big question, Steve. Um, but I have to tell you, I think it comes down to, um, what does it actually mean to take care of a patient? And frankly, it’s a community. It’s the, the patient is now the community. Um, what does it actually take and what is my role in it?

So let me start with, um, maybe a, a ground-level understanding of- maybe it’s a mindset shift, but, um, I used to- so I spent 25 years in, in one organization. That’s a long time. And I, I learned so much, tremendous experience all around. But a turning point for me was when I said I work for X. I work for Bayhealth. I’m currently deployed here as the chief nurse executive.

I work for Bayhealth. I’m currently a nurse in the emergency department at X campus. But the, the reason I say it that way is that we are all here. To have rally around the same mission. We’re all here to care for patients.

I love executive rounding. So here’s a great example of this. I was assigned for executive rounds to plant ops at one of our campuses. And like, OK, as a nurse, yes, I know. I’m calling them when the elevator’s broken, I have water shooting out of the sink, plant ops.

So I go in, I said, okay, um, tell me about what you do here. And the, um, administrative assistant for the department said, we take care of patients. I was like, yeah, I love it. I mean, it was a moment. And of course I’m freaking out.

I have a lot of energy. I’m an eye on the disc, if anyone’s, you know, tuned in there. Um, I was like tell me more. What does that mean? So what that turns into is, you know, the nurse who is, um, you know, my favorite nurse.

I refer to someone called Joe Nurse. Joe Nurse is like, um, everybody’s nurse. So I use Joe Nurse as an example. And, um, let’s say Joe Nurse is stashing linen and supplies in like a, you know, a spot in the patient room where they know they’re going to have the items when in fact maybe those items expire, maybe they take them away from another patient, something like that, because they’re not really sure, they’re not secure that linen’s going to come when they say they’re going to come, that kind of thing. So let’s talk about Joe Nurse and how can we not have them do that?

How can they be in tune with supply chain? They can say, listen, what we do, we are here to take care of patients. So my role here is to be seamless with my partners and say, OK, supply chain takes care of patients. I take care of patients. One of the ways that I can contribute to that is not stashing supplies that are going to expire and going to be expensive.

Because my patient needs to, you know, we need to be thoughtful in our finances so that we can be here for the long term for our patients. It’s making connections like that for people. And I also, I have to tell you, since I’m on this little soapbox on this, you know, you can tell the difference between nurses who really understand that whole picture, how we all contribute to the greater mission. And I think that’s how we pull it all together. Another example is how does the- how does coding, how does the coding department contribute to taking care of a patient?

Well, they keep us really honest in our records. They allow for what the reimbursement is so that the reimbursement can come back and we can maintain sustainability so that we’re here for our patients. Is this resonating with you? Absolutely, absolutely. So, you know, I, I’ve had a similar experience, and like with food service or environmental services, right?

Like you go down and, and I love when we go to new hospitals, walk around. I love meeting everybody and get a chance to ask the same questions, you know, what do you do here? Uh, you know, and you’ll get the I clean toilets or I, you know, I mop the floors. And it’s like, you are in charge of infection control. You are one of the most important people.

And I’m sure you’ve been in so many hospitals. One of the first things I do is I typically go into the restroom because you can get a great sense of how good a hospital is and how well people care for it. And it’s the same with environmental or food service. You’re walking into the food service and man, the pride that they take in their cafeteria, that everything looks good, the food tastes good, that’s nutritious. I love that.

My little anecdote to that side of it is, I’m sure you’ve seen the movie Top Gun or Maverick, one of the greatest movies of all time, right? I totally agree. So Chris, Force Master Chief Chris Ingalls, was the Command Master Chief of an aircraft carrier. And I asked him one time, I said, you know, Chris, describe to me a hospital. And he’s like, oh, Steve, this is easy.

A hospital is just like an aircraft carrier. I said, oh, I said, how is that? I’m not catching it. He’s like, you know the jets going off the front of the aircraft carrier, the one everybody’s looking at, think it’s the coolest? He’s like, those are the docs, right?

Everybody’s looking at those docs, they’re all excited, they’re doing all that, but nobody thinks about how much everything has to go on behind the dock to make it all function, right? The 400,000 gallons of fresh water, you know, the 36,000 meals a day, all the cleaning, the laundry. The, the steam pipes, the mechanics, all those people work to make that jet go off the front of that aircraft carrier, right? And all those people are the same in a hospital. You have food service, environmental service facilities, you have the nursing, you have everybody doing their job to make sure that ultimately that doc can provide care to that patient, or that nurse can provide care to that patient.

And, you know, To your point, it’s being on a team, right? You have heard- I’m sure you’ve heard the saying, “There’s no mission without the margin.” I think that’s another aspect that we talk about all the time because you get- it’s not uncommon to hear like, “Hey, that’s not my job. My job is patient care.” But it- to your point, you brought up a great thing about coding, right? It’s coding, it’s registration. All those aspects go to make sure that patients are taken care of properly, that we’re documenting it right so we can prevent medical mishaps.

Mishaps or, uh, errors that occur. Uh, I’m sure you’re familiar, uh, Johns Hopkins study in 2016, 255,000 deaths a year on average of medical mishaps, the third leading cause of death in the United States. There are so many aspects that go into that for quality, for taking care of them, from billing, coding, registration, nursing, to the providers. I think it’s a, it’s a huge aspect, and I love the way you brought it all together. In that direction.

All right. So I’m with you. Please. Just a quick anecdote. There was a- I worked for a really wise nursing vice president at one time.

She’s just amazing and huge impact on my career and life. And she said, you know, healthcare is filled with very difficult problems, whether they’re clinically related, risk, corporate compliance, supply chain, you know, what is more complex than a hospital supply chain? I mean, that is really complicated. But here’s what she said. She said, start with the patient, work your way back.

And that is a never-fail strategy. Start with the patient, work your way back. How does this affect a patient? And let me cover all the steps I need to in between my patient and what, you know, the problem that we’re trying to solve. Really key for me.

I love it. I love it. All right, let’s get into our next discussion. So in the terms of healthcare nationwide, we’re going through all sorts of challenges right now, uh, CMS challenges, changes to Medicaid, Medicare, uh, the Rural Health Transformation Fund, all sorts of things going on. I would love to get your take.

Think of it in the macro, you know, big healthcare on the nursing side, and then I loved it in smaller communities. So let’s talk big nursing and big changes, how you’re seeing this affect things. Yeah. So really large scale, watching a number of things. So I have a great seat at the table here.

I’m the president of Delaware Organization for Nursing Leadership presently. So I get to be at that national table when we’re talking about The American Organization for Nursing Leadership, American Nurses Association, talking about the American Hospital Association. You know, really, when I think large scale, I first go to, let me see what the professional organizations are thinking. Because that’s going to really help with the trickle down of how does this affect my patient. Frankly, my patient.

And nationally, there’s just so much going on and it continues the pace of change. It’s like somebody’s got their hand on the button on the treadmill that just keeps kind of going up and up and up. So I think the theory of, I don’t know what comes next, but I’m going to be really tuned in. Is very important. I also think we’ve got to be, as healthcare leaders, we must be listening at the legislative tables, at the federal legislative tables.

We have to be listening and thinking, how is this affecting our patient? And frankly, how is this affecting our ability to deliver care? Because there is a lot at risk there at the national level. So I think it’s, you know, you have to have a seat at the table. If it’s not you who has the seat, please know who in your organization does so that you can be talking about that.

You know, I really gravitate towards legislative issues with this kind of discussion, Steve, because that hits national, regional, and then local. Regionally, it is so- I’ll say it is so hot in Delaware right now. I just can’t even believe this legislative session has been just remarkable. So much going on. So let me, if it’s okay with you, I’ll talk a little bit about that legislative piece and then maybe a little further into rural health because that’s kind of- that’s one of my hottest topics here.

So, um, in Delaware we’ve got this really great, um, mix of individuals in the legislature. Our Speaker of the House is a nurse, and, um, that has been wonderful in terms of shedding light on healthcare. It has shed light on healthcare. There are a number of things going on here to make public comment, um, at the House and Senate for a variety of bills that have gone forward. Critical to be understanding what legislator is interested in healthcare and to having face time with them.

I think legislators, they want to hear from us because remember, most of them are not coming from a healthcare background. So I think that’s a key element. And then, you know, so a number of healthcare suggestions, bills on the table this year. But let me also talk about some of the key partners here. You know, there’s one thing to be said for, you know, the government relations leader in your organization.

It’s better to be directly connected with your legislator. So I have a number who I sort of ping here and there. Hey, how are you? And what sort of happens in return is that then they call me and say, oh, well, you’re chief nurse here in Delaware. What’s the, you know, what’s the real deal?

Which is exactly how we want that to be. Absolutely. Yeah. And then we have to, I think it’s important right now for health system leaders to be modeling scenarios. Now, this may sound like a, I hesitate to say this to you with your extensive military background, but this may be sort of a wartime tactic, but we have to model what the actual effect is going to look like if some of this legislation passes, some of it plays out, you know, create those scenarios and model what it’s going to look like so that we are not behind the 8-ball.

Because remember, our patient is the one that we are responsible to take care of. No, I agree with you. So I think that modeling, you know, wargaming, war rooming, I think you almost have to because you never know what ultimately is going to occur. And, you know, goes back to our very beginning conversation, we said, right, you need to be prepared for the unknown. And it’s a lot easier to have a series of possible solutions in your back, or at least even going towards the right direction.

Yeah. To be able to get there. You know, you think about, uh, this is a great example. You go back to being an ED nurse, right? You had a base understanding of everything you needed to do in ED, but you never knew what was coming through the door.

And so when it came through the door, you knew you could adjust based on your training and education to adapt to it. Same as being a pilot, you know, uh, or in the military, we say everybody’s plan is great until they get punched in the face, and then, or you get shot at. So, uh, you know, I think that’s a great approach to it. I think, I think the other thing that people are worried about- nobody likes change, um, that is proven over and over again. Nobody likes change.

And so that change, that uncertainty, yeah, causes a little bit of consternation and fear. I think the other thing I would throw out to people is educate yourself, right? Take the time to understand what’s going on, whether it’s at the federal level or the state level or the local level, that will affect you. Because a lot of people will start- Facebook and Twitter and all these other itters and adders and whatever else they call them these days. Um, it’s easy to post something and it not be accurate, and then all of a sudden it catches like wildfire.

And so I would say to educate yourself. Now, looking down at the community level, at the smaller level, like at your hospital, now it’s affecting you, or the smaller communities in Delaware, you know, how do you think the future of nursing is looking and the challenges you’re going to face in, say, the next 3 to 5 years? Yeah, so I- we’ve talked about legislative, um, impact. That’s certainly one. But I think one of the pieces, one of the things that we’re going to have to really think about is, um, sort of how do we scale as the community grows.

We’re in a really unique spot here, Steve, where our population is seriously growing and we’re an independent health system. So we have to be sort of right on with, um, keeping up with the needs of the community. And, um, internally what that means is how do we effectively systemize and then scale as needed? A little bit further into that, knowing where we need to scale. So here’s an example, um, and I’ll talk about sort of how nurses intersect this.

Right now there’s a huge sign when you come into the state of Delaware from a variety of different directions that says Delaware is the best place to retire. Okay, people are doing it, they’re doing it. And what we see is an influx of people who, um, you know, post-COVID, work remote, I’m gonna buy my dream house at the beach and I’m going to, you know, continue to work remotely for a number of years and then I’m already in my retirement spot. Great, wonderful, welcome to Delaware. We have to provide healthcare.

So we’ve got to, you know, maybe we are doubling down in how we’re gonna care for adults as they age. Well, we’re also having an influx of of families. So now we’ve got to look at how are we in the education system. So we actually partner with the state. We’ve got health centers in every high school, and we’ve got those sort of in the Kent and Sussex County areas.

But those are the things we’re going to have to think about. And here’s where I see nursing in that. We’ve heard this before, But we really have to do it, and that is push down the walls of the hospital. We cannot be limited by the walls of a hospital. Nursing can, and frankly should, be in the leadership zone for how we are caring for our ambulatory population.

That’s where it’s going. You can pull any kind of healthcare business. Article and it talks about the, you know, double down in ambulatory. What’s your ambulatory surgery strategy? What’s your, you know, how many days is it for a primary care visit?

Nursing can lead in that space, not just in advanced practice, but, you know, nurses are tremendous at the innovation. So, you know, I feel really lucky here in my organization where I, you know, I have the opportunity to have nursing grow into that ambulatory zone. That’s awesome. Rosie, I know we are getting long on time and I want to tell you thank you so much for joining us on the H&H Impact Podcast. It was awesome getting to talk to you, getting to know more about you and your philosophies around leadership.

And I appreciate it. I know we’re going to have you back on the podcast in the future. Awesome. Um, it was wonderful. So thank you so much for your time today.

Uh, everybody check out the H&H Impact Podcast. This will be Podcast 13 with Rosemary Worcester and Steven Hartz talking about, uh, challenges in nursing, nurse leadership, and, and how nurses, uh, they change the world. They absolutely do. Absolutely. Thanks so much, Steve.

Thank you.