How can nurses and doctors work together to change the healthcare system for the better? With Jennifer Thietz

[00:00:00] Mat: Welcome to Doctors at Work. My name’s Mat Daniel and this podcast is about doctors’ careers. Today, I’m having a conversation with Jennifer Thietz, who was a nurse, first of all, in South Africa, and then in the U. S. And we have a conversation about how nurses and doctors can work together to change the healthcare system for the better.

Now, the healthcare system is in crisis across the world. Jennifer shares her experiences of working as a nurse across two continents and stresses that by working together. Nurses and doctors are a stronger force for good than either alone could be. Her top tips for doctors include the importance of social chit chat, involving nurses in decision making about patient care, and publicly praising the nurses that you work with.

I hope it’s useful.

Welcome Jennifer. Tell me a little bit about yourself.

[00:00:58] Jennifer: Good morning, Mat. It’s a pleasure to be here this morning. Yes. I have been a nurse for a very long time, 34 years, and I’ve had the privilege to be nursing in Africa and California. I grew up in Zimbabwe and from an early age, I knew I wanted to nurse.

It was something that I had thought about for years. I studied hard. And managed at 18 to get into a nursing program in South Africa. So, I left Zimbabwe and did my nursing training and midwifery in South Africa. Worked there for 15 years after the after my graduation. And then in 2003, we immigrated to the USA, to California.

And I’ve worked in nursing for 18 years in California until last year. And the most of my time nursing, I’ve been working at the bedside. It’s been a profession that I love, but I am deeply concerned about what’s going on currently in healthcare.

[00:01:54] Mat: Thank you, Jennifer. And I invited you for this discussion because I thought that it would be great to have a perspective because you’re a nurse and also because of all of those.

different countries that you worked in. And I thought we could have a global healthcare discussion today. And principally, really, what can we do about it? And how can we as doctors and nurses across different countries work together to make healthcare better across the entire world? And why is healthcare in crisis?

[00:02:23] Jennifer: The COVID pandemic, I think, was the death knell for health care, certainly in America. We’ve had problems for the last, I would say, 15 years when it comes to nurse burnout and compassion fatigue. And slowly but surely over the last years, positions have been cut and nurses are working more and more on their own in the units.

They’re wearing many different hats now. When I first came 15 years when I first arrived in America 18 years ago and started working there, we had nurse assistants who would help with the, the normal tasks like vital signs, handing out food trays, et cetera. But as time has gone on, those positions have been cut, and it’s always, obviously, to do with the financial aspect of running healthcare, and so nurses are now doing all of those positions and jobs, as well as their nursing specific tasks, and it’s just too much, and They are now being taken away from patient care face to face.

They’re working more on computers because there’s a lot more charting involved. And I think nurses are becoming stressed, more and more stressed because they don’t have the support, they need to do their jobs because of all the hats they’re wearing.

[00:03:35] Mat: And do you think is this unique to the U. S. or is this, it sounds very similar to UK, but is this a global phenomenon?

[00:03:41] Jennifer: I think it is. I’ve had the privilege of the last couple of the last couple of years being in contact with nurse leaders in other countries. I have friends in New Zealand. I have friends in Australia, nurses and the UK and just the contact the conversations we’ve been having, I think this is a global problem.

I don’t know about Europe, but certainly the South Africa where I’m from. And in Australia and New Zealand, we tend to be in similar situations that the nurses are required to do more and more with without the support that they need.

[00:04:18] Mat: And specifically, do we have any data that tells us what nurses are particularly worried about?

[00:04:23] Jennifer: Yes, so this is interesting. Mat, I’d like to share Baker’s Healthcare. They had a great webinar yesterday by Incredible Health, and they have a new survey out, which is brand new, hot off the press. And these are the stats. They interviewed a group of nurses, quite a big group of nurses. And 73 percent of these nurses are very concerned about staff shortages, specifically nurses.

I think they’re realizing that they just don’t they know that they just don’t have the other nurses in in their pool. And many of them, when they arrive at work, they are told we’ve, we three nurses down, so you’re going to be picking up. Maybe two or three more patients, so nurse concern about staff shortages is huge.

73%. Then 70 percent of nurses are worried about burnout, and they themselves are feeling the effects of working in these conditions, and so they are very concerned about their own mental health. 70 percent 7 out of 10 nurses are concerned about how they are responding to pressures at work. We have 68 percent who are concerned about salary.

And as we discussed previously, this really depends on the state. Some states of the nurses are very well paid. For example, California, where I’m from, we were very well paid, but other states are not. So that is a concern for them. 45%, and this is a huge concern. And I think healthcare organizations should really be looking at this.

They work environments. So almost half 45 percent of nurses and they actually label this as a major concern. Are they work environments? They feel unsafe. They feel they’re providing care that is subpar. And so, this isn’t a real issue. 30 percent of nurses are concerned about scheduling.

Again, this is, life work balance. And they want to be more flexibility. in order to have their lives at home do what they need to at home. And so, 30 percent feel they are not able to work the way they would like to regarding scheduling. And then 25 percent would, a quarter of the nurses are concerned about limited career advancement, which I found very interesting too.

Generally, I was a nurse supervisor and leader, and we would take time with our nurses to speak about what courses they might be interested, what was available if they were interested in other different sections of healthcare, for example, if they were oncology, they felt burnt out, maybe going into endoscopy, et cetera.

We would discuss that, but 25 percent feel that they are really limited when it comes to career advancement, which again is a concern, I think, for our healthcare organizations, because you’re losing nurses because they feel that they don’t have a path forward. They’d rather go elsewhere.

[00:07:03] Mat: I suspect that those numbers are replicated.

In the UK where I work and probably also across other professions, the allied health professionals, speech and language therapists, audiologists, as well as doctors. I want to start our conversation with what all of us can do on a day-to-day basis. I’m going to come on to the bigger picture in a minute about how we can change the world together.

But let’s imagine, I’m going to go to work. And I’m going to be working with the nursing team, and I’m wondering what can I do to make nurses lives better? And what can nurses do to make doctors lives better?

[00:07:39] Jennifer: What a great question, Mat. And this is, this really is the crux of a happy work environment is the relationship one has with each other.

I think that communication is vital. And I know because I was working at the bedside until, a year ago. I know how important it is to be able to communicate with my team, with my physicians, with my other nurse colleagues, with my other medical health providers. And I think what’s been happening is we are we have become so busy and so focused on specific tasks that many of us have lost the ability to communicate clearly.

And when you’re rushing and distracted, you think you, I know for myself, I think that I’ve said something, I’ve told a physician, this detail about a patient, or I’ve asked for help in a specific way from another nurse. And I think that message has come across, but it hasn’t. And so later on in the day, a physician will come up to me and say did you do this?

Or what is the outcome here? And I’ve thought that I’ve communicated clearly about it, but I haven’t. So, I think. To actually make number one eye contact. I think to stop and, just to stand still and look at each other and make eye contact is extremely important. I think for nurses, we can be we can give a lot of information to our physicians, which is for us, it’s important, but obviously for the physician, it’s not that important.

They want specifics. So, I think in order for nurses to communicate better with physicians we that we use a tool where we can be very specific about, we can say, Dr. Mat, I have a concern about patient by about Mrs. Smith. And this is why I’m concerned her blood pressure is so and so it’s trending down, etc.

Just to have those specifics to be making eye contact to, to really see that my physician is listening and hearing what I’m saying. And in the same way when a physician. Stops a nurse to say, I have these concerns. To make that eye contact, to stop everything, to really be in the present moment to write down those details obviously, because we think we can remember everything.

But when you have a hundred tasks, it’s very difficult to do that. So again, I think it’s just that moment that you’re communicating where you really know eye to eye, I’m speaking and I’m being heard, and then. If there is a situation where the feedback that you get from each other is not sufficient is to say again, sorry, please repeat because nurses, I know we have a lot of respect for our physicians.

We can see they’re very busy, we’ll get a message and we’re not 100 percent sure. And we can see the physician is walking away because he’s got another task, but to stop each other and say, hold on. Did you hear me? Can you just repeat back what I’ve told you, if it’s an important, obviously, and mostly the communication is important, but just to repeat that back.

So, communication is extremely important as is mutual respect. Now, I don’t know what it’s like in America. In England, but I can say in America, a lot of the nurses feel that there isn’t the same level of respect. And so, they, I think this is something and it’s worldwide. When I’m speaking with you and you speaking with me, if we use honey together, we’re going to be making, making something palatable and something good.

But if we’re using vinegar, it might be a little bit sour. So just to have that mutual respect to say, good morning. Thank you so much. Gosh, this is, you just have a little tiny bit of chat as well, if it’s possible makes the world go round. So that, those are the two big things.

Communication, eye contact and that mutual respect from one professional to another.

[00:11:01] Mat: I hope you’re enjoying the show. If you are, please click subscribe so you’ll be notified when new episodes come out. This podcast is part of my mission to help doctors create successful and meaningful careers.

You can be part of that mission, too, by forwarding this show to any one person who you think might benefit from listening. Thank you. Now on with the show. I love that and playing out that mutual respect in acknowledging each other, saying hello to each other, passing the time of day, things that are easy and Arguably, they don’t take an awful lot of time, whether you’re busy, you can say hello in a nice way, or you can say hello in a very short way, one way or another, you’re going to have to say hello, so you might as well do it.

In a way that’s nice and welcoming.

[00:11:49] Jennifer: I would just like to just bring in that one other point I worked with the most wonderful Irish chaplain, and he would always say to me, Jennifer, just basic, basic chit chat is the elixir of life. So, he would say you never waste if you ask, do you have children, is it birthday party, just, it takes 30 seconds, but just that’s elixir of life too, just to have that little bit of a personal contact. That’s also very helpful when working with staff members, as I’m sure, okay.

[00:12:17] Mat: So, when it comes to the workplace, all of us need to recognize the importance of just little social chit chat stuff that takes literally seconds but goes an incredibly long way.

Yes. Yeah. And you’ve mentioned the importance of good. communication. What’s the cost when that breaks down?

[00:12:37] Jennifer: Oh, gosh. Sentinel events is the worst scenario. When you’re not communicating clearly, there are so many pitfalls the risk associated with carrying out orders that are not correct.

The not communicating, a concern about a patient clearly, if we could communicate clearly, I think 50 percent of the errors that happen, maybe even more would not happen. And because it’s just vital to healthcare. And because we are so siloed. And because we are so stressed in our workplaces.

Particularly physicians, but nurses are, I know, because again, I’ve been at the bedside, we are constantly distracted by charting, by telephone calls, by patients, going out and helping patients to the bathroom, et cetera. So, we are always we, our minds are not always where we are supposed to be.

And it’s just the nature of the beast. And so, when we communicate vital information, we have to be present. And the mistakes that happen. I can just, give you a brief example. And there was, my, my daughter’s also a registered nurse. She’s in labour and delivery. There was a Sentinel event about two months ago where a mother was in labour, and they were two nurses in the room and a physician.

They weren’t communicating clearly. The baby strip was of concern to one nurse. But because they, because she hadn’t been able to really communicate that the physician was busy, he was in and out. When they eventually all three got to the point where, oh my gosh, this is a concern, it was too late, and the baby had brain damages and since died.

So, there you have an incident, a settled event. And I think if they had just been more communication at the very beginning when the nurse was concerned, but she felt she was a younger, she was a junior nurse, he has a physician, he has another senior nurse. Why aren’t they picking it up? I feel about, feel this may be a concern, but I’m not communicating clearly because is it really my role in this, in this scenario.

So again, it’s just the importance of communication that could have prevented the second event.

[00:14:39] Mat: What do doctors need to do to encourage people around them to speak up and communicate and raise concerns?

[00:14:48] Jennifer: Mat, that’s a great question. And if a physician ever asked me to, if, asking my opinion as a nurse is fantastic.

I love it. And I’m working with a physician and the doctor says, hey, Jennifer, what do you think about this? Or are you concerned about that? It’s a doorway. It’s an opening. And being able to communicate on the same level and being able to give my input as a nurse is extremely empowering and nurses really appreciate it.

And they are there, they’re the boots on the ground. They are there with the patients 12-hour shifts, eight-hour, 10-hour shifts. They really have a lot of information on what’s going on, but they’re not going to share it. If necessarily. If they see the physician is very busy and you are very busy, obviously, but just that opening.

What do you think? Do you have concerns? It’s just amazing what how the communication can improve with those questions.

[00:15:41] Mat: It’s interesting because I’m thinking. As a physician, if I say, what do you think? I’m wondering, will you think that actually your mat has no idea what he’s doing? He’s asking me that doesn’t mean that he knows what he’s doing, but perhaps he isn’t as good as doctor as I thought he was going to be.

[00:15:59] Jennifer: No, Mat, we as nurses don’t see that. I can, and I can speak for many nurses. I’ve been working for 34 years. I’ve been working in South Africa. I have, huge bedside experience. This is not the case at all. This is, when a physician asks a nurse what they think, it’s inclusion.

It’s gosh, I’m part of this healthcare team. I’m important. I get to say, and there’s never a moment. It’s just oh my gosh, how cool. Physicians asking my opinion, it’s not that I think the physician is in any way doesn’t understand or needs really needs my input.

It’s just a case of, I can give, we are a healthcare team. We can work together. We’re on this as a team. And I’m open to tell my physician and my physician is open to tell me, and that’s the goal really. So no, not in any time, shape or form would it, would a nurse ever feel the physician is.

He doesn’t know. He’s just asking for my input, and we can do this together as a team and I’m important too in this team.

[00:16:55] Mat: So, you’ve obviously worked with, I’m going to say thousands, if not tens of thousands of different positions. So, to give me some examples of two or three that have really stood out, but also why they stood out and how people listening to their podcast can try and replicate that in their everyday work.

[00:17:14] Jennifer: So, I can think of three physicians in the past that I’ve worked with who have really made an impact on me. I had a very good work relationship with each of them. The first one was an older physician. We worked closely together and, going back to the relationship, obviously there needs to be.

be trust built up between a physician and a nurse. So having those daily interactions, realizing that the nurse says, Hey, I’m worried about this physician. I’m worried about this patient. That’s all important as a basis. But when he introduced me to his patients, he would say, this is Jennifer. She’s a fantastic nurse.

She’s going to be helping you with your questions. She’s going to be contacting you, et cetera. So, we would always build me up in front of patients. And that as a nurse, it made me work that much harder because now, gosh, the expectation Dr. Lali is telling me, telling the patients about, about me.

So, it was wonderful just building up each other in front of patients. Number one. The second physician is a young physician. I have deep respect for him. He’s a thoracic surgeon. He is. He’s very laid back and very comfortable to speak with and he’ll say, while we were working together, he’d say, hey, have you read this article?

Have you, what do you think about this? He just conversation and it was academic conversation. It wasn’t just, how’s your child, et cetera. It was, what do you think about this new chemotherapy? What do you. What are your thoughts on this intermittent fasting for cancer patients?

What are your thoughts? So, he would have these conversations very much as an equal. And I love that. The third physician I’m thinking of was a radiation oncologist and he just had this gentleness about him where when he spoke to me, I, he, it was this respect, deep respect. What do you think, Mrs.

Smith is really battling with this diagnosis. She doesn’t want to go on to palliative care. What do you think, why do you think she’s in this situation? And then afterwards, would you please go and speak with her and discuss this with her and see what, what she thinks. And then, I could come back and say, okay we’ve discussed this.

These are concerns we’ve addressed these and yes, she’s open to palliative care. And so, it was just, again, teamwork. What, being there as a team and it really is extremely effective. I think physicians can use nurses. To really improve the care of their patients by letting nurses oftentimes be the mouthpiece, you and having them there because they spend so much time and they build up their own relationships with these patients and patients to, to a large extent, respect nurses and will hear what they are saying.

[00:19:51] Mat: And it’s that the different relationship with the doctor, it’s typically very transactional short term, isn’t it? Correct. Correct. Whereas the relationship between a patient and a nurse is inevitably much longer, even if I think of somebody who comes in for a day case procedure, they’re going to be with that nurse for eight hours, they might be in a day case procedure, and they’ll spend eight hours with the nurse.

It’s been five minutes with me, right?

[00:20:19] Jennifer: And Mat, another, just an interesting point is the way and I’m trying with my book, I’m trying to teach nurses to communicate in a way that, that a physician is open to, for example just ambling on and saying, oh, doctor, this blood pressure was this, and this patient had, was stating so and I think the nurses need to use code and I think when a nurse says to, to, to you, Mat, I am very concerned about, I think that should be, there should be terminology between a patient, between, sorry, a provider, a physician, and a nurse. And I think using certain word words to really get that message across that the concern is there is vital.

And I think physicians and nurses together can build that up and say, hey, if you are concerned about a patient, you have to tell me directly, don’t go on about this and that say to me, I’m concerned about the patient because of this. And if you use that terminology, then that physician is all there. A hundred percent.

I’m hearing, what is it that you’re concerned about? So just to get to know each other enough that you have this. Speech with this terminology.

[00:21:24] Mat: Okay. So, in terms of tips for doctors, it worked so far. So, I’ve got social chitchat I’ve got ask the nurse what they think and involve them to be part of a team.

I’ve got publicly praised the nurses and build them up and also have those academic conversations. Yes. So, what about the people that you worked with that haven’t been great. And what could I, or what could other doctors learn from some of the bad doctors that you’ve worked with?

[00:21:54] Jennifer: Okay. So, I had a physician that I worked with my team of nurses who would not, and I’m sure with the electrical, the EMRs that the medical records, we do a lot of communicating on an EMR with the physician. They would send a message concerned about this or what, whatever about the patient.

Mrs. Smith has run out of this prescription, please renew, whatever it was. And they would have no response from that physician, nothing, not a. Not even a T H X. Thanks. There was, you did not even know that physician had received the message. Now this makes an enormous amount of extra work for the nurse, because the nurses are worried.

It’s five o’clock on Friday afternoon. This patient must have this medication over the weekend. I need that prescription. Has the physician actually done this for this patient? I would say just. Even if it’s a thanks, three letters, even if it’s a yes, one word, just to acknowledge that when a nurse communicates with you and just basically say done, whatever it is, so that the nurse doesn’t have to go looking for that information.

That’s a really important part of keeping your nurses happy.

[00:23:04] Mat: Let’s move on to the bigger picture then. Healthcare is in crisis the world over. Why are we as doctors and nurses together standing up for better healthcare? Why are we together more powerful than we are as individual professions?

[00:23:21] Jennifer: That’s a great question. And I address this with my book again we, as, so nurses are over 50 percent of the healthcare workforce. I don’t know exactly, but it’s, it is over 50 and 90 percent of patients are touched by nurses. So, we are a huge force when it comes to the contact we have with patients.

And I think when nurses unite, and even more so if physicians are on board with nurses when we can say we have we have a concern about X, Y, and Z I think that the amount of voices that we can have out there, I think using tools like LinkedIn is vital because people are active on LinkedIn.

And when conversations are started, if a physician says, for example, I’m working with a wonderful physician who is concerned about his nurses. And so, he will post. Concerns that nurses have or articles or Becker’s review on his way on his LinkedIn site and the conversation that starts is amazing.

There’ll be nurses from Kentucky. There’ll be physicians from here. So just to start that conversation and get people’s attention to the shared problem that is. We also have patients; we are a team. The number one, the patient is what, why we come to work, whether you’re a nurse, no matter whether you’re a janitor, physician, we come to work because of our patient.

If we can share this and have conversations about what we are doing to try and help patients or not help patients, it’s, I think this is vital to move the message forward globally. We are in a crisis. We need to acknowledge that. Why are we in a crisis? We are all short physicians. We are shorter physicians, nurses.

What can we do personally about that? Those are all very important factors and together our voices, millions of voices, can move can start movements, can get the message across. If you’re sitting on your own, you, on you can affect the patients and the physicians you work with one on one, but you don’t have that same power to do it collectively.

[00:25:22] Mat: And how can we make change?

[00:25:26] Jennifer: So how do we make change? We this is a little shout out to a chap called Greg Satell. He’s written a great book. He’s a world expert on transformation and change. And he’s, so I’m giving you his tips. If you want to change something, you need to go to, thank God, to the digital world, because in the old days used to march in the sun and the rain and all the rest.

We don’t have to do that anymore. But what we can do and we can become extremely powerful as we can start in our small social groups, whether it’s a small social group on Facebook on X on, particularly LinkedIn is very powerful to start commenting to start bringing out ideas and then those posts, hashtags, those those messages are given out to a greater group and a greater group.

And it’s like a ripple effect. And the more comments, the more we can share, the more we can have people looking online and saying, oh yeah, that’s something that pertains to me. And these, this is affecting these, this affects my patients. This affects me or my, my, my colleagues. So, you get that ripple effect going and you build up allies, you build up a name for yourself.

You build up, there’s going to be conflict. They’re going to be people that disagree with you. But the more that conversation gets out, the better. So, it is a digital world, and we need to use our social platforms to get that message out that we are powerful and together we can make change.

[00:26:54] Mat: Wonderful, thank you.

I’ll perhaps bring our discussion to a close and maybe I’ll ask you to give what would be your top tips for doctors, for physicians at work.

[00:27:04] Jennifer: Number one, top tip. You are amazing. Your nurses who work with you think you are fantastic. We have deep respect for you. So just don’t forget that you are amazing because I think in the hustle and the bustle, physicians and nurses tend to forget the impact they’re making.

So, you are life changes. The second thing I would say is what comes out of your mouth has such a profound effect on your patients, on your nurses and, the same with nurses the smallest thing, the smallest bit of kindness, the smallest touch. It goes a long way for patients and, for nurses just to have that interaction and that respect and then just keep going because without you there’s nothing we can do in healthcare without our physicians.

And we here as a team as nurses, and we want to be, we want to be there for you. We want to be able to support you. So just, it’s that kindness. It’s that. Just that moment of connection with your patients and your nurses and stay strong, look after yourselves because we are all going to end up as a patient one day, each of us, you, me, all our loved ones.

I have children, grandchildren. It’s going to, we are going to be needing that nurse, that physician. And so, anything we can do to build up nurses and physicians as a group, we need to do because we need each other, and our patients need us. Wonderful.

[00:28:19] Mat: Thank you very much.

[00:28:20] Jennifer: You’re most welcome. Thank you, Mat.