Our guest: Suzanne “Suzi” M. Waddill-Goad, DNP, MBA, RN, CEN, CHC President, Suzanne M. Waddill-Goad & Company, Inc.
Welcome to our podcast, where we explore critical issues in healthcare leadership and patient safety. Today, we’re honored to have Dr. Suzanne Waddill-Goad, a licensed nurse with extensive experience in healthcare leadership, including serving as a Chief Nursing Officer.
In this episode, Dr. Waddill-Goad shares her invaluable insights on the evolving landscape of nursing and healthcare over the past few decades. Drawing from her wealth of experience, she delves into the challenging topic of drug diversion in healthcare settings, recounting personal experiences that underscore the gravity of this issue – including two heartbreaking incidents where diversion led to loss of life.
We’ll also discuss essential strategies for new Chief Nursing Officers, gleaning from Dr. Waddill-Goad’s expertise on what every CNO should prioritize when stepping into this crucial role.
Additionally, we’ll explore her groundbreaking research on leadership fatigue, which formed the basis of her dissertation. This work has since blossomed into three co-authored books, which we’ll be highlighting with links for our listeners.
Join us for this enlightening conversation that bridges the gap between nursing leadership, patient safety, and the personal toll of healthcare management. Dr. Waddill-Goad’s unique perspective promises to offer both practical insights and compelling narratives that will resonate with healthcare professionals at all levels.
Stay tuned for an episode that tackles some of the most pressing issues in modern healthcare leadership.
Book links: Sigma Marketplace | Beyond Burnout, Second Edition, Sigma Marketplace | Workbook for Beyond Burnout, Second Edition, Sigma Marketplace | Business Basics for Nurses
Transcript:
Terri
Welcome back, listeners, to Drug Diversion Insights. My guest today is Dr. Suzanne Waddill-Goad. She is a licensed nurse and has extensive experience in leadership, including roles such as chief nursing officer. And it is from this perspective that she will share her experience with diversion events. But before we jump into that, Susie, welcome and tell us a bit about your career and how your work focused. Focuses. What your work, what work you’re doing now, what are you focusing on now?
Dr. Waddill-Goad
Great. Thank you, Terri, for having me as a guest. Let’s see. So my clinical career began very young, so I had some experience as a respiratory therapy technician. Then I moved through a number of different roles when I was actually in college. I did some transcription. I worked in medical records while I was going to nursing school. And then my clinical areas that I focused on in nursing were I just did one year med surg. And then I moved more into critical care. That was really interesting. And the emergency department. And so I had a, you know, pretty broad breadth and depth of experiences with those and then moved into a leadership role probably about the mid-90s. So it’s been, you know, sometime, obviously from then to now. So.
Dr. Waddill-Goad
And I, you know, kind of worked my way, not traditionally into the chief nurse’s office because I was more on the operations side, so doing like, operations improvement and then became the chief nurse. So I didn’t take the traditional path that many do where you’re a manager and then a director, you know, with specific service lines. So it was great because I got to look really across the whole organization, which gave me a lot of interesting information that was useful, you know, in that role. And then about 22 years ago, I started my own company. And so I really wanted to focus on operational improvement. And then in addition to that, do some interim leadership assignments. And so I’ve had many experiences, you know, doing those. Many of them have been in the nursing director roles. I’ve done the chief nursing officer.
Dr. Waddill-Goad
I’ve done quality and risk management, either together or separate. And so I’ve traveled, you know, in many states across the country and seen lots of interesting things along the way and met some very nice people in my travels as well. And so that’s kind of in a nutshell.
Terri
Yeah, that’s pretty cool that it’s neat that you kind of came up from the beginning of. You learned a lot of stuff in health care before you ever got to that CNO role, which I think is great because I think sometimes if they’re too narrowly focused, they don’t. It all interconnects and so you really understood a lot of those things. And, and the interim, I’m curious to. I’ve done a little bit of interim myself, which I think is great. I mean, it’s a different perspective. You’re, you’re in there to do the job, but there isn’t that whole political tied up with. I mean, I found it to be a little bit liberating, actually.
Dr. Waddill-Goad
It’ refreshing.
Terri
Yes. You can make changes, you’re there to. Yeah, yeah, that’s neat. So you’ve been in healthcare as long as I have, so you’ve seen a lot of things. I’m curious to hear from your perspective, what has changed when it comes to nursing. I mean, I’m, I see it from the pharmacy perspective, but I hear it when we’re talking about holding people accountable because of diversion risk and all of this stuff and, oh, you can’t go outside your scope. And the more mature nurses get a little frustrated. It’s like, why? I mean, I know what I’m doing. I know more right than the bedside what to do. So I have seen that change, I think more restrictions, shall we say. What is your perspective on how things have changed with nursing over the years?
Dr. Waddill-Goad
Well, I think it’s pretty interesting now that we have five generations of people in the workforce. And so like you described, you know, we have novice all the way to, you know, expert nurses practicing in addition to that. And we’ve had so many changes, like with thinking about, you know, during the 2000s when we started getting, you know, electronic records of whatever type, you know, for a lot of them started with order entry, so, you know, like with pharmacy, you know, to begin and then, you know, move more into an electronic health record. And so I think that, you know, that’s been a big change.
Dr. Waddill-Goad
I think the other thing is now looking at different new models of care and so trying to figure out, are there new ways to do the same work and better ways to do the same work, you know, and can we leverage the knowledge of the nurses who are expert nurses who many of which may be thinking about leaving the workforce, but leverage their knowledge in a way that can help onboard, you know, some of the more novice or younger, you know, younger in the profession of nurses. And so I think that’s kind of an exciting thing that’s changing. The other thing that I see that’s changed a fair amount is the amount of stress and just trying to do more with less trying to do things in a probably not as efficient way as maybe we should.
Dr. Waddill-Goad
Sometimes we’ve been victims of adding another form. And it can be an electronic form, it can be a paper form, but it’s always adding more, more. And rarely do we actually stop and look at the entire process without adding more things to do. And sometimes we end up doing things that I term sort of nonsensical and they’re non value added just because we always have. And so, you know, a big process person like, okay, let’s look at how this, how the work gets done. Let’s make sure the right people are doing the right work. You know, you mentioned scope. So make sure everybody’s working within their scope of practice and specifically for nurses to the, you know, top of their license. So are there things that are appropriately can be delegated, you know, to other skills? And the answer is yes.
Dr. Waddill-Goad
But, you know, delegation itself is a skill. And not everyone, you know, has been, you know, probably trained necessarily in delegation. And, you know, part of a big part of delegation is supervision. And so just because you ask someone to do something, you know, doesn’t mean that they’re not necessarily going to do it. And that, you know, part of delegation is following up. And so you have to make sure you close the loop, you know, So I think some of those things with, you know, all these generations in the workforce, people, you know, having different things they want from work, you know, different experiences. We have many different cultures, you know, and so you add on all of those things, and I think people are feeling a different kind of stress. And so I think with that comes ways to mitigate the stress.
Dr. Waddill-Goad
And in some cases, you know, like I found in my own research on leadership fatigue, some of the choices people make are not as healthy as they should be.
Terri
Yeah, but you’re speaking my language. Yeah, we don’t want busy work. And we’ve got to look at things, you know, from that big perspective to see what should we be changing and doing that. That all perfectly makes sense. I’m curious. I’m sure you’ve heard, you know, nurses eat their young or it’s a really tough. They’re really not very supportive for new nurses coming in. Have you seen that? And okay, has it always been that way or do you think that has come with.
Dr. Waddill-Goad
Oh, no, I would say it’s been that way since the day I said, which has been many decades ago. Okay.
Terri
So we can’t blame that on the.
Dr. Waddill-Goad
It really is not. It’s not a new thing. And it sort of is. You have to prove your smarts, I guess, is sort of what People are after, you know, which really is not a good way to onboard people, especially people that are new, you know, to the practice. It really is much better to have a wing person, you know, and be on the buddy system, I mean, which is great, you know, and to really have good preceptors that one, are interested in precepting and two, are good at it. And not everyone should do it.
Terri
Right.
Dr. Waddill-Goad
That’s the other thing is making sure that, you know, we pick the right people to onboard, you know, new people and, you know, kind of train them in the. This particular organization’s way. And these are policies, and these are procedures, and this is how we want you to practice and have some standards that are very specific. And I think when you do that, you develop a culture where the nurses will hold each other accountable. I’ve had many leadership roles, either in term or permanent, where rarely did some things get to my desk or my office. They were dealt with by peers, which is good, you know, because it’s like, we don’t do things that way. And so, you know, we do things this way. And this is. This is the standard that we all want to, you know, ascribe to.
Dr. Waddill-Goad
And so I think some of those things are good.
Terri
Right. Yeah. Well, and it’s a patient safety issue, too. If your new people don’t feel comfortable going to the more seasoned people, then they, you know, might be doing things they shouldn’t be doing. But they’re afraid to ask.
Dr. Waddill-Goad
Exactly. Yeah. You don’t want to have a chilled culture so that people don’t have, you know, the confidence that you can speak up and speak out. That’s very important, you know, as you know, for patient safety, that everyone, regardless of your role, needs to speak up if there’s something isn’t right or they.
Terri
Feel it’s not right. Yeah. So let’s talk about diversion or impairment on the job. In all of your years, have you run into any situations where this has been a factor and you’ve had to deal with that?
Dr. Waddill-Goad
Oh, yes. I’ve seen that in many of my roles. Unfortunately, I hate to say that, whether they’ve been permanent roles or inter. I’ve had experiences with both. I’ll tell you about some of them. Some have been, like, the best nurses that no one would ever suspect. I mean, which is fairly typical, where they don’t get questioned. They’ve also been with people who float who, you know, are really usually very well received because they’re going around helping everyone. Well, that’s great, but, you know, with that, you need to have some other, you know, controls in place. One of the other, probably the most memorable one was when I very first started my own business and I was doing my first interim role, very large hospital, complicated, had a lot of problems, had a turnover of leadership. And I went.
Dr. Waddill-Goad
And I’ll never forget, I got two phone calls while I was there that are burned into my brain. One was in the middle of the night and. And the person on the other end of the phone said one of the techs in a department had gone missing. And I was like. And they’d already talked to their supervisor. And the supervisor called me and they said, hey, we can’t find this person. And I was like, what are you talking about? What do you mean you can’t find someone?
Terri
What do you mean?
Dr. Waddill-Goad
So I said, well, you better start sort of a search party within the hospital and see if you can find out where they were. Well, unfortunately, this particular person had obtained access to drugs even when they were not licensed. And I mean, we’re talking about, you know, drugs of abuse, and so managed to get their hands on something that they shouldn’t have, which was a narcotic, and decided, for whatever reason, which this has not been my experience with, except for in this particular location where people actually did the drugs that they diverted on duty. I mean, my experience has been more typical that people take them and don’t do them while they’re, you know, on duty taking care of patients. Which is better. I mean, it’s not good. Either one of those are not good. Right.
Dr. Waddill-Goad
But anyway, so they find this person, you know, unconscious, and then. And subsequently she actually died. Yeah. So, I mean, it was horrible, and it was a horrible thing. So that was the first one. And then within about two, probably two or three months later, in my office during the day, it was on a weekday in the hospital, and 1:00 I get a call from the OR that said, hey, you need to come down here right now. We just had one of our. And this was anesthesia tech go on a break. And he didn’t come back. And so they were like, what? Where is he? So they go looking and they go into the break room and into the bathroom and had to find the key because the door was locked. And this particular person had OD’d on while. Also while on duty.
Dr. Waddill-Goad
So, you know, had a needle hanging over his arm kind of thing. I mean, now, as you know, both of those situations not only are complicated for the people who work there, you know, for the organization itself. But there’s so many regulatory bodies, and, you know, people have to be notified. And so it brings on a whole cascade of regulatory and, you know, survey processes that take years, really, to recover from. And so those. It was. It was shocking. I mean, there were many things that happened in this particular organization that I had never heard of, never seen, because I had come from, you know, like, the hospitals that I had worked in and that I had run, like a division or a department, you know, were really by the book.
Dr. Waddill-Goad
I mean, I’ve always been a very good rule follower, you know, when the rules make sense. And so I tried to encourage other people to do the same, you know, and if it was a rule that didn’t make sense, well, let’s figure out why do we have it? And is there any way we can change it, you know, make it better, for example? But this particular hospital had a culture that was really different. And I mean, I’m sure it got this way, you know, over time. It wasn’t an overnight kind of thing, but those were, you know, two that were very, you know, radically different than others.
Dr. Waddill-Goad
And then I’d had, you know, other situations where, you know, depending on what kind of surveillance was used, you know, typically by pharmacy, you know, making sure the reports get to the right leaders, and the leaders actually follow up on the report, you know, and act on the information. Because it doesn’t do us any good if we get reports and we don’t look at it and we don’t use it, you know, and these were really kind of reporting mechanisms that looked at, you know, standard deviation. And so was this particular nurse, you know, sort of outside the box of what looked like it was acceptable, you know, with the rest of the patient volume and the rest of the nursing staff. And so, you know, sometimes it was just sort of, you know, on random surveillance, I guess we could call it that.
Dr. Waddill-Goad
You would identify something and then somewhere, all the way, like I said, to, you know, being really extre.
Terri
Yeah. Wow. So, yeah, a couple. A few takeaways. One is for the hospitals think it’s not happening at their location. You know, it is. I mean, you saw a lot of it in various very degrees. And then in terms of your two people that went missing, you specifically mentioned the one in the. Or they, you know, they needed a key to open. Open things up. So that, you know, note to self, right. Is like all of these doors, we need to be able to access them from the outside. I’m not sure where you keep all those keys in an organized manner.
Dr. Waddill-Goad
For everything.
Terri
But that’s kind of an important part, unless you’re just gonna, you know, unscrew your door and take it off that way. But. And then also the hospital where you had these two incidences, they were clearly different than a lot of the others in terms of their culture and the way they did things in terms of. Because I was going to ask you how many of these places had what you would call solid diversion monitoring programs in.
Dr. Waddill-Goad
Not many. I mean, that was one of the things that after, you know, I had experience with that. Well, I had experience in my permanent roles, you know, prior to, you know, being an interim. And so I knew it was something that was always on my radar. So I actually added it to my own assessment list. So when I would go into. Typically when I go into an organization, especially as an interim, I’ll take, you know, a list of things I want to see. And so I’ll look at, you know, data sources. I’ll interview certain people, you know, just to kind of get sort of the lay of the land. And so that was one of the things that I always, you know, kept on my list.
Dr. Waddill-Goad
And so for clients that really didn’t have a program, I helped them find someone who could help them implement one.
Terri
Right.
Dr. Waddill-Goad
Because like you said, a lot of people believe this is not happening here. It’s not going to.
Terri
Yeah.
Dr. Waddill-Goad
And it’s like, well, okay, I probably can prove you different, you know, if you give me some data. And so, you know, and I think that’s the other thing is that, you know, we have to look after our people, you know, in the event that they make a choice that they’re not looking after themselves.
Terri
Right. Yeah. And not too long ago, recently, there was a hospital that had a diversion incident and the CNO lost their license, albeit temporarily. I believe she got it back. But, you know, the CNO holds some ownership. Usually I just think about the pharmacy director of pharmacists in charge that, you know, is going to end up being in trouble. But the CNO did as well. So that’s. That’s good that you have.
Dr. Waddill-Goad
Well, as you know, I mean, there are so many people that this had to be reported to, you know, law enforcement because we had two dead people.
Terri
Well, and. And, yeah, two. I, like, hopefully you reported the first one so that they weren’t like, why didn’t you report.
Dr. Waddill-Goad
Right, yeah, exactly. So, I mean, so then you have a whole new kind of thing with law enforcement inside a hospital for a death that’s not a typical kind of death. You know, and then there’s all these people that have to know, like you said, the board of Pharmacy, you know, the dea. You know, there are things that people don’t think of. All your regulatory bodies, so state, you know, federal Joint Commission, you know, whatever other kind of quality regulatory bodies. I mean, it was. It was a laundry list of people that just had to be notified. And then, you know, we had to figure out, okay, how do we error proof the systems here?
Terri
Right, that’s what I was going to ask.
Dr. Waddill-Goad
Do you.
Terri
I don’t know how long ago it was. Do you recall what was done, put into place? What. I mean, some of it was probably mandatory.
Dr. Waddill-Goad
Yeah.
Terri
From the regulatory.
Dr. Waddill-Goad
Well, it really was. Yeah.
Terri
Told you what to do.
Dr. Waddill-Goad
Yeah. And so I think there were some, you know, programmatic changes that needed to happen. So things that were, you know, to safety related to safety and to error proof the systems, you know, and just to have better control of, you know, controlled substances that you can’t, you know, and this has always been, at least in my career, has always been a problem, you know, typically problematic in or type areas where sometimes whoever’s using, you know, using the drugs for a patient, you know, you can’t leave them unsecured. And I mean, like laying on a table, laying on the counter.
Terri
Yeah, because both your people were techs that didn’t have accessed.
Dr. Waddill-Goad
Yeah, both were unlicensed, and so they didn’t typically have access. And so it was, you know, like holes in the system that were really exploited. And so it was either, you know, fishing things out of, you know, the old type style of needle boxes or picking up things that they saw that, you know, that you don’t really know exactly what it is and what it’s for. But it could be interesting. I mean, you know, I’m not sure who thinks that way, but, you know, and then really we had to go to the medical staff as well and say, all right, look, you know, if you’re obtaining these, you know, drugs for use, you have to close the loop.
Dr. Waddill-Goad
And so one, you have to keep them in your control, and then secondly, you have to waste it and make sure that you know where it went, you know, from the moment you accessed it to the moment that either the patient got it and it was done, or if you had some leftover, to waste it properly, you know, close that loop. And so I think, you know, just helping people understand that. And like you said, you know, there’s a lot of things in most people’s license that they read once when they get licensed. So they forget that there are all kinds of things that, you know, you’re responsible for and that you can be held accountable for.
Dr. Waddill-Goad
And so I think that was the other thing is just having a refresh of, okay, you know, most all licensed people in healthcare, you know, have an obligation to, you know, pay attention to what their peers are doing.
Terri
Mm.
Dr. Waddill-Goad
You know, and if you see something, you better say something, you know, and especially from a patient safety standpoint, because none of us would want to be the patient and have an impaired provider.
Terri
Right. Well, I would venture to guess in that or after that event, they saw things very differently, even without you needing to tell them. Right. I mean, I have found from my experience, procedural areas of all sorts especially, they’re kind of like this close knit family. And like, oh, we wouldn’t do that. We don’t need to worry about that. Nobody here would do that. And so they’re a little bit more, I don’t know, they can be a little. Don’t tell us what to do. We got this under control.
Dr. Waddill-Goad
You know, I mean, it can be kind of incestuous. I mean, that’s a good word because it’s like, look, you know, were not trying to break into your group.
Terri
Right.
Dr. Waddill-Goad
But we want to make sure you’re following the rules.
Terri
Yeah, yeah. And protecting. I mean, because you may not realize it. You know, you started off by saying a lot of these were the best nurse that, you know, people didn’t realize it. And so you just then enable this person to hurt themselves more because you refuse to do your due diligence, which you should be doing anyway, you know, per your license. Right. So take care of your. If you really care about your people, then, you know, make sure you discard of your. Your waste timely and you don’t leave things laying out and you take responsibility for it. So there’s more than one reason to make sure you’re keeping an eye on your thing.
Dr. Waddill-Goad
Yeah, absolutely.
Terri
Yeah. So advice for a cno. I heard you say your checklist and some of those things that you put on there. Is there anything else that you would tell somebody taking on this role or an interim position, even as a nurse director?
Dr. Waddill-Goad
I would say trust but verify.
Terri
Yeah.
Dr. Waddill-Goad
That’s another thing is, you know, people can tell you a lot of things, but data doesn’t lie.
Terri
Yeah.
Dr. Waddill-Goad
I mean, and I’m a big data person. You know, like I said, when I do these, do an assessment, you know, I’ll talk to people, but then I’ll also ask for all the different data sources, like, what kind of unexpected occurrences do you have? What is your onboarding program like when you get new people, whether they’re experienced or not, all the different things that basically are risk related and patient safety related, that become problematic, especially when you’re in an executive role. And so kind of looking at just the basic boots on the ground, how do things get done? And the other thing I always love to do is work shadow.
Terri
Yeah.
Dr. Waddill-Goad
Because you can learn so much by just being back in the trenches. You know, whether it’s, you know, a few hours, if it’s an entire day, you know, you move yourself around the hospital. I mean, it helps you also get to know people and get to know, you know, their world. And I think, you know, it helps build trust. It’s a great thing. You know, it’s better. I even think it’s better than rounding, I mean, because you can round yourself to death, right?
Terri
Yeah.
Dr. Waddill-Goad
But if you can’t connect with people, you know, if you’re working side by side with them for the day, you know, and you put on scrubs and you do whatever they’re doing and you help them do whatever they’re doing, I mean, it’s always very, I think, impressive also for nursing staff to see that even though most of us are wearing a suit, you know, that every bit of nursing knowledge has not been purged out of our head.
Terri
Yeah.
Dr. Waddill-Goad
You know, you would hope that.
Terri
You would hope they don’t walk away saying, oh, she doesn’t know what she’s doing.
Dr. Waddill-Goad
Yeah, exactly. But we really do know some things, you know, still, you know, and we. Just because we have a different role doesn’t mean we forgot everything that were, you know, the clinical parts of our training. And many of these things, you know, they don’t change. It’s like textbook. You do this thing in this way, and that’s the only way you should do it.
Terri
Yeah. Okay. You did a dissertation on leadership fatigue, and I believe you have written a book. So let’s talk about that. Can you share some main takeaways from that?
Dr. Waddill-Goad
Yeah, sure. So I. I think when I started back to work on my doctor, probably about five or six years after I’d been out consulting, so I’d been doing some interim and some consulting, and I thought, gosh, all of the places I go, all of leaders, you know, look like this is sort of a Suzi-ism. Looks like people yanked them through a keyhole backwards, you know, where they’re just like, just so. Like, it’s almost like standing in the middle of a tornado where you can’t figure out how to get out.
Terri
Huh.
Dr. Waddill-Goad
And so I thought, huh. And so I thought, I’m just gonna make up these words, and I’m gonna call this leadership fatigue. And so we, you know, went to. Went to class, like, our first week, because it was a program where you had to present yourself for a couple of weeks. Then went away for a year, and you did, you know, we did our classes online and then back the next year and saw the same people kind of thing. So we got to know some of our classmates as well. And so I think the first week, they asked us if we had any ideas about our project, which was really going to be two years later. And I wrote those two words one of those big, you know, yellow sticky notes. And all the professors that came in said, hey, what is this?
Dr. Waddill-Goad
And who wrote it? And I thought, well, okay, this is good, because clearly, it’s like sort of a novel concept. And so I wanted to find out, you know, specifically in nurse leaders, because I needed to have a sample size that was large enough to be statistically significant, but small enough that actually would show, you know, whether this concept even made any kind of sense, you know, So I did two focus groups, some quantitative research based on, you know, my definition of leadership fatigue, and then moved into, okay, do a quantitative survey. So that was the third step of the process where I really wanted to find out if I sent this across the country.
Dr. Waddill-Goad
And so I actually leveraged my membership in the local and then the National Professional association for Nurse Leaders and asked them if they would help me, you know, as a student, gather data. And so I really was very fortunate that all of five states, all but five states really helped me. And so I had a sample size, which was pretty large, of about 525 people. The other thing I did is I cut it out by role. And so what I found was because I wanted to know if there were nurse educators in the group, nurse managers, nurse directors, and then chiefs. And then I carved out just the chief nurses and used that to basically get out of school. But I wanted the rest of the data set because I wanted to see if there was any difference.
Dr. Waddill-Goad
And what I learned was that you have to develop a thick skin. The more that you move up in an organization, in a leadership role, the harder it gets, you know, the harder it gets because you have, you know, to figure out what are the priorities. You have multiple customers, you have metrics that you have to, you know, kind of live and die by that sometimes your compensation is based on success or a portion of it, you know, and so there were different things at different levels that people just became like, for example, with hardiness, people became much more hearty and much more tolerant to stress. The more you moved up because honestly, if you couldn’t or you didn’t, you couldn’t stand. These jobs will chew you up and spit you out.
Dr. Waddill-Goad
And I’ve always told people, you know, it’s a 247 job, but human performance doesn’t allow you to, you know, run 24, 7. You know, we’re not machines, you know, and your health will, and your mental health, your physical health and your mental health will suffer, you know, if you don’t have your own boundaries. And so, I mean, I asked specific questions about those kind of things, like what kind of things do you do, you know, related to stress, fatigue and then typically, hopefully you don’t get to burnout. And so I talked about, you know, each of those and like, when you’re feeling stressed, you know, what kinds of things do you like to do if you’re tired? You know, do you rest and what kind of rest?
Dr. Waddill-Goad
You know, is it something like for some people, they might want to go get a massage and for someone else, they want, might want to go on a hike or take them out. Yeah. And so, yeah, take a nap. I mean, so it’s those different kinds of rest that are, you know, doing for people. And then just specifically, I also talked about burnout in this dissertation. Well, interestingly enough, when I was in, I think it was about the second year, so it was a three year program. I was contacted by nursing publisher who asked about nurse burnout. And they said, you know, we’ve been looking for someone to write a book, you know, would you be interested in that? And I said, well, yes, I’d be interested, but it depends on the timing.
Dr. Waddill-Goad
I said, because for my first priority is get out of school. I said, then I’d be happy to entertain the idea. And so I finished school in December of 13 and then the book was published in January of 16. And so I spent most of 15, you know, working on the book, you know, my spare time, besides working. And it was great because I had a lot of information, you know, from my own research because my dissertation was about, I don’t know, 350 pages. And I had, they had 62 tables of data. So I had a lot of really good information that was new and relevant. I also had a very hard Time finding very much information that was leadership research focused in healthcare. I mean, I had to go look in the psychology literature, the business literature, you know, nursing literature.
Dr. Waddill-Goad
I looked at the medical literature, but it was very hard to find research related to leaders in healthcare. So when that book got published, then I went out and started talking about, you know, my own dissertation and my results from my research and then the book. And it was interesting because the audiences were all like, well, this is great. This is well and good, but what do we do about it? And so I thought, oh, hey, there’s some more opportunity for, you know, helping people figure out, okay, we’re here and we want to go there. You know, what do we do to get from here to there? Or what do we do to get better? You know, if it’s. If it’s a personal goal. So I’m trying to think.
Dr. Waddill-Goad
Then I wrote another book for Sigma, actually, that was Sigma Theta Tau International about business, because they asked the following year if I’d write a book about business. And so I did that. So it was Business Basics for Nurses. And then we have Fast forward a little bit, and then we have Covid. And so during COVID I was actually in an interim role during COVID in a very large hospital. Yeah, I’d been there one day before it became a thing. And so that was a very interesting. Many, many interesting months. When I was finished, I said, look, we really need to revise the first edition of Nurse Burnout, because by this time now we’re into 21. And it was from, you know, 15, 16. And so I said, but I want to retitle it. And I said, I want to widen the audience.
Dr. Waddill-Goad
I said, I really want it to be applicable to everyone in healthcare, and I want it to be called Beyond Burnout. I said, because I was waving the white flag, like, you know, six years ago that we’re headed towards the edge of a cliff. And then, of course, Covid was the cliff. Basically. There was a lot of things that went on in healthcare before that were, you know, kind of under wraps. I mean, we all knew that it happened, but the public didn’t know.
Terri
Yeah.
Dr. Waddill-Goad
And then, you know, when Covid came, it basically blew the lid off of all the things that we all knew. Yeah. But really that other people didn’t know. And so we published it in, let’s see, April of last year. And then I also convinced them that we needed to do a workbook. So we actually, in the book, there are every. At the end of every section or during, through the sections, like each chapter, there are practice pearls. And so I wanted to put in there, okay, here’s a bunch of verbiage, you know, about this, that and whatever else, and a bunch of current research. But then here are some takeaways. And so the takeaways were the practice pearls. And then what we did in the workbook was we took the practice pearls from every chapter and said, how do you implement these?
Dr. Waddill-Goad
You know, like, how do you. How do you de. Stress, you know, like, what are some ideas for, you know, managing stress? And so then actually put action items against each of the practice pearls so that you could basically read the book and then you could use the workbook to implement changes for either yourself, your organization, you know, a book club, a leadership group, you know, training in an organization, you know, in school, there’s actually a chapter written for students. And so we really try to cover, you know, a wide audience of how could this be? How could the information be used? And so, you know, the results have been favorable. I’ve been out, you know, speaking about the book and talking to people, and you can see here behind me.
Dr. Waddill-Goad
So beyond burnout right here, like I said, published by Sigma Theta Tau International, which is a nursing honor society type publisher, widely available though Amazon, Barnes and Noble, pretty much anywhere people buy books. And you can buy electronic format. A book format sounds very practical. Yeah, that’s really what we wanted was it’s fine that the five of us have all different kinds of knowledge from our hundreds, over 100 years of experience. But, you know, how do you. How do you convey that information to other people and how can they apply it? And so I think that’s the most important thing is to, you know, look at things like, you know, do you have an internal locus of control or is it an external locus of control?
Dr. Waddill-Goad
And so many nurses, not the leaders, I would say people that are nurse leaders, but the nurses in a lot of cases think more about things being done to them versus them controlling how things are done. And so it’s a different, you know, it’s a different mindset about locus of control. As we talk about some of those kinds of things in the book, we talk about, you know, just mindset. You know, do you have a growth mindset or is your mindset fixed? You know, are you open to change? Are you open to experimentation, you know, with. In a controlled sort of way, you know, and doing things different? And, you know, so talking about that and how that actually impacts, you know, stress, fatigue and burnout, certainly if you have more of a fixed mindset.
Dr. Waddill-Goad
It’s more of a negative connotation, so to speak, and would be negative for the outcome. And then the other thing is, one of my travels, I actually ran across a book called the Upside of stress by Dr. Kelly McGonagall. And she’s like an adjunct type professor at Stanford. And what she basically said is that there is an upside to a certain amount of stress. So not all stress is bad. And I think that’s the other thing, is that you can’t look at stress as your enemy. I mean, you can look at it as an acceptable amount of stress. Can be useful for peak performance, like peak human performance. Like if you look athletes, for example, you know, when they’re getting fired up for whatever their sport is, you know, that you need some, you know, adrenaline and some stress to have peak human performance.
Dr. Waddill-Goad
But what happens is it was where it gets overdone and your body goes into that, you know, cycle of having, you know, too much cortisol, too much adrenaline, and then people start having, you know, health problems and mental health problems. And so I think, you know, understanding that, you know, we’re like, really, your health is wealth and that you really have to look after yourself and, you know, and kind of know yourself as far as, you know, what things are good for you and what things aren’t necessarily. And things I’m talking about are like, you know, nutrition, sleep. You know, there’s lots of new research about sleep and about, you know, sleep and weight loss, sleep and stress sleep and, you know, health, so to speak, exercise is key. I mean, that’s another thing. Like, that’s one of my.
Dr. Waddill-Goad
One of the things I use, you know, for stress reduction is I’ve always been an exerciser. And I notice when I don’t get it that my mind and my body need it. So looking at, you know, all those various areas, you know, of having, you know, balanced relationships and, you know, having some fun built into your life. And so all the things that, you know, make your life more balanced, you know, not kind of like all work and no play.
Terri
Yeah, yeah. It sounds very practical. I have two questions for you. I’m going to ask them both at the same time, just so that I don’t forget them. And between the two of us, we can remember. The first one is, have you gotten any feedback from people that have read the book and, like, given you feedback on how it’s made a difference or things that they have done and it’s really changed things. And then two do you feel that substance use disorders and burnout fatigue are related to each other? Like, did you come across any of that with your research or just have any thoughts on it based on all your research?
Dr. Waddill-Goad
Let me answer the second question first. Do I think that those are connected? I do. I mean, because I think honestly, you know, when people are too stressed or overstressed, they look for ways to mitigate the stress. And like I said with my own research, sometimes it’s publicly positive, you know.
Terri
Other times it’s a glass of wine.
Dr. Waddill-Goad
Yeah, exactly. And other people sometimes use substances, you know, and it can be anything. It can be legal substances, you know, like bite. It could be cigarettes, it could be food. It can be, you know, and then it can be things that are not legal as well or things that are, you know, sort of illicit. And so there’s all different kinds of addiction, so to speak, that could be unhealthy. And then, you know, even some things like people that exercise too much, that’s probably an unhealthy addiction, you know. So, I mean, there’s. So I think that’s. The other thing is finding sort of a balance. But do I think they’re connected? I mean, I do.
Dr. Waddill-Goad
I think this amount of stress that people are under today and, you know, if you look at the, like, just general population percentages of people that feel burned out, I think it’s like 6, 7 and 10. Many reasons for doctor’s office visits, you know, you can tie back to stress. You know, so lots of. There’s lots of interesting information coming out, you know, in the medical literature as well, that, you know, different kinds of stress are potentiating health problems for people. You know, and if you’re, you know, lack of time under stress, you know, people make different choices. Like, even as far as food, you know, we’re starting to really understand, you know, that nutrition is medicine, like food is medicine.
Dr. Waddill-Goad
And certain kinds of food and certain types of food, you know, interact differently with your brain, which obviously affects people’s ability to think and cope and their coping mechanisms. So I think, you know, a lot of that is pretty interesting, but I think, you know, that there probably are some elements where they’re definitely tied together. Now, whether anybody’s actually done any research, I’m not sure. Now as far as the book, you know, I don’t get too many direct messages, but I think, you know, anecdotally, the people that, like, I’ve sent some, you know, copies to various people and people have read it, and the people that, you know, there Were I had four different people that worked on the. Both the books with me as well that have used them. Two actually have used them in academic settings.
Dr. Waddill-Goad
And so I think I’ve gotten really good feedback from those people. And kind of in general, just looking at sales, I mean, that’s another thing that always gives me an idea, okay, is this working? Is it doing what it was supposed to do in the industry? I don’t get too much. Sometimes people will mail me, especially students, and want to know if they can use certain things, you know, their own smaller research project or they want to use for a paper or that kind of thing. And, you know, I’m always really open to that.
Terri
Yeah. Yeah, that’s a good indication. All those things. Yeah. That it’s making a difference for people. And really, I mean, I’m sure it’s made a difference for many, but really, if it just makes a difference for, you know, a handful, it’s probably worth it because it’s an important area. So. Okay, well, that’s great. Well, I want to thank you for your time. This has been fascinating and especially all the research and stuff that you’ve done. And you certainly have a lot of experience to wrap up the whole package, you know, and kind of see what’s going on out there. So thank you very much for sharing. Is there any final words of advice or anything that you’d want to give anybody that’s listening out there, either a leader or just someone in healthcare? You’ve given plenty already.
Dr. Waddill-Goad
But gosh, I was going to say any funny final words of advice is you have to take care of yourself. You know, you have to remember to take care of yourself because sometimes, you know, nobody else will remind you. And, you know, like I said, especially in a leadership role, you know, the jobs are 247 and you have to, you know, have your own kinds of boundaries. And, you know, if you don’t, they’ll pretty much chew up and spit you out.
Terri
Yeah. And recognizing too. I mean, we feel that sometimes we can’t. We don’t have the time, but we will be a better performer if we take care of ourselves. So we’re really not doing anybody a favor by. Nope, gotta work, gotta work. You know, the other thing.
Dr. Waddill-Goad
That’S kind of interesting, that might be a good closing exercise is to work sample yourself. And so, you know, basically you can use, you know, piece of paper, you can do it on your phone, you can use a spreadsheet, but really to look at all the hours in the day and to just log, you know, what do you do and what do you spend your time doing? I mean, very insightful. You know, you can track it over a period of weeks because, you know, there are certain things in your role, specifically your job, that you can’t say no to. But there are many other things that I think, you know, doing something like that will identify areas where you may be able to make an adjustment.
Terri
Yeah.
Dr. Waddill-Goad
And things. That makes sense.
Terri
Yeah. Sometimes at the end of the day, I’m like, I was so busy. What did I do? Like, I have nothing to show for today.
Dr. Waddill-Goad
I understand that. I completely understand that.
Terri
Maybe not what you’re talking about, but sometimes that happens to me.
Dr. Waddill-Goad
Yeah. I always tell. I always those. My husband tells me I get sidetracked. Yeah.
Terri
It’s like, I’m sure there’s something I did, but I don’t know anyway. But a lot of little things that didn’t mount up to anything, and certainly nothing on my list of to dos. Yeah. All right. Well, thank you very much, Susie. I’ve been. I’ve enjoyed my time with you.
Dr. Waddill-Goad
Thank you. Thank you, Terri. And I hope I helped some people in your audience.
Terri
I’m sure you did. It was great information. Thank you.
