#11: Understanding Moral Injury: Insights with Jennie Byrne, MD, PhD
Broken Beautiful Me - Stories of Hope, Gratitude & ResilienceSeptember 15, 2024
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#11: Understanding Moral Injury: Insights with Jennie Byrne, MD, PhD

Understanding Moral Injury: Insights with Dr. Jennie Byrne

In this compelling episode of Broken Beautiful Me - Stories of Hope, Gratitude & Resilience, host Kelly Buckley sits down with Dr. Jennie Byrne, MD, PhD, bestselling author of Moral Injury, to explore the complex topic of moral injury and its impact on individuals, particularly within high-pressure professions like healthcare, the military, and law enforcement.

Dr. Byrne, a renowned psychiatrist and neuroscientist, offers profound insights into how moral injury differs from traditional forms of psychological distress, such as PTSD, and how it arises from situations where people feel they have betrayed their own moral or ethical beliefs. Through her groundbreaking research and practical experience, Dr. Byrne provides listeners with a deep understanding of this often misunderstood condition and offers strategies for prevention and healing.

In this episode, Dr. Byrne shares her expertise on:

  • The nature of moral injury: Understanding what moral injury is, how it develops, and the toll it takes on individuals in both personal and professional settings.
  • Prevention strategies: Key insights into how leaders, organizations, and individuals can create environments that prevent moral injury from occurring, particularly in high-stress fields.
  • Healing from moral injury: Exploring the pathways to recovery and the role that community, connection, and professional support play in the healing process.
  • Ethical decision-making and resilience: Practical tools for fostering ethical clarity and moral resilience to better navigate complex situations without compromising personal values.

Dr. Byrne's empathetic approach blends science with deep human understanding, providing listeners with both the knowledge and the tools to protect themselves and others from the long-lasting effects of moral injury. Whether you're a healthcare professional, a leader, or someone interested in personal growth, this episode will help you gain valuable insights into moral integrity and its vital role in a fulfilling life.

Connect with Dr. Jennie Byrne:

LinkedIn: https://www.linkedin.com/in/drjenniebyrne/ Website: https://www.constellationpllc.com/

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00:00:01
Hello and welcome to another

00:00:03
episode of Broken Beautiful Me.

00:00:04
I'm Kelly Buckley.

00:00:06
And today I have the honor

00:00:08
of having Dr. Jenny Byrne as my guest.

00:00:12
As an advisor for health care innovators,

00:00:15
Dr. Jenny leverages her

00:00:16
extensive clinical,

00:00:18
entrepreneurial and

00:00:19
leadership experience to

00:00:20
help shape the future of health care.

00:00:23
She is an advisor for Luna Joy Health,

00:00:26
Psych Now,

00:00:27
and Nuco at Healthcare Foundry.

00:00:30
These three companies are

00:00:31
transforming the delivery

00:00:33
and quality of mental

00:00:34
health care through technology, data,

00:00:36
and collaboration.

00:00:38
She is a co-founder of Belong Health,

00:00:40
a made-for-purpose

00:00:41
healthcare company that

00:00:42
serves vulnerable

00:00:43
populations through health

00:00:45
plan partnerships and ACCO reach.

00:00:49
Her mission is to connect

00:00:50
the dots between the ideas

00:00:52
in new and unexpected ways

00:00:55
and to translate complex

00:00:56
concepts and challenges

00:00:58
into actionable solutions.

00:01:00
She has a dual background as

00:01:02
an MD and a PhD in

00:01:04
neuroscience and a

00:01:05
board-certified psychiatrist,

00:01:07
giving her a unique

00:01:08
perspective on human

00:01:10
behavior and health's

00:01:11
biological and psychological aspects.

00:01:15
She is a thought leader in

00:01:16
the healthcare community,

00:01:17
appearing on podcasts, webinars,

00:01:20
and live events.

00:01:21
And she's also a

00:01:22
best-selling author of Work Smart,

00:01:24
a book on how to use brain

00:01:26
and behavior science to work smarter.

00:01:29
Her second book, Moral Injury,

00:01:31
Healing the Healers,

00:01:33
focuses on the clinician

00:01:34
crisis facing the American

00:01:36
healthcare system today.

00:01:38
She is a practicing

00:01:39
psychiatrist with a focus

00:01:40
on caring for other

00:01:41
physicians with mental health needs,

00:01:44
including depression, anxiety, ADHD,

00:01:47
burnout, and moral injury.

00:01:50
Jenny,

00:01:51
thank you so much for being on the

00:01:53
program today.

00:01:55
I am honored to have you here as a guest.

00:01:57
Thank you for having me.

00:01:58
I'm excited to chat with you.

00:02:01
Yeah.

00:02:01
So to just jump right in,

00:02:04
if you could just tell the

00:02:05
audience a little bit just

00:02:06
about your background for

00:02:09
people who may not know

00:02:09
about your work and how you

00:02:11
came to kind of focus on

00:02:13
this area of medicine.

00:02:18
Yeah.

00:02:18
So my path was very nonlinear,

00:02:22
as I'm sure many of your

00:02:24
listeners can relate to, and

00:02:27
I grew up in a pretty poor

00:02:29
part of central Pennsylvania,

00:02:31
although I was not poor,

00:02:33
but growing up there,

00:02:35
did not know I wanted to be

00:02:37
a doctor when I grew up at all.

00:02:39
I was a musician when I went

00:02:42
into college and switched

00:02:43
gears because I wanted to live overseas.

00:02:46
So I lived in Europe for a

00:02:47
year and then I came back

00:02:49
and I landed in a class

00:02:50
called brain and behavior

00:02:52
and I just fell in love.

00:02:53
So pretty much everything in the last,

00:02:57
plus years at this point has

00:02:59
circled around human brain

00:03:01
and behavior in some form or fashion.

00:03:03
And that has led me to all

00:03:05
kinds of interesting work

00:03:07
and different jobs.

00:03:09
A lot of entrepreneurial work,

00:03:10
which again was not really planned.

00:03:13
National healthcare executive work, again,

00:03:15
not planned.

00:03:16
And then more recently,

00:03:18
really enjoying working

00:03:19
with earlier stage

00:03:21
companies or companies

00:03:23
looking to do a major pivot.

00:03:25
And I'm all about quality.

00:03:27
So I love to help companies

00:03:29
accelerate to quality.

00:03:33
And along the way,

00:03:34
as a physician who's been

00:03:35
practicing this whole time

00:03:37
and working with a lot of

00:03:38
other clinicians and healthcare people,

00:03:41
this topic of moral injury

00:03:44
really got me concerned and

00:03:46
really got me to start

00:03:48
doing some research.

00:03:49
And I think the crisis,

00:03:51
I actually don't like negative

00:03:53
crisis scare tactics but in

00:03:55
this case I think it truly

00:03:57
is a crisis and as somebody

00:03:59
patient and a physician I

00:04:01
see a lot of different

00:04:02
aspects of the problem and

00:04:04
that inspired me to write

00:04:06
the second book and I wrote

00:04:08
it and published it in four

00:04:09
months so if anybody who's

00:04:11
published a book you know

00:04:12
that is like breakneck

00:04:14
speed to get the interviews

00:04:15
and get it all done so it

00:04:17
was really a passion

00:04:18
project the reason I did it

00:04:19
so fast was because I felt

00:04:21
like it was so important

00:04:22
to get the word out.

00:04:23
So that's how I landed here today.

00:04:26
And I'm happy to talk about

00:04:28
moral injury or just kind

00:04:29
of any other conversation

00:04:32
or questions that might come up.

00:04:33
Okay.

00:04:35
So you have taken your

00:04:37
knowledge and I love that

00:04:39
your journey was not linear.

00:04:42
Mine certainly was not either.

00:04:43
It was all over the place.

00:04:44
But I think that gives you

00:04:46
such a broad view and

00:04:48
perspective that it kind of

00:04:51
allows you then once you

00:04:53
hone in on a certain area

00:04:54
that you're working in, it allows you

00:04:57
kind of a bit of wisdom that

00:04:58
you may not have otherwise

00:05:00
had that makes you a better clinician,

00:05:03
a better listener, a better leader.

00:05:06
So you have applied your

00:05:07
knowledge and expertise in

00:05:08
such an innovative way.

00:05:11
Talk about mental health

00:05:12
support and care and caring

00:05:14
for teens and what you saw

00:05:17
and what you wanted to do about it.

00:05:21
So what I've seen, and again,

00:05:22
I've had a lot of different perspectives.

00:05:24
So I've sat in the seat of

00:05:26
the medical student, the trainee,

00:05:30
the practicing real world physician,

00:05:33
the manager,

00:05:35
the healthcare executive for

00:05:36
a whole giant national company,

00:05:38
and then an investor in early stage.

00:05:40
So I've really seen all the

00:05:42
different perspectives and lived them.

00:05:44
And that helps me, I think,

00:05:45
have a deeper empathy and

00:05:48
kind of a visceral understanding

00:05:50
understanding of what is

00:05:51
happening with these teams.

00:05:53
Because in reality, we were trained,

00:05:56
at least as physicians,

00:05:57
mostly to be kind of a solo entity.

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At least I was trained

00:06:01
basically that I should be

00:06:02
able to do everything.

00:06:04
But today's world in healthcare,

00:06:06
which is increasingly complex,

00:06:08
does require more teamwork

00:06:10
and collaboration.

00:06:11
So as you said, like the teams,

00:06:15
it's really not just one person.

00:06:17
It's a person,

00:06:18
but it's also a whole

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interdynamic and people are all human.

00:06:22
And so interpersonal

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relationships and things really matter.

00:06:26
So what I was seeing is

00:06:27
really pretty simple.

00:06:28
Every time I would talk with someone,

00:06:30
and this could be somebody in the field,

00:06:33
you know,

00:06:33
a clinician just out there day to day,

00:06:36
a trainee, a manager, an executive,

00:06:39
anybody I would talk to

00:06:40
would just behind closed doors,

00:06:43
whisper the same things and

00:06:45
I think I'm a shrink,

00:06:46
so people just tell me things.

00:06:48
But they would, behind closed doors,

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all say the same thing, which is,

00:06:52
I feel like something is wrong.

00:06:54
Inside of me, something doesn't feel good.

00:06:57
I don't necessarily know what it is.

00:06:59
I don't feel right when I go to work.

00:07:02
I feel that something is wrong.

00:07:03
Something is eating at me.

00:07:06
I feel like a cog in a machine.

00:07:07
That one I heard literally

00:07:08
from almost everyone I talked to.

00:07:11
Yeah.

00:07:11
And then they would say in

00:07:13
even more hushed tone, and I'm,

00:07:14
I'm ready to leave.

00:07:16
I just don't know what to do.

00:07:18
This is so bad.

00:07:19
I think for my own health,

00:07:20
I'm going to have to leave medicine.

00:07:23
And this,

00:07:23
and this comes from the executives too,

00:07:25
by the way, they'll be like,

00:07:27
as soon as I can get enough

00:07:28
money to get a kid through

00:07:29
college or whatever,

00:07:31
as soon as my opportunity presents itself,

00:07:33
I'm going to leave.

00:07:34
And I got really scared.

00:07:36
The more I started to hear this because,

00:07:39
um, you know, I'm, I'm,

00:07:40
a Gen X. I'm getting into middle age,

00:07:44
right?

00:07:44
I am in middle age.

00:07:45
And I want someone to take care of me.

00:07:49
I'm a patient.

00:07:50
I have aging parents that

00:07:52
I'm helping take care of.

00:07:54
I have kids.

00:07:55
I have teenagers that I

00:07:57
still am responsible for.

00:07:59
I have a husband with some

00:08:01
health conditions.

00:08:03
And I want to be taken care of.

00:08:06
I want someone to heal me.

00:08:07
I don't want to, in five years from now,

00:08:10
look around and realize

00:08:12
there's no one to take care

00:08:13
of me or the care I'm

00:08:14
getting makes me feel like

00:08:15
I'm part of a machine.

00:08:17
So it was really that

00:08:20
perhaps selfishness thinking about myself,

00:08:23
but everybody's like me, right?

00:08:24
We're all patients.

00:08:26
Many of us care for someone else.

00:08:28
Many of us are,

00:08:29
are worried about our own health.

00:08:31
So this matters for all of us.

00:08:33
It's not just the people

00:08:34
working in healthcare.

00:08:37
And I think there are,

00:08:38
ways to heal quicker and

00:08:40
easier than others may believe.

00:08:42
And so that's what really

00:08:44
inspired me to write and

00:08:45
get the word out.

00:08:48
Okay.

00:08:48
So let's just jump into that with,

00:08:50
with your writing.

00:08:51
So two books work smart and moral injury,

00:08:55
healing the healers.

00:08:56
So if we could start,

00:08:58
what is a moral injury?

00:09:01
So the term moral injury was

00:09:03
new to me when I started

00:09:04
researching this problem.

00:09:05
So I had heard about burnout.

00:09:07
When I'm sure you've heard about burnout,

00:09:08
everyone's heard about burnout.

00:09:09
That's like the buzzword.

00:09:11
And it is so used at this

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point that it means

00:09:15
millions of different things.

00:09:17
Moral injury, on the other hand,

00:09:20
comes from the military experience.

00:09:22
And the military found that

00:09:23
when there were soldiers

00:09:24
and others coming back from deployment,

00:09:27
that they were really

00:09:27
struggling to kind of

00:09:29
reintegrate with their lives.

00:09:32
And sometimes it wasn't PTSD.

00:09:34
And sometimes it wasn't

00:09:35
depression or anxiety,

00:09:37
and they were really trying

00:09:37
to figure out what is

00:09:39
happening with these folks

00:09:41
and how can we help them?

00:09:43
So the idea of moral injury

00:09:45
is that there is a threefold definition.

00:09:48
The first part of the

00:09:49
definition is that you witness something,

00:09:52
you do something,

00:09:54
or you're part of something

00:09:56
that goes against your core values,

00:09:59
whether those values be personal, family,

00:10:02
religious,

00:10:03
or professional values.

00:10:06
The second part is that the

00:10:10
thing that you have done or

00:10:11
witnessed is either ordered

00:10:13
by or condoned by somebody

00:10:15
superior to you.

00:10:17
And the third part is that

00:10:19
you feel like the stakes are high.

00:10:23
So you can see in healthcare in particular,

00:10:25
we feel like the stakes are high,

00:10:27
even with tiny little decisions,

00:10:29
doctors and other clinicians,

00:10:31
we feel like the stakes are high.

00:10:32
But honestly,

00:10:33
moral injury as a concept can

00:10:34
apply to other sectors and

00:10:37
other corporate America.

00:10:38
But I focus mostly on health

00:10:40
care because that's where I

00:10:41
feel like perhaps the

00:10:42
crisis is the worst.

00:10:45
But moral injury is a concept.

00:10:46
It's almost like a wound on your soul.

00:10:52
Very different than burnout,

00:10:53
which is more of a

00:10:54
physiological state of depletion,

00:10:57
of energy depletion.

00:11:00
By the way,

00:11:00
I don't like the term burnout

00:11:01
because I think that in of

00:11:03
itself is an industrial term.

00:11:06
Burnout is like a light bulb, right?

00:11:08
Think about things that burn out.

00:11:11
What do you do?

00:11:12
You go charge a battery or

00:11:13
you replace them.

00:11:15
Well,

00:11:15
I would argue that most people are

00:11:20
not light bulbs.

00:11:21
And when you've had a deep injury,

00:11:25
it's not enough to take a vacation.

00:11:27
And it's not enough to just

00:11:29
go swap you out for a new person.

00:11:31
So the term burnout is real.

00:11:33
And I do believe it applies

00:11:35
to many scenarios.

00:11:36
But what I think we're

00:11:37
seeing in healthcare and

00:11:37
other sectors is sometimes

00:11:39
it's way more than that.

00:11:40
And it's this wound on your

00:11:43
soul and wounds require healing,

00:11:47
not fixing.

00:11:48
And so when people say I'm

00:11:49
going to fix burnout,

00:11:50
it's very industrial.

00:11:52
And that's really the core

00:11:53
of the moral injury for

00:11:54
many people is they feel like

00:11:56
They have become part of a factory.

00:11:59
Right.

00:11:59
So just the words,

00:12:01
I do believe words matter.

00:12:02
And so even just the lexicon,

00:12:05
I believe is very important.

00:12:09
I totally agree with that.

00:12:11
And in terms of the roles

00:12:14
that you have in healthcare,

00:12:16
I come from a nursing

00:12:17
background primarily.

00:12:19
And back to that loneliness

00:12:21
aspect that you talked

00:12:22
about a little bit ago and

00:12:24
that moral injury,

00:12:27
I found when I was in

00:12:29
university and when we were training that

00:12:31
that we were separated by

00:12:33
our roles and

00:12:34
responsibilities and that we

00:12:36
were not brought together

00:12:38
as a holistic team.

00:12:41
When we had challenges,

00:12:44
we were alone in those

00:12:45
challenges in how we dealt with them.

00:12:47
Now, nursing,

00:12:48
we had other nurses who were

00:12:50
on a unit with us,

00:12:52
but I could see how

00:12:53
physicians in particular

00:12:57
would really shoulder a

00:12:58
great deal of that burden

00:13:01
of things that happen as

00:13:04
you treat patients.

00:13:07
Let's discuss the stressors

00:13:10
for health teams.

00:13:11
Because, you know,

00:13:13
from when you graduated or

00:13:15
when I graduated,

00:13:17
things have changed dramatically.

00:13:20
Let's talk about the past just ten years,

00:13:22
just pre-COVID, post-COVID,

00:13:25
and what you have seen with

00:13:28
the complexities that

00:13:30
healthcare professionals deal with.

00:13:33
So some of the things that have changed,

00:13:36
and if you go back and look,

00:13:38
it's really since about two thousand,

00:13:42
I would say that these

00:13:43
things have started to accelerate.

00:13:46
But the framework probably

00:13:49
was like the late nineteen

00:13:50
eighties or the early nineteen nineties.

00:13:53
And it really comes down to

00:13:55
the industrialization of health care.

00:13:58
And if you go back before

00:13:59
the nineteen eighties or

00:14:01
back to the post-World War era, where

00:14:04
I had one family member who

00:14:05
was a doctor as my grandfather,

00:14:08
and I didn't know him

00:14:09
because he died when I was young,

00:14:10
but he was a pediatrician

00:14:12
in post-World War II Pennsylvania.

00:14:16
And so from his world to my world,

00:14:18
there was already a dramatic shift.

00:14:20
But I would say since two thousand,

00:14:22
what you're referring to

00:14:25
has been this rapid

00:14:26
industrialization of the

00:14:28
health care world.

00:14:29
So what does that mean?

00:14:31
So first of all,

00:14:33
Healthcare is just more complex,

00:14:35
which is a good and a bad thing, right?

00:14:38
In nineteen forty,

00:14:40
my grandfather had a little

00:14:41
black bag with powders in

00:14:42
it that he would mix

00:14:43
together and give to people

00:14:44
and maybe some aspirin and some stitches.

00:14:47
And there weren't, you know, penicillin.

00:14:49
There wasn't that much out there.

00:14:52
So the good news is we have

00:14:54
a lot more treatment

00:14:55
options available to help people heal.

00:14:57
So that's the good news.

00:15:00
The bad news is.

00:15:02
it's gotten to the point

00:15:03
where any one human being,

00:15:05
our brain is not really

00:15:07
designed to hold all that

00:15:09
information any longer.

00:15:11
The complexity of treatments

00:15:13
out there and the types of

00:15:15
medicines and the research.

00:15:19
And like, it's really, I would offer,

00:15:23
it's not possible for a

00:15:25
normal human being.

00:15:26
Maybe some people can, but

00:15:28
nobody I know anyway,

00:15:30
to keep up and keep all

00:15:31
that in your mind.

00:15:33
So the complexity has

00:15:35
outstripped our cognitive

00:15:36
ability to know everything.

00:15:40
So once you don't know everything,

00:15:42
you're dependent on other

00:15:44
people and you're dependent on technology,

00:15:49
right,

00:15:49
to help guide you because you don't

00:15:52
know everything.

00:15:54
So I think, first of all,

00:15:55
the sheer complexity of

00:15:57
The second big shift that a

00:15:59
lot of clinicians point to

00:16:01
as being very harmful,

00:16:02
and I would take argument

00:16:04
with this actually,

00:16:05
but is the shift from paper

00:16:08
to electronic health records.

00:16:11
I personally believe that

00:16:12
the shift from paper to

00:16:13
electronic records is extremely helpful.

00:16:18
However, the devil is in the details.

00:16:21
And so the path that we took

00:16:24
to get to electronic health records

00:16:27
was really based on billing

00:16:29
and coding for medical

00:16:31
services as opposed to

00:16:32
clinical meaningfulness.

00:16:35
So now we have a legacy infrastructure,

00:16:38
which is really based on

00:16:39
this billing and coding.

00:16:41
So that was a huge shift.

00:16:42
So I don't know about you.

00:16:44
I actually had a mixed,

00:16:45
when I did my training,

00:16:46
some stuff was on paper and

00:16:48
some stuff was digital.

00:16:50
It was kind of like a combination.

00:16:53
Yeah, very much the same for me.

00:16:55
So that's a huge shift and

00:16:56
it can be for the good or for the bad.

00:16:58
Technology in of itself is

00:17:00
not inherently good or bad.

00:17:02
The other big shift that has

00:17:03
happened is increasing specialization.

00:17:08
So this has been a trend over the last,

00:17:10
you know, maybe one hundred,

00:17:11
one hundred fifty years.

00:17:13
There didn't used to be

00:17:14
specialty training.

00:17:17
Even as a nurse,

00:17:17
you can have specialty

00:17:19
training in all sorts of areas.

00:17:22
Absolutely.

00:17:24
So once you become more and

00:17:25
more specialized,

00:17:26
it's very easy to become

00:17:28
more and more siloed.

00:17:30
So keeping up with others in

00:17:33
your field is hard.

00:17:35
Another big shift which has

00:17:36
happened is that the

00:17:39
mobility of clinicians has

00:17:41
dramatically increased and

00:17:42
nursing especially saw this during COVID.

00:17:45
And there was kind of this

00:17:46
history of nurses being

00:17:49
I don't want to say mistreated,

00:17:50
but feeling like they

00:17:53
weren't being respected or

00:17:54
they weren't being paid well.

00:17:56
As the system became more industrialized,

00:17:58
they were asked to do more

00:17:59
and more with less and less.

00:18:01
And they very understandably

00:18:02
got quite fed up.

00:18:04
And so what you saw during

00:18:05
COVID was a complete

00:18:07
breakdown of what used to

00:18:10
be where a nurse might work

00:18:12
for twenty years in one

00:18:15
clinic or one hospital unit.

00:18:18
And then you saw this

00:18:19
evolution of the travel

00:18:20
nurse or in the physician case,

00:18:22
the locum tenens physician,

00:18:24
which is really a

00:18:25
short-term fix to burnout or moral injury,

00:18:28
right?

00:18:28
Like you leave one place and

00:18:30
you go to another place and

00:18:31
there's a honeymoon period

00:18:33
and everything's great.

00:18:34
People are so happy you're there.

00:18:35
They treat you well.

00:18:36
They pay you better.

00:18:38
You're not in the politics, et cetera,

00:18:40
et cetera.

00:18:40
And then you get fed up and

00:18:41
then you just move on.

00:18:43
So this like constant churn

00:18:45
of clinicians through,

00:18:47
clinics, through hospitals,

00:18:49
through healthcare systems,

00:18:50
the churn has really

00:18:53
disrupted what we would

00:18:54
have typically as teams in the past.

00:18:59
And then I'll say one,

00:19:00
I could give a hundred reasons.

00:19:01
I'll say one more final

00:19:02
reason is that the way that

00:19:06
management happens now is

00:19:07
very different than how it used to be.

00:19:10
Nurse managers or physician

00:19:12
managers used to be much

00:19:13
more embedded in the day to day

00:19:16
of the teams on the ground,

00:19:17
but now due to regulatory

00:19:20
and quality work,

00:19:21
which again is neither good nor bad,

00:19:24
there has become more of a

00:19:25
silo between the manager

00:19:27
and the frontline.

00:19:28
And when people are feeling bad inside,

00:19:31
it's a very quick narrative

00:19:33
jump to us versus them.

00:19:35
And so you'll see a lot of

00:19:36
literature and even some

00:19:37
recent books on the topic

00:19:39
of moral injury.

00:19:41
And they conclude, well,

00:19:42
clinicians are good and

00:19:43
executives are greedy and bad.

00:19:45
And I take great issue with that.

00:19:48
I think it's a very easy, you know,

00:19:51
black and white narrative,

00:19:52
which is totally

00:19:53
counterproductive and

00:19:55
actually just not true.

00:19:57
So anyway, I could go on and on, Kelly,

00:19:58
but those are a couple of the reasons.

00:20:01
No, those are some excellent examples.

00:20:04
And, you know,

00:20:05
as someone who started off

00:20:07
as a frontline nurse and

00:20:08
moved into management,

00:20:11
that really speaks to me

00:20:12
because I had these lofty

00:20:16
goals and beliefs of the

00:20:18
change that I could make.

00:20:20
to better the unit when I

00:20:22
first moved into a position

00:20:24
as a nurse manager and then

00:20:27
as a VP of nursing.

00:20:28
And what I found was the

00:20:32
budget reports were really important.

00:20:34
So we can't talk to you

00:20:35
about the improvements for

00:20:36
the staff scheduling right

00:20:38
now because we have to get

00:20:39
those budget reports in and we have to,

00:20:41
and it's,

00:20:43
When you have, and I,

00:20:46
for leaders who move into those roles,

00:20:48
it's devastating really,

00:20:50
because you have this goal

00:20:52
and this vision for what

00:20:53
you're going to do for your

00:20:55
coworkers that you were on

00:20:56
the front line with not too long ago.

00:20:59
And then you get in that

00:21:00
position and it is not at

00:21:02
all what you thought it would be.

00:21:07
That it makes,

00:21:08
and then you feel like

00:21:09
you're disappointing everybody,

00:21:10
that middle management area

00:21:12
where there's just, it's a no win.

00:21:13
And when I interviewed,

00:21:15
I interviewed people at all

00:21:16
different levels of

00:21:17
management or frontline.

00:21:19
And sometimes the folks in

00:21:21
the middle management,

00:21:22
or even the executives,

00:21:23
the one who were telling

00:21:24
you to fix that budget

00:21:26
behind closed doors,

00:21:28
they are actually sometimes

00:21:29
suffering worse than the frontline.

00:21:31
Because like you said,

00:21:32
they feel totally trapped in the middle,

00:21:35
very helpless, even though in theory,

00:21:38
they're the ones making the decisions.

00:21:41
They feel like they're

00:21:41
letting everybody down.

00:21:43
Exactly.

00:21:44
And there it's burning a

00:21:46
hole in their soul.

00:21:47
And a lot of them are

00:21:48
leaving for that very reason,

00:21:50
but they won't tell you.

00:21:51
And they'll put on a front

00:21:52
because they think that's

00:21:53
what they have to do to be a good leader.

00:21:56
And it's true even with the

00:21:58
people making the budgets.

00:22:01
It goes the whole way up the chain.

00:22:04
And I'll tell you,

00:22:05
nobody goes into healthcare

00:22:07
if all they want to do is make money.

00:22:10
If you are a business person

00:22:11
and you go to whatever

00:22:12
business school and you get

00:22:13
an MBA and you're like,

00:22:15
all I want to do is make a

00:22:16
giant pile of money,

00:22:18
you do not go into healthcare.

00:22:20
That is not where you go to

00:22:22
make all the money.

00:22:23
So even those executives who seem

00:22:26
Like they're the ones

00:22:27
pushing the budget or

00:22:28
they're the ones being

00:22:29
greedy or they're the ones, well,

00:22:30
they make more money than me.

00:22:32
Like they're not the villain of the story.

00:22:36
Some of them, of course, are, you know,

00:22:38
greedy or et cetera.

00:22:39
But in general,

00:22:41
if you really want to make money,

00:22:42
you do not go into health care.

00:22:44
So the folks have been in

00:22:45
health care for twenty, thirty years.

00:22:47
There was something that

00:22:49
sent them into health care

00:22:50
that was not money,

00:22:51
because if it was all you

00:22:52
cared about was money,

00:22:53
you would just not go into that field.

00:22:56
No, you would not.

00:22:58
Just looking outside of the

00:23:00
United States for a minute,

00:23:01
because I know that, you know,

00:23:05
the approach to work is

00:23:06
different depending on

00:23:08
where you are located across the globe.

00:23:11
So what are some of the

00:23:12
commonalities and

00:23:13
differences that you have

00:23:15
seen for healthcare

00:23:16
professionals and what they face?

00:23:18
You know,

00:23:18
are they experiencing the same

00:23:20
thing around the world?

00:23:22
Great question.

00:23:23
And my assumption when I,

00:23:25
started writing the book,

00:23:27
I had this assumption that

00:23:28
other countries didn't have moral injury.

00:23:31
Because I was like, well, the, you know,

00:23:33
healthcare systems are so

00:23:34
different in Europe, for example.

00:23:37
Your medical education is paid for.

00:23:39
You don't have debt.

00:23:41
You have a kinder, gentler workplace.

00:23:44
You work fewer hours.

00:23:45
You have these crazy

00:23:47
extended parental leave programs.

00:23:50
You have daycare.

00:23:51
Like, I assumed...

00:23:53
that they didn't have moral injury,

00:23:54
but that's not true.

00:23:56
It turns out that when you

00:23:58
look at healthcare

00:23:58
professionals around the world,

00:24:01
most of them feel some of

00:24:02
this moral injury,

00:24:03
even if their working

00:24:05
conditions are to an American eye,

00:24:08
the best working conditions

00:24:10
you could ever have.

00:24:13
So there's a kind of feeling

00:24:15
that in the US where we work long hours,

00:24:18
there's a culture of busy, busy, busy.

00:24:20
And that's kind of what I

00:24:21
wrote about in the first book is the

00:24:23
American culture of the last

00:24:25
two hundred years being

00:24:28
what I call the cult of busyness.

00:24:30
That's another topic.

00:24:32
But I thought that looking

00:24:34
at Europe or other

00:24:35
countries where you work fewer hours,

00:24:37
it's all better that you

00:24:38
don't feel this way, but they do, too.

00:24:40
So what I had talked about a

00:24:42
little earlier in terms of

00:24:43
the complexity of health care,

00:24:45
the specialization, the teamwork,

00:24:48
I think that's actually

00:24:49
felt around the world.

00:24:52
And one interesting thing,

00:24:54
you may have heard of or

00:24:55
seen is clinicians who will

00:24:58
go on these medical

00:24:59
missions and they'll go to

00:25:02
third world countries and

00:25:03
provide medical services,

00:25:05
which are episodic, like a surgery,

00:25:10
for example,

00:25:10
they'll go and do cleft palate surgeries,

00:25:12
or they'll go something, an intervention,

00:25:14
which is defined and brief

00:25:17
and they can fix.

00:25:19
And I think the reason,

00:25:21
people love those medical

00:25:22
missions to third world

00:25:23
countries is because that's

00:25:25
kind of how medicine used

00:25:26
to be in this country a

00:25:27
hundred years ago.

00:25:29
You had an infection, you went in,

00:25:32
you gave some penicillin and you went out,

00:25:34
you know, you broke your arm, you said it,

00:25:35
you left.

00:25:36
It felt really good because

00:25:38
you could with a very small

00:25:40
team and a small amount of

00:25:41
resources make a big

00:25:42
difference in someone's life.

00:25:45
So I think we're attracted

00:25:46
actually ironically to like

00:25:47
third world country medicine,

00:25:50
where things are a lot more

00:25:51
straightforward.

00:25:52
Because to be honest,

00:25:54
if you wanted to do a medical mission,

00:25:56
there's plenty of places in

00:25:57
the US that need a whole

00:25:58
lot of help and you don't go there.

00:26:01
So why do you go to Guatemala instead of,

00:26:04
I don't know,

00:26:06
rough part of LA or Detroit or whatever,

00:26:09
rural Arkansas,

00:26:12
or there's so many places that need help.

00:26:14
Why do we go there?

00:26:15
So I think there's something about that.

00:26:19
What is different in other

00:26:20
parts of the world is that

00:26:24
I think the social status

00:26:28
of clinicians is still

00:26:29
different in other places.

00:26:31
So in the US,

00:26:32
one of the things people point to is,

00:26:35
yeah, I signed up for long hours.

00:26:37
I signed up to take on huge

00:26:38
responsibility.

00:26:39
I signed up for

00:26:42
Patients dying.

00:26:43
I signed up for maybe getting sued.

00:26:45
Yeah, I get it.

00:26:46
I signed up for all of those things.

00:26:48
But what I didn't sign up

00:26:49
for was to have patients

00:26:52
yelling at me about vaccines.

00:26:54
I didn't sign up for the lack of respect.

00:26:57
I didn't sign up for people

00:26:59
to stop calling me doctor.

00:27:01
I didn't sign up for this

00:27:04
kind of low status in my community.

00:27:08
I didn't sign up for a

00:27:09
lifestyle while I'm

00:27:10
struggling just to pay my

00:27:11
student debts and get, you know,

00:27:13
get my kids to college.

00:27:15
So I think in other countries,

00:27:16
what seems different to me

00:27:18
is that the social standing

00:27:20
and the respect and the way

00:27:22
clinicians are treated is different.

00:27:25
I think after COVID here,

00:27:26
we had a complete,

00:27:28
we really just had a

00:27:29
complete and utter meltdown

00:27:31
of that respect,

00:27:33
that feeling of respect and

00:27:35
that feeling of autonomy.

00:27:37
and our status in our communities.

00:27:40
I think that's what really

00:27:41
fell apart in COVID in this country,

00:27:43
but in other countries,

00:27:45
I think you don't feel

00:27:46
quite as bad inside perhaps

00:27:48
because you are getting that respect.

00:27:51
Mm hmm.

00:27:52
So do you feel like when you

00:27:54
we talked about people

00:27:55
going on those missions, and they go in,

00:27:57
they do a surgery, and then they're out.

00:28:00
So in a way,

00:28:01
do you feel like that kind of

00:28:03
it doesn't necessarily heal

00:28:05
that moral injury.

00:28:07
But it may be in in the way

00:28:09
they process that is I went

00:28:11
into this profession to heal, I healed,

00:28:13
that's great.

00:28:15
And then maybe a bandaid?

00:28:18
It's a great bandaid.

00:28:20
It's a healing bandage,

00:28:21
maybe more than just a bandaid.

00:28:23
Maybe it's a salve.

00:28:24
Because when you go on a mission,

00:28:27
how wonderful that feels, right?

00:28:29
Like to go to a community

00:28:31
that has no medical care.

00:28:33
And like,

00:28:33
let's say you're doing these

00:28:34
cleft palate surgeries,

00:28:36
you have these little babies,

00:28:38
or these little kids with a deformity,

00:28:40
which is making it hard to

00:28:41
breathe or hard to eat.

00:28:43
And in a very short amount of time,

00:28:46
you can repair that for

00:28:47
them for their whole lives.

00:28:49
And their parents are just

00:28:50
overjoyed when the

00:28:52
community just wants you to

00:28:53
come back every year.

00:28:55
And just, I mean,

00:28:56
think about how great that must feel.

00:28:58
So I do think that feeling

00:29:02
can heal your soul.

00:29:05
But if you go back to the

00:29:07
same environment you left, eventually,

00:29:10
you know,

00:29:11
you're going to have to find

00:29:13
other ways to repair it.

00:29:14
So I do see the people

00:29:16
making these mission trips.

00:29:17
That is one strategy I think is probably,

00:29:21
I've never done a mission,

00:29:22
but I imagine it would be

00:29:23
extremely healing to them

00:29:26
to be able to go and do that.

00:29:28
Well, and it's so needed.

00:29:30
But as you said,

00:29:31
it's also needed within the

00:29:32
borders of the United States.

00:29:35
And so that's something for

00:29:36
us all to think about.

00:29:38
So what do we do about this moral injury?

00:29:44
How do we together?

00:29:46
Because no one person can

00:29:48
solve this alone.

00:29:49
So how do we as a community fix this?

00:29:54
So I believe...

00:29:56
And this is part of why I wrote the book.

00:29:58
The good news is that the

00:30:00
healing of moral injury

00:30:01
sometimes actually is much

00:30:03
easier than we think.

00:30:04
And sometimes it doesn't cost any money.

00:30:07
So at the very lowest level,

00:30:10
you ask what everybody can do.

00:30:11
And this includes me as a patient.

00:30:13
If you are a patient,

00:30:15
what are the ways that you

00:30:17
can show respect and

00:30:18
gratitude for the

00:30:19
clinicians that you go to,

00:30:23
your family goes to,

00:30:24
or that are in your community?

00:30:26
And if there's nothing else you do,

00:30:29
and this is a big takeaway for a listener,

00:30:31
if nothing else you take away,

00:30:34
if you genuinely feel

00:30:36
thankful to have a clinician, say to them,

00:30:41
thank you for all you do.

00:30:44
Not thank you what you do for me.

00:30:46
That's different.

00:30:47
Because when you say thank

00:30:48
you for all you do,

00:30:49
you acknowledge their role

00:30:52
in the community and the society and

00:30:55
And I guarantee you that will feel good.

00:30:58
Every time I hear that,

00:30:59
it makes me feel wonderful.

00:31:00
So in terms of a bandaid,

00:31:01
if everyone just did that little bandaid,

00:31:04
it has to be authentic.

00:31:05
I mean, you can't fake it, you know,

00:31:07
but if you feel it, just say it.

00:31:11
That is a bandaid that

00:31:12
everyone can do every day.

00:31:16
I think showing respect

00:31:19
means using people's titles.

00:31:24
when they want to.

00:31:26
So if you're going to go see a doctor,

00:31:29
you should assume that you

00:31:31
should call them doctor unless they say,

00:31:33
no, please call me Jenny.

00:31:34
That's fine.

00:31:35
Or if you have somebody and

00:31:37
you don't know what their title is.

00:31:40
So sometimes nurse

00:31:41
practitioners fall into

00:31:42
this weird place where

00:31:44
people call them doctor and

00:31:45
they don't know what to do.

00:31:47
Or then you have doctorate

00:31:48
of nurse practitioners who

00:31:49
are technically doctor,

00:31:51
but they're not an M. So it

00:31:52
gets very fuzzy, you know, just,

00:31:55
if they have a name tag on,

00:31:56
they probably do look at

00:31:58
what their name tag says.

00:32:00
And if you're not clear,

00:32:01
ask them how they would

00:32:02
like to be addressed.

00:32:04
It's very, that's a very simple thing.

00:32:08
I think another way you can

00:32:09
really show respect for a

00:32:11
clinician when you go to an

00:32:12
appointment is to be prepared.

00:32:16
Yes.

00:32:17
The reality is most of them

00:32:18
do not have a lot of

00:32:20
minutes to spend in the room with you.

00:32:23
So if you can come to them prepared,

00:32:26
so that means your list of

00:32:27
medications and how you take them.

00:32:29
That means what is the most

00:32:30
important thing to you to

00:32:31
get out of that visit?

00:32:34
Do you have any documents from others?

00:32:36
You know,

00:32:36
if you come prepared and you take

00:32:39
notes or use a voice recorder, I mean,

00:32:41
I actually urge patients

00:32:42
just to take a voice memo

00:32:44
and ask the clinician if

00:32:46
that's okay with them and say,

00:32:48
is it okay if I just record

00:32:49
this because that'll help

00:32:50
me remember it later.

00:32:52
These are all little things

00:32:54
you can do to show respect.

00:32:57
So the next thing that we

00:32:58
can do at the next level is

00:33:01
really... What I love the

00:33:03
most is just talk about it.

00:33:05
So when you feel something bad inside,

00:33:08
most clinicians think

00:33:09
they're the only ones.

00:33:10
Most clinicians think nobody

00:33:12
else feels this way.

00:33:13
They shouldn't feel this way.

00:33:14
And they should be very

00:33:15
embarrassed about talking about it.

00:33:18
So if you're a clinician, find...

00:33:22
some safe space to talk

00:33:24
about it whether that is

00:33:26
with your peers somebody

00:33:29
you trained with that you

00:33:30
trust maybe your workplace

00:33:32
you don't feel safe and you

00:33:33
have to go to someone else

00:33:36
online maybe their support

00:33:37
groups or maybe you go to a

00:33:39
therapist or whatever

00:33:41
whoever it is who can

00:33:43
understand what's going on

00:33:44
with you talking about it

00:33:46
in of itself will heal and

00:33:48
that is one of the most

00:33:49
powerful things I learned

00:33:50
after writing the book

00:33:52
I've had so many people come to me and say,

00:33:57
wow, that happened to you?

00:33:59
That happened to me?

00:34:00
I didn't know that happened

00:34:01
to anybody else.

00:34:02
Can I tell you what happened to me?

00:34:04
And so just talking about it

00:34:06
is a huge part of the healing.

00:34:09
Then you go kind of to the next level,

00:34:11
which is the systematic part.

00:34:14
And this is where the

00:34:14
managers and the leaders have to work.

00:34:17
They have to figure out how

00:34:18
to align the clinical

00:34:20
values with the organizational

00:34:23
Strategy, priorities, et cetera.

00:34:25
And this is what you said, Kelly,

00:34:26
like the middle manager.

00:34:27
This is what's really hard.

00:34:29
You have to figure out how

00:34:30
to translate what is

00:34:32
meaningful to your

00:34:32
clinicians into what is

00:34:35
meaningful to the bottom line.

00:34:37
And this is what I do for a living.

00:34:39
So I can tell you it's not

00:34:40
impossible in most scenarios,

00:34:42
but it does take a lot of

00:34:44
translation and it often

00:34:46
requires a lot of creativity.

00:34:50
So there's a lot of, with AI especially,

00:34:53
I mean, AI is not really new,

00:34:54
but it's getting a lot of

00:34:55
attention in the healthcare space.

00:34:58
It has tremendous potential

00:35:01
to improve the way the

00:35:03
clinical teams work,

00:35:04
but it can also make it

00:35:05
worse as we saw with the health records.

00:35:08
So again,

00:35:08
the devil is in the details and

00:35:10
this is where the

00:35:11
leadership has to really be

00:35:13
given the time and space

00:35:15
and ability to chat, to work on that.

00:35:18
Um, and then,

00:35:19
and then at the very highest

00:35:20
level as a society,

00:35:24
There's many different ways

00:35:25
to tackle this problem.

00:35:28
I think, again, society can show respect.

00:35:32
I truly believe that most clinicians,

00:35:36
at the end of the day,

00:35:37
we just want to feel

00:35:38
respected and autonomous

00:35:41
and valuable to our society.

00:35:43
And if you can make us feel that way,

00:35:45
whether that is in the press,

00:35:49
in social media, in providing

00:35:52
supports and daycare and

00:35:56
elderly parent care or find

00:36:00
ways to support us with

00:36:01
additional administrative staff.

00:36:02
I mean, there's so many ways.

00:36:04
And I don't know if you saw recently,

00:36:06
there was just an

00:36:06
announcement in the news

00:36:08
from our Surgeon General

00:36:10
that they are going to be

00:36:11
working on not just for

00:36:12
healthcare workers,

00:36:13
but parental supports.

00:36:17
A lot of clinicians are parents.

00:36:20
Yeah.

00:36:21
And

00:36:22
we're feeling completely

00:36:23
crushed at having to be a parent,

00:36:28
having to be a clinician,

00:36:29
especially during COVID.

00:36:31
So, you know, legislatively,

00:36:34
our country can opt to

00:36:37
support healthcare clinicians.

00:36:40
I think they started to do

00:36:42
that during COVID, but

00:36:44
It wasn't enough.

00:36:45
And when COVID ended,

00:36:46
everybody really just wanted to move on.

00:36:49
And there was never really

00:36:50
that moment to reflect and say,

00:36:52
what did we learn?

00:36:53
And how can we, you know,

00:36:55
as a country make it better

00:36:57
for our clinicians?

00:36:58
It did seem like people just

00:37:00
wanted to move on from that discussion.

00:37:02
As soon as they felt like

00:37:03
they could take the mask off,

00:37:04
they wanted to stop talking

00:37:06
about it as well.

00:37:07
And, you know, to a point,

00:37:09
I do understand that.

00:37:10
I mean,

00:37:11
it was a tremendously trying time

00:37:12
for the world.

00:37:15
But I think that there were

00:37:17
some lost opportunities for

00:37:19
us that we have to reclaim.

00:37:22
One of the things that I

00:37:23
remember from my nursing days,

00:37:25
I primarily worked in

00:37:27
intensive care and emergency.

00:37:29
And so we would have after a

00:37:33
particularly hard incident,

00:37:36
we would have a critical

00:37:37
incident debrief.

00:37:39
And, you know, to a point that was helpful,

00:37:42
sitting together,

00:37:43
kind of going through things,

00:37:44
reviewing what happened.

00:37:47
how we felt, but then it was over.

00:37:51
And what I think we lost

00:37:55
sight of is that there

00:37:57
doesn't need to be a large

00:38:00
incident that happens for a

00:38:02
moral injury to occur.

00:38:05
And those,

00:38:06
they build on each other slowly

00:38:09
until you don't recognize

00:38:11
yourself as the nurse or

00:38:14
physician maybe you were

00:38:15
ten years before because

00:38:17
you've just been beaten down.

00:38:20
How can we take the concept

00:38:23
of a critical incident

00:38:25
debrief and apply that to daily practice?

00:38:30
So I think the debrief

00:38:34
And sometimes hospitals used to have M&M,

00:38:38
which was kind of that

00:38:39
larger scale analysis.

00:38:42
Those are good and bad.

00:38:43
Again, the devil's in the details, right?

00:38:45
So if it comes across as a

00:38:47
punitive exercise that we

00:38:50
are shaming clinicians for

00:38:52
doing something wrong,

00:38:55
it will actually make the wound worse.

00:38:57
And it will create a space

00:38:58
where we don't feel safe to talk.

00:39:01
because we will see how our

00:39:03
colleague just got shamed.

00:39:05
So if done in the wrong way,

00:39:08
it can make the wound much worse.

00:39:10
If done in the right way,

00:39:12
it can be extremely

00:39:14
supportive and create more

00:39:16
vulnerability and more

00:39:17
safety to talk about things.

00:39:21
I think one of the biggest

00:39:22
nuances in like doing it

00:39:23
right and doing it wrong is

00:39:25
the idea of perfectionism.

00:39:28
So most clinicians were

00:39:29
trained to be a hundred percent perfect.

00:39:32
You are a hundred percent right.

00:39:33
A hundred percent of the time.

00:39:35
And you just are.

00:39:36
And anything like anything

00:39:37
less than that is not really acceptable.

00:39:40
And you might be shamed or whatever,

00:39:43
but that's how I was trained.

00:39:44
I don't know if that's how

00:39:45
you were trained,

00:39:46
but mistakes were not an option.

00:39:49
Yeah.

00:39:50
The mistakes were not something that were,

00:39:53
it wasn't, it wasn't okay.

00:39:56
It just wasn't okay.

00:39:57
Right.

00:39:58
And so now today,

00:39:59
the equivalent of that is

00:40:01
quality assurance.

00:40:03
So there is a huge

00:40:04
regulatory oversight of health care,

00:40:07
which as a patient, you're like, great,

00:40:09
I don't want there to be a mistake.

00:40:10
I don't want to be a mistake.

00:40:12
But as a clinician,

00:40:13
it just reinforces you have

00:40:16
to be a hundred percent,

00:40:17
a hundred percent of the time,

00:40:17
which is not possible.

00:40:22
Well, we're not robots, right?

00:40:25
We're human.

00:40:26
And even robots are not a hundred percent.

00:40:29
Correct.

00:40:29
Yeah, that's right.

00:40:31
So it is not realistic.

00:40:33
So how do you talk about

00:40:37
these things in a way that is supportive?

00:40:39
Again, I think the leaders and managers,

00:40:41
this is where they can make

00:40:42
a huge difference.

00:40:44
If you have a leader or a

00:40:47
manager who is very self-aware and

00:40:51
and who is very comfortable being human,

00:40:55
but also you respect as a

00:40:58
clinician and they show up and they say,

00:41:02
wow, this thing happened.

00:41:04
And, you know,

00:41:05
that reminded me of

00:41:06
something that happened to me.

00:41:08
I, you know, I remember at this stage,

00:41:10
I made this mistake.

00:41:12
I remember how I felt.

00:41:13
I felt ashamed.

00:41:15
I felt scared.

00:41:16
I felt this, it was really hard.

00:41:19
And,

00:41:20
Luckily,

00:41:20
my friends really supported me and

00:41:22
they said that they had

00:41:23
experienced something similar.

00:41:25
And, you know, I'm just making this up.

00:41:28
But when you have leaders

00:41:30
who show up authentically

00:41:32
vulnerable and share how they felt,

00:41:37
they don't have to say, oh,

00:41:39
I'm sure you're feeling ashamed.

00:41:41
I'm sure they can just say,

00:41:42
I had this thing happen to me.

00:41:44
This is how I felt.

00:41:45
I don't know if this is how

00:41:46
you're feeling.

00:41:47
But if you are,

00:41:48
I could totally relate to

00:41:50
that because this is how I

00:41:52
felt when it happened to me.

00:41:53
When you frame it that way,

00:41:54
it's totally different.

00:41:57
Well,

00:41:57
and that's really the human experience,

00:41:59
right,

00:41:59
is telling someone that they're not

00:42:01
alone.

00:42:04
And there are opportunities

00:42:05
to have quality assurance,

00:42:07
quality improvement without

00:42:10
necessarily that punitive aspect to it.

00:42:12
Now, there are certain occasions,

00:42:14
certainly, where, you know, obviously,

00:42:16
if someone makes a mistake that is grave,

00:42:18
that it needs to be addressed.

00:42:20
That's a different situation.

00:42:21
But I remember in...

00:42:25
for medication errors is a great example.

00:42:29
People shy away from

00:42:30
reporting a medication

00:42:31
error and you can do,

00:42:33
you can look at the data

00:42:35
and see what time of day, you know,

00:42:37
between four and six AM on

00:42:39
a night shift is,

00:42:40
There's a higher incidence

00:42:41
of medication errors.

00:42:43
And why does that happen?

00:42:45
And so, but people,

00:42:47
that's a mistake and people are,

00:42:49
may hesitate.

00:42:51
Now, a lot of nurses will, you know,

00:42:53
obviously the care is for the patient.

00:42:55
They will bring that forward.

00:42:57
But if we were more open and

00:42:59
less punitive about the

00:43:00
fact that we're human at four to six AM,

00:43:04
and then we could look at, well,

00:43:05
why is that happening?

00:43:06
Is that happening because of

00:43:08
human error or

00:43:09
Or is that happening because

00:43:10
there's two similar

00:43:11
medications who are in two

00:43:14
drawers right next to each other?

00:43:15
And at four to six a.m.,

00:43:18
we could make that change

00:43:19
and that that would

00:43:20
eliminate that error from happening.

00:43:22
Would you agree?

00:43:24
Like just being able to talk

00:43:25
openly about those things

00:43:27
that we can fix?

00:43:29
Of course.

00:43:29
And I think, again,

00:43:30
the key here is for a nurse or a doctor,

00:43:33
for any clinician to feel

00:43:34
comfortable saying, oh, my gosh.

00:43:37
I made a mistake.

00:43:38
Here's the mistake I made.

00:43:39
I want to make sure, like,

00:43:40
I don't want to make this again.

00:43:42
I don't want to, you know,

00:43:42
maybe there's something we

00:43:43
can do to make it so

00:43:44
somebody else doesn't make this mistake.

00:43:46
For you to feel that way,

00:43:47
a couple of things have to be in place.

00:43:50
You have to trust the

00:43:51
manager that you work with.

00:43:53
You have to feel safe that

00:43:54
you're not going to lose

00:43:55
your job because you made that mistake.

00:43:58
And you have to yourself be

00:44:01
in a very psychologically good place.

00:44:04
So if you're already broken

00:44:05
down and beaten up and

00:44:07
depressed and you got kid

00:44:08
issues and you didn't get

00:44:10
any sleep and all this

00:44:13
other stuff in your life is

00:44:15
piled up on top of you,

00:44:17
I think it's totally

00:44:18
understandable that you

00:44:19
wouldn't be able to do that.

00:44:21
So this is where that

00:44:22
baseline taking care of our

00:44:25
clinicians as a society

00:44:26
comes in because the more

00:44:28
we take care of them,

00:44:29
the better able they are to show up

00:44:33
as the best version of

00:44:34
themselves so that when

00:44:35
there is a mistake, they can feel inside,

00:44:38
okay, I got this.

00:44:40
I trust my manager.

00:44:42
I feel okay.

00:44:43
I can talk about this.

00:44:45
But to expect them to do

00:44:46
that on this backdrop of

00:44:49
feeling like out of control, helpless,

00:44:51
hopeless, not supported, not respected,

00:44:54
underpaid, you know, whatever,

00:44:56
that's not very human.

00:44:58
And so I really...

00:45:01
I would love to reframe the

00:45:02
conversation around human

00:45:04
beings and how we work.

00:45:06
And if we have robots that

00:45:08
can do something to support

00:45:09
us so that we don't have to,

00:45:10
like you said,

00:45:11
the pill drawers or the

00:45:12
automatic pill things open or whatever,

00:45:15
the robots can support us

00:45:17
so that we can be the best

00:45:18
humans possible.

00:45:20
But again, I want to refocus it away.

00:45:23
It's not always an operational fix.

00:45:27
It's sometimes a human thing.

00:45:29
is a human healing first and

00:45:33
then you layer the

00:45:34
operational fix on top of

00:45:35
it and you'll have more success.

00:45:37
But if you are always just

00:45:40
jumping to the operational

00:45:42
fix because that's easier

00:45:43
and you don't have to get

00:45:44
into messy human psychology,

00:45:47
you're never going to get

00:45:48
where you want to go.

00:45:49
So a lot of the,

00:45:50
the reason we keep injuring

00:45:52
each other and sometimes

00:45:53
clinicians injure each other, by the way,

00:45:55
um,

00:45:56
Is because it's really

00:45:57
uncomfortable and it gets

00:45:58
really shrinky and like

00:46:00
we're not very good at

00:46:02
talking about feelings.

00:46:03
I wasn't before I went into

00:46:04
psychotherapy training.

00:46:06
I was terrible at it.

00:46:07
So it's just this discomfort

00:46:12
and the culture, I think,

00:46:13
that gets in the way.

00:46:15
But sometimes these

00:46:16
uncomfortable conversations

00:46:18
just take five minutes.

00:46:20
It's not even like it takes a lot.

00:46:23
People say, oh, we don't have time.

00:46:24
We don't have time.

00:46:25
I would argue with that I

00:46:26
think time is just a proxy.

00:46:29
Sometimes the hardest

00:46:30
conversations take five minutes.

00:46:33
You know,

00:46:34
I had a nurse manager when I was

00:46:36
a young nurse in emergency,

00:46:39
and we had a particularly trying coach.

00:46:45
And I was very upset after it.

00:46:49
And she took my hand.

00:46:50
She said, come with me.

00:46:52
And we just went into the

00:46:53
little quiet room off to the side.

00:46:55
And she held my hand.

00:46:58
And she said, everything's going to be OK.

00:47:01
And I watched you.

00:47:03
And you tried your very best.

00:47:04
Everybody in that room did

00:47:05
their very best.

00:47:07
And so I want you to

00:47:08
remember that as you go on with your day.

00:47:11
And it was literally three minutes.

00:47:14
And it was three minutes.

00:47:17
Healed.

00:47:18
I felt healed.

00:47:20
In three minutes.

00:47:20
In three minutes.

00:47:22
In three minutes,

00:47:23
she made me feel seen and heard.

00:47:27
I mean,

00:47:28
I could cry right now even thinking

00:47:29
about it because she's one

00:47:32
of the people in my life.

00:47:34
That was twenty-odd years ago, right?

00:47:37
And I still remember her.

00:47:39
I still remember how she

00:47:40
made me feel in three minutes.

00:47:43
And we all have the

00:47:44
opportunity to do that.

00:47:46
Exactly.

00:47:46
And like I said, even as a patient,

00:47:48
we have the opportunity to be kind.

00:47:51
You know,

00:47:52
if you're sitting in the waiting

00:47:54
room and you're a patient

00:47:54
and the doctor is an hour

00:47:56
late and you're mad because

00:47:57
you have somewhere to be,

00:47:58
it's one of my pet peeves.

00:48:00
And, you know,

00:48:00
you're sitting in the stupid

00:48:01
waiting room on the stupid

00:48:03
chair and you're just like, oh, God,

00:48:04
this is ridiculous.

00:48:06
You know,

00:48:07
instead of walking into the room

00:48:08
with the clinician being angry at them,

00:48:10
which is normal, right?

00:48:13
Just to reframe for a second and say, wow,

00:48:15
I'm sure they don't really

00:48:16
want to be an hour late.

00:48:18
I wonder what has happened

00:48:19
to them that they are an hour late.

00:48:20
And to just say, gosh,

00:48:23
I know you were running

00:48:23
behind and I'm imagining

00:48:25
you've had a really tough morning already,

00:48:28
but I'm glad you're here.

00:48:30
Right.

00:48:30
Just imagine as a clinician

00:48:32
hearing that on the other end,

00:48:34
because you probably feel bad inside.

00:48:36
You feel rushed.

00:48:37
You feel worried.

00:48:38
You think they're mad at you.

00:48:40
You're mad at the system for

00:48:41
making you behind.

00:48:42
You know,

00:48:42
you have all this emotional stuff.

00:48:44
Maybe you're not aware of it consciously,

00:48:46
but it comes in the room

00:48:48
into that healing.

00:48:50
Even, you know,

00:48:50
you may only have fifteen

00:48:51
minutes with that person to heal them.

00:48:53
You come in the room with

00:48:54
all that baggage.

00:48:55
They come in the room being

00:48:56
angry with all that baggage.

00:48:59
It makes it hard for healing to happen.

00:49:00
But if the two of you just

00:49:02
pause for a moment, literally a moment,

00:49:06
five seconds, ten seconds to say,

00:49:11
wow,

00:49:11
I'm only imagining what your morning

00:49:13
must have been like.

00:49:14
Or the clinician to say, you know,

00:49:17
I can imagine you had to

00:49:18
sit and wait and that was very upsetting.

00:49:19
If that happened to me,

00:49:20
I would be upset too.

00:49:23
I think it just reframes the

00:49:24
entire encounter.

00:49:26
And it doesn't take a lot of time.

00:49:28
This is what I keep telling people.

00:49:29
Like, it's not time that is the problem.

00:49:32
Yes,

00:49:33
we have issues with these short visits,

00:49:35
but it's really not the time factor.

00:49:37
Like you said, that three minutes.

00:49:39
Mm-hmm.

00:49:41
made a difference to you for decades.

00:49:44
But both sides,

00:49:45
both on the patient side

00:49:47
and the clinician side,

00:49:48
we both have to take

00:49:49
responsibility for that getting better.

00:49:52
And it doesn't have to take.

00:49:54
But if you do that,

00:49:57
if the patient and the

00:49:58
clinician take that responsibility,

00:50:01
then that's where healing

00:50:03
can happen because you're

00:50:03
both actively listening to

00:50:05
each other without all of

00:50:07
that noise that you brought

00:50:08
into the room.

00:50:10
Because you both made that

00:50:11
effort to recognize each

00:50:13
other's learning.

00:50:14
you had a moment of empathy

00:50:16
for the other person and you said, yes,

00:50:18
we may be bringing all this

00:50:20
garbage in the room with us,

00:50:21
but we're going to,

00:50:22
we're both going to put it

00:50:23
aside so that we can have

00:50:25
this healing interaction.

00:50:27
Yeah.

00:50:28
Right.

00:50:28
And so we can all do this.

00:50:30
We can all do it.

00:50:31
It's really,

00:50:32
and this is what I guess I'm

00:50:34
trying to emphasize in the book.

00:50:36
These small acts of kindness

00:50:37
or empathy do not take a lot of time.

00:50:40
It really just takes the mental,

00:50:42
effort to be aware of what

00:50:44
is going on and then have a

00:50:46
couple phrases or things in

00:50:49
your mind that you can say

00:50:51
when you walk in the door.

00:50:53
Yeah, I love that.

00:50:55
So what has been probably

00:50:57
the most surprising thing

00:50:58
you've learned about

00:50:59
yourself through this whole journey?

00:51:03
I love that question because

00:51:05
as I was writing and interviewing,

00:51:07
as I mentioned,

00:51:08
people started to tell me these stories.

00:51:11
very vulnerable stories.

00:51:12
And then they would email me

00:51:13
after the interview a couple days later.

00:51:16
And they would say, wow,

00:51:17
I didn't mean to tell you that story.

00:51:18
But it just came out.

00:51:20
And, you know,

00:51:21
after I told you that I felt better.

00:51:24
Like even just telling you

00:51:25
that interview was healing.

00:51:27
So the wheels were turning in my head.

00:51:29
And I was like, okay,

00:51:32
if I am seeing healing

00:51:34
after these short interviews,

00:51:37
I'm going to challenge myself.

00:51:38
And I'm going to put some stuff in there.

00:51:41
that is scary so I made a

00:51:45
big decision as I was kind

00:51:48
of putting the chapters

00:51:49
together and I had one

00:51:52
moral injury that happened

00:51:53
to me that was extremely

00:51:54
painful and I was very

00:51:56
embarrassed about and I

00:51:58
said I'm gonna put it in

00:51:59
the first chapter I'm gonna

00:52:01
tell my story I'm gonna

00:52:02
tell the whole story the

00:52:04
whole world can be in print

00:52:05
forever and ever anybody can read it

00:52:08
I don't know who's going to look at it.

00:52:11
You know,

00:52:11
some people that I work with may be like,

00:52:13
oh, gosh,

00:52:14
I didn't know that happened to you.

00:52:15
But I was like,

00:52:16
if I really am going to

00:52:18
practice what I preach and be healed,

00:52:20
I'm going to just put it out there.

00:52:22
And I'm so glad I did

00:52:24
because it did heal me.

00:52:26
And after people read it,

00:52:29
they came back to me and

00:52:30
said the same thing.

00:52:31
Like, I didn't know that happened to you.

00:52:35
That happened to me.

00:53:15
Okay, back again.

00:53:17
I don't know what happened there.

00:53:20
That's okay.

00:53:21
It cut out at the question.

00:53:23
You said what surprised you.

00:53:24
So I don't know how much of that you got.

00:53:28
So you had, we were, I think it was fine.

00:53:30
We were talking about,

00:53:32
and we'll just edit this.

00:53:34
Yeah, yeah, of course.

00:53:35
Issue it.

00:53:36
But you were talking about

00:53:37
what you had learned about

00:53:38
yourself and that you decided to be,

00:53:41
to put it right in the

00:53:41
first chapter and put it out there.

00:53:46
I did that in my own book.

00:53:47
I was brave in my own book at the very,

00:53:50
I think it was the second chapter for me.

00:53:52
But there's something

00:53:54
incredibly healing and

00:53:56
freeing about being honest,

00:53:59
about being human.

00:54:02
And something that was very, I thought,

00:54:04
unflattering about me, right?

00:54:06
Something I was very ashamed

00:54:08
of or feeling a lot of.

00:54:10
I thought it had healed,

00:54:12
but when I wrote it,

00:54:13
I realized it hadn't healed at all.

00:54:16
It was still there.

00:54:17
I had just kind of

00:54:18
compartmentalized it

00:54:20
without really healing it.

00:54:21
And so it's still painful,

00:54:24
but it's better in getting

00:54:26
the feedback from others.

00:54:28
And one of the people that

00:54:30
gave me that feedback was

00:54:31
somebody who is a mentor to

00:54:34
me who is much older,

00:54:38
who I have looked up to for many,

00:54:40
many years.

00:54:41
And they said the same thing

00:54:42
happened to them.

00:54:43
And that totally blew my mind.

00:54:45
Because that was someone I

00:54:46
have so much respect for

00:54:48
who also never talked about

00:54:50
it because he felt the same way.

00:54:54
And for him to come to me and say, wow,

00:54:56
I'm so glad you did that.

00:54:57
And I had that happen to me.

00:54:59
I mean,

00:54:59
that was just a full circle moment.

00:55:01
And I realized that this is

00:55:04
just so much more common

00:55:08
than anybody knows.

00:55:09
And it's happening way more

00:55:10
than anybody knows to get

00:55:11
that kind of feedback from

00:55:13
so many people.

00:55:14
so early on in the publication.

00:55:17
Again,

00:55:18
it made me feel good that I got the

00:55:20
book out so fast because I

00:55:22
do think it's a very common experience.

00:55:26
Absolutely.

00:55:27
And, you know, I mean,

00:55:29
this is we talk about our

00:55:31
stories and this is the

00:55:32
very reason I launched this podcast.

00:55:34
And the title says it all, because for me,

00:55:39
I look at I talk about a

00:55:41
lot the Japanese art of Kintsugi,

00:55:43
where they repair the

00:55:45
pottery with the gold in the plaster,

00:55:47
making it more valuable and

00:55:49
more beautiful.

00:55:51
And I look at my own

00:55:53
brokenness in that way,

00:55:54
that because of that, that, you know,

00:55:57
the perspectives I've gained or, you know,

00:56:00
and just anybody in anybody's life.

00:56:03
I work with the bereaved primarily,

00:56:06
and I'm a bereaved parent myself.

00:56:09
What would you say to

00:56:10
someone who is facing all of this stuff?

00:56:15
They're a health,

00:56:15
they're a clinician in some

00:56:17
way or form in the health

00:56:18
system and they are bereaved.

00:56:21
And we know that,

00:56:23
don't get me started on the

00:56:24
three-day bereavement leave,

00:56:25
but we know that they're

00:56:28
walking into this.

00:56:29
And when I was being educated,

00:56:33
you leave your problems at the door,

00:56:34
right?

00:56:35
It's not about you once you open that door,

00:56:36
but-

00:56:37
But that's not really realistic, is it?

00:56:39
Because you see all these

00:56:40
other people hurting.

00:56:42
You're hurting yourself.

00:56:44
You can't help but bring

00:56:45
that through the door.

00:56:46
So what would you say to

00:56:47
those individuals?

00:56:51
Well, I'm not a grief expert,

00:56:53
but certainly have helped a

00:56:55
lot of people who were

00:56:57
grieving in the grieving process.

00:56:59
And I would say that it's

00:57:01
not just the grieving process.

00:57:03
It's any of that stuff that

00:57:05
comes in the room with you.

00:57:07
um well how do you handle

00:57:08
that because life is there

00:57:09
you're human you know

00:57:10
unless you live in a bubble

00:57:11
life is going to affect you

00:57:13
so what do you do with your

00:57:14
own stuff that comes with

00:57:17
you when you walk in that

00:57:18
door so and I know grieving

00:57:21
is different for different

00:57:22
people as well so some

00:57:24
people and this is where

00:57:27
you really the

00:57:27
self-awareness to me is the

00:57:29
key the first thing is the

00:57:30
self-awareness if you are

00:57:31
grieving and you are not in

00:57:34
a space to heal other people

00:57:38
you need to take a break,

00:57:40
whatever that break looks like.

00:57:42
And it doesn't matter how

00:57:44
many vacation PTO, I don't know,

00:57:46
whatever you have in your file,

00:57:48
you need to take the break

00:57:49
that is going to heal you.

00:57:51
And so you need to have

00:57:52
self-awareness to know what that is.

00:57:55
And if you don't know,

00:57:55
this is where I said earlier,

00:57:57
you just have to find

00:57:58
someone to talk to that is

00:58:00
safe so that you can understand, well,

00:58:02
do I need a vacation?

00:58:04
Do I need to just cut back on my days?

00:58:07
Do I need to go to therapy?

00:58:08
Maybe I need a psychiatrist.

00:58:10
I need to be on medication.

00:58:12
What do I actually need to heal?

00:58:14
So if the answer is you need a break,

00:58:17
then you have to find out

00:58:18
how to advocate for

00:58:19
yourself to take a break.

00:58:21
And this is where sometimes

00:58:23
those difficult

00:58:23
conversations with a manager come in.

00:58:27
And this is where a

00:58:28
therapist or a coach or

00:58:29
somebody up here who's been

00:58:31
through it can really help

00:58:32
give you some ways

00:58:33
to have that uncomfortable conversation.

00:58:38
But let's say you're the

00:58:39
kind of person that maybe

00:58:41
taking a break isn't an

00:58:42
option or maybe it isn't

00:58:44
what is going to heal you.

00:58:45
Because some people actually

00:58:46
that is not healing to them.

00:58:48
Right.

00:58:49
To sit around at home.

00:58:50
Sometimes that makes them worse.

00:58:52
Yeah.

00:58:52
So if you're the kind of

00:58:53
person who does need to

00:58:54
come in the room with the

00:58:55
patient with your stuff,

00:58:57
which I think is the majority of the time,

00:59:00
you know, like if I have a kid issue,

00:59:02
It's rare that I'm going to

00:59:03
take a whole day off work, right?

00:59:05
I mean, unless it was a crisis.

00:59:09
So what do you do in that scenario?

00:59:11
So if you are a manager,

00:59:12
what I recommend doing is

00:59:15
if you have one-to-one

00:59:17
conversations or very

00:59:19
important conversations

00:59:20
scheduled for that day,

00:59:23
I would call the person and just say, hey,

00:59:27
just got a quick heads up.

00:59:29
I got some personal stuff going on.

00:59:31
Um,

00:59:32
it's nothing that you have to worry about,

00:59:34
but I just wanted to let you know, no,

00:59:36
I may not be a hundred

00:59:36
percent today and I want to

00:59:38
give you the attention you deserve.

00:59:40
Would you,

00:59:41
would you like to reschedule and

00:59:44
just give them the option

00:59:45
to just reschedule so that

00:59:47
you can show up in a,

00:59:48
in a more present way with them?

00:59:51
I love that approach.

00:59:53
Yeah.

00:59:54
And then the other thing is just to,

00:59:55
I mean, this is the way I handle it.

00:59:57
I have days certainly where

00:59:58
I'm not a hundred percent.

01:00:01
And I'll join my meetings or

01:00:04
the work I'm doing and just

01:00:05
give people a heads up and say, hey,

01:00:07
just to let you know, you know,

01:00:09
I'm not feeling a hundred percent today.

01:00:11
I feel, I feel pretty good.

01:00:12
I think I can do a good job today, but I'm,

01:00:14
I may not respond as

01:00:16
quickly to this thing,

01:00:17
or I may save this thinking

01:00:19
work I need to do for tomorrow, or,

01:00:23
you know, I may not go on camera as

01:00:25
just do an audio meeting,

01:00:27
like whatever it is you need to do,

01:00:28
just say, you know,

01:00:30
I'd like to run this by you.

01:00:31
This is kind of what I'm

01:00:32
thinking I'm going to do today.

01:00:36
You know,

01:00:36
if you're a nurse on the floor

01:00:37
and you have a certain set

01:00:38
of responsibilities,

01:00:39
maybe there's the flexibility to say,

01:00:42
you know,

01:00:42
I'd really rather just not go

01:00:44
into patient rooms today because I

01:00:46
I'd feel like there's a cold

01:00:47
brewing and I think I'm

01:00:49
good to be here today.

01:00:51
Or maybe I need to wear a mask today,

01:00:53
or maybe I need to leave early today or,

01:00:57
you know,

01:00:57
try to find a way to meet your needs.

01:01:01
And when you're in the room

01:01:02
with the patient,

01:01:05
I think clinicians feel

01:01:07
like they can't be human there.

01:01:09
And that's a little bit

01:01:10
trickier to figure out how

01:01:12
much to disclose or how much to share.

01:01:15
So again,

01:01:16
if you're in a situation with a

01:01:17
patient where you really

01:01:18
just don't feel that you're

01:01:20
a hundred percent to do the healing,

01:01:23
that's where I think maybe

01:01:24
finding a way to step out

01:01:25
or have someone else step in for you.

01:01:28
But if you feel like you can heal them,

01:01:30
but maybe you're a little bit off,

01:01:32
I actually just call it out

01:01:34
to the patient because they

01:01:35
can pick up on you not

01:01:37
feeling a hundred percent

01:01:39
consciously or subconsciously.

01:01:40
And then people typically go

01:01:42
to assumptions.

01:01:43
Like, oh, the doctor doesn't like me.

01:01:45
Or, oh,

01:01:46
today they don't want to talk to me.

01:01:48
People will come up with all

01:01:49
these scenarios in their

01:01:50
mind about why you seem not

01:01:53
quote unquote normal to them.

01:01:55
So I actually,

01:01:56
I would say just let the patient know,

01:01:58
like, hey,

01:01:59
I'm just having one of those days.

01:02:01
I'm so happy to see you today,

01:02:03
but I just got to let you know, like,

01:02:04
it's been a crazy morning for me.

01:02:06
So do you mind, like,

01:02:07
maybe just let me gather my

01:02:09
thoughts for a couple

01:02:10
minutes before we jump in today.

01:02:11
Is that okay with you?

01:02:13
Right.

01:02:14
It's, I mean, and it's just,

01:02:16
it's just being honest, right?

01:02:18
We're being honest with each

01:02:19
other about our stories and we're not,

01:02:21
you're not disclosing a

01:02:23
great deal to a patient, but you're,

01:02:25
you're just telling them, I just,

01:02:26
I just need a moment and that's okay.

01:02:29
And it, it sounds like,

01:02:31
but the commitment needs to

01:02:33
go to the entire team.

01:02:35
They need to make that

01:02:36
commitment to each other to

01:02:37
show that grace.

01:02:39
So to say, okay,

01:02:42
We're about this group here.

01:02:45
We realize we're all human

01:02:47
and we're going to support each other.

01:02:48
So show grace to Martha this

01:02:52
day and Ben the next day,

01:02:54
whoever needs it,

01:02:55
that we all agree that that's okay.

01:02:58
And it's what we do here as a team.

01:03:02
It is.

01:03:02
And then the hard part is

01:03:03
Martha needs grace every day, right?

01:03:07
Because then it creates

01:03:09
dynamics that people feel like,

01:03:12
they can't trust Martha.

01:03:14
Right.

01:03:15
Yeah.

01:03:15
So that's where the nuance

01:03:17
again comes in and a good

01:03:18
manager can help to say, Hey Martha,

01:03:24
let's have a five minute talk.

01:03:26
Hey Martha.

01:03:27
Um,

01:03:28
I really appreciate how you took care

01:03:29
of patient Bob.

01:03:31
I've noticed in the last

01:03:33
week that you haven't been

01:03:35
able to be a hundred

01:03:37
percent and I'm concerned that,

01:03:40
That means the team may not

01:03:42
be able to feel they can

01:03:43
trust you to get things done.

01:03:46
Are you comfortable sharing

01:03:47
with me what might be going

01:03:49
on so I can help you figure

01:03:52
out what to do next?

01:03:54
Yeah.

01:03:55
So it requires that it's the

01:03:59
awareness of leadership.

01:04:01
So the leader,

01:04:02
it's not only about the bottom line, it's,

01:04:04
it's about those humans that you're,

01:04:07
that you're managing as well.

01:04:09
Before we finish out, I just,

01:04:11
I have a global gratitude

01:04:13
group called just one little thing.

01:04:15
And I started this as part

01:04:18
of my own grieving process because I,

01:04:22
I wanted to make sure that

01:04:24
our younger son had a happy life.

01:04:26
So we were pretty sad and broken,

01:04:30
but we agreed that we would

01:04:31
look for one little thing

01:04:32
each day to be thankful for.

01:04:35
And the reason I say just

01:04:37
one little thing was

01:04:38
because some days I could

01:04:39
only find just one little thing.

01:04:42
And so we would say a good

01:04:43
day at school or whatever.

01:04:45
You know, our dogs or, you know,

01:04:49
hearing my son laugh for

01:04:51
the first time after a

01:04:53
while of no laughter,

01:04:55
that was a great gift.

01:04:57
So today, I am thankful that,

01:05:01
as I am with a lot of

01:05:02
podcast recordings that my

01:05:03
two Labrador retrievers stayed quiet.

01:05:05
Mm-hmm.

01:05:07
Also thankful for this just

01:05:09
beautiful conversation with you.

01:05:12
I'm just incredibly grateful.

01:05:13
So what is your one little thing today?

01:05:17
Gosh, well,

01:05:17
we are recording around morning

01:05:20
where I am.

01:05:21
So my one thing this morning,

01:05:24
and this happens a lot of mornings,

01:05:25
which I'm grateful for.

01:05:27
I live in North Carolina and

01:05:29
our house is kind of in the trees.

01:05:32
And I'm very grateful that I

01:05:33
get to wake up in the

01:05:33
morning and go sit on the screen porch

01:05:37
In nature, with no one else to talk to me,

01:05:40
and I get to do a little bit of writing.

01:05:42
So today I got to do some

01:05:43
writing for about half an hour,

01:05:46
and I was extremely

01:05:46
grateful that I was in the

01:05:48
right place to do that.

01:05:49
And I was surrounded by

01:05:51
lovely green things and

01:05:53
birdsong and things like that.

01:05:55
So I felt very grateful for that.

01:05:57
Oh, that's beautiful.

01:05:58
Yeah,

01:05:59
there's nothing like the wind in the

01:06:00
trees in the fall in the Carolinas.

01:06:04
It's just my favorite as well.

01:06:06
So before we close out,

01:06:08
if you could tell our

01:06:09
listeners how they can find

01:06:11
you and your books and any

01:06:15
other work that you want to plug.

01:06:17
Sure.

01:06:17
So the books are easy.

01:06:19
Just go to Amazon.

01:06:20
That's where all the books live today.

01:06:22
Search my name, Jenny Byrne.

01:06:24
It's J-E-N-N-I-E.

01:06:27
B-Y-R-N-E and put in either title,

01:06:30
which is Work Smart or Moral Injury,

01:06:32
and it'll pop right up.

01:06:34
So you can get the books there.

01:06:36
The best place to follow me

01:06:37
is actually on LinkedIn.

01:06:38
So I've chosen that as my

01:06:39
only social media platform.

01:06:41
And I do respond to random

01:06:44
direct messages.

01:06:46
I always do respond.

01:06:48
So that's the best way just

01:06:49
to reach out if you wanted

01:06:51
to actually have a conversation.

01:06:53
Or LinkedIn is where you can

01:06:54
typically find my posts.

01:06:56
I write articles there.

01:06:58
I link to other podcasts

01:06:59
that I've done like today.

01:07:00
I'll link to that.

01:07:01
So if you're on LinkedIn,

01:07:03
that's the best place.

01:07:04
And if you're not on LinkedIn,

01:07:06
I do have a website,

01:07:08
which is drjennyburn.com.

01:07:11
Perfect.

01:07:12
Well, Dr. Burn,

01:07:13
thank you so much for being

01:07:15
with me today.

01:07:16
I so appreciate our chat.

01:07:18
Me too.

01:07:19
It was lovely to meet you, Kelly.

01:07:21
You too.

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