EP 36: Nursing Shortage and the Future of Healthcare

Episode Description:
This episode of the Hope4Med podcast features Dr. Will Harvey, who has been in healthcare in various clinical and executive roles over the past 20 years. In achieving his RN, MBA, and Ph.D. in social service, Dr. Will brings a unique perspective to the field of community health. He shares his experiences with burnout and how learning his limits helped him recuperate. We explore the factors contributing to the ongoing nursing shortage in healthcare and what needs to change to retain our current nurses. We also discuss challenges faced by aspiring health professionals in our current society.

Transcript:
[00:00:00] Dr. JB: Welcome to Hope4Med.

[00:00:03] Welcome back to the Hope4Med podcast with me, Dr. JB, as your host. Today’s featured guest is Dr. Will Harvey. He has been in healthcare in various clinical and executive roles over the past 20 years. In achieving his RN, MBA, and doctorate in social service, Dr. Will brings a unique perspective to the field of community health. Welcome, Dr. Harvey.

[00:00:26] Will Harvey: Thank you, Dr. JB, I appreciate you having me, been looking forward to the conversation.

[00:00:30] Dr. JB: So Dr. Harvey, please tell us, what brought you into healthcare in the first place?

[00:00:37] Will Harvey: Oh, jeez, I’ll try, I’ll try to give you the cliff notes version. I’ve always been into healthcare, and as cliche as that is, I was diagnosed with asthma pretty much, as my mom likes to joke, like at birth. Like right out of the womb, you got asthma. It was really bad. When I was a kid kinda coming up and my mother sent me to this asthma camp in southern Maryland, and as geeky as that sounds, it actually really helped me in the sense that like the nurses in particular and the pediatricians were absolutely phenomenal. So when I really started to understand, getting indoctrinated to what your career path was going to be, I just gravitated towards medicine. And I was very fortuitous enough to go to a pretty progressive high school in Prince George’s county, Maryland, where you kind of like have a pre-college, pick electives kind of a deal, and I just picked the social services track with medicine and kind of went from there. Then after I got my CNA and then eventually became an emergency nurse, like this was just, it was almost like I was predestined.

[00:01:35] Dr. JB: And how long did you work as an emergency nurse?

[00:01:38] Will Harvey: So for about 10 years at the bedside. I was an emergency tech before that and then an emergency nurse after, and then eventually, I wanted to prove, wanted to have a bigger impact. Emergency medicine is profoundly rewarding in a sense, but as you know firsthand, it can be severely draining. And in trying to look for ways to really impact my community, I entered home health, which has been a great community and public health arm that– it’s finally starting to get its due, but a well-run agency can have a pretty big impact on the community alone.

[00:02:12] Dr. JB: Indeed. And when you were in the emergency department working as an ER nurse, did you ever experienced any symptoms of burnout?

[00:02:20] Will Harvey: Uh, pretty much all of them. I mean, it’s, you know, what I find interesting– well, let me answer your question first. So, yes. I mean, I was lucky enough to be night shift, which if you’ve ever spent two seconds in emergency department, there’s always internal struggle of night shift versus day shift. But in working night shift, we were kind of a band of brothers and sisters and would help each other and try to hang out and become friends outside of the emergency department, just to kind of find ways to deal with some of the hard things that we were going through. But as good as your support system is, nothing’s foolproof, right? You’re seeing people dying on a daily basis, you’re seeing overdoses and gunshot wounds and cases of abuse and the police department bringing in this convicted felon and you find out what he or she has done, I mean, you have to be made of stone for it not to take its toll on you.

[00:03:10] And what I find interesting when we talk about burnout, at least recently, from the podcasts and readings that I’ve listened to, it’s always been the context of your job. I’ve always thought that really interesting, like, as a physician you’re burned out or as a nurse you’re burnt out or anything like that, it’s rarely, at least in some of the things that I’ve listened to ,it’s rarely talked about what that person’s life is outside of work that may be adding to it. Right? I mean, when I first started experiencing, I guess, my first burn out, if you will, mid twenties or so, new into the career, trying to make a name for myself. And as much as I’m trying to really gravitate and do all I can for my job, I’ve got life going on. Your spouse is going through something. My mother’s going through something. My trying have a relationship with my dad. Trying to worry about my own health issues. All those types of things, it’s like a perfect storm that adds to this burnout. So I’ve always just found that interesting, that we talk about burnout, typically first talk about, okay, what do you do for a living? And then oh, that’s the reason that you’re burning out. It’s just seems to be rarely talked about what life events that are weighing on this person daily, while they’re working, that’s contributing to that burnout. But yes, I mean, I would easily say with all humility that I’ve probably burnt out, quote unquote, three or four times in my career. And I say that without shame, it just, it happens when you really give yourself all to your profession.

[00:04:29] Dr. JB: Going along those lines about why is it that burnout has always just affiliated with your workplace, because if you look at the definition of burnout, like the way that it’s classified ICD 11, burnout is a syndrome conceptualized as resulting from chronic workplace stress. And so that’s why there’s always emphasis on the workplace. The way that burnout is conceptualized, at least to me, is that it’s not something inherently wrong with the person. I think that there’s different schools of people that, that some people don’t like to use the word burnout because they feel like it’s a negative connotation and instead other words are more applicable, like moral injury and things like that. But for me, whenever I talk about burnout, it really is in the context of your occupation, according to the definition by the WHO. That’s what, when I use that word, that’s what I’m stressing. How does your work, your chronic stress that you’re experiencing day to day cause or contribute to the symptoms of burnout, but to your point, it is multifactorial.

[00:05:26] Will Harvey: I definitely think so. And it’s not to say, I mean, your job takes up an extraordinary amount of time in your life. Not just from when you clock in from when you clock out, but if you’re a professional, paraprofessional, or truly embrace the concept of having a career, that’s all the schooling and training that you’ve gone through, that’s after hours thinking about it and then prepping. And if you’re a nurse or a physician, the documentation you have to do that may be after hours. No, I, 100% get the time consumption why are we so affiliated, but then I guess I challenge definition, if you will, to think about all the ways or some of the mainstay ways that we ask folks to combat burnout. Seeking emotional support, setting boundaries with others, don’t adhere to these new commitments that you’re taking, they’re typically all types of things that have to happen outside of the workplace, right? In your, quote unquote, “personal time,” so I think it’s hard to just say that it’s just workplace– and I know you’re not saying that, but, but if it’s going to bleed into your normal life, and then I think consequently, your normal life stressors are only going to add to it. And if you are truly one that, you know the buzz word is work-life balance, if you’re truly one to try to have that, you’re going to try to dedicate yourself equally to your family, friends, as much as your job. And if you’re doing that with any type of empathy and compassion for your families and friends, their struggles, and what they’re going to go through in the course of their life is ultimately going to weigh on you and I think add to that burden, it that makes sense.

[00:06:52] Dr. JB: Yeah, no, that’s completely, completely accurate. And so, I know that you mentioned “my first episode of burnout,” and so you’ve experienced numerous periods of burnout in your life?

[00:07:04] Will Harvey: 110%. So, honestly, if I could really, really trace it back, the first probably was even before I became a nurse, like, so, I don’t, I don’t think the story of how I became a nurse is necessarily unique, but it was filled with a lot of hard work. I was an emergency tech for an emergency department in Montgomery County, Maryland, and I went to nursing school in Johnstown, Pennsylvania, and I did both at the same time. I would literally go to nursing school Monday through Friday, get out of nursing school and clinicals, change, drive the two, two and a half hours south from Johnstown to Rockville, clock in for that overnight shift, once I was done with that at 7:00 AM, either crash at my mom’s, crash in my car, come back in, shower, work the next overnight shift, and then drive back up to Johnstown. I did that consecutively for two years. And I would be remissed if by like the end of the first, as successful as it was, I was exhausted. I mean, I was just, you know, I think as part of birth, you’re taking inventory of why you’re burnt out and it’s like, do I just drop this huge burden and let me just figure out another career path? Or is it just worth sticking to for the end goal? So, when I was in nursing school, that was probably the first bout. And the only way I think that I really got through it is, you just try to keep your eye on the prize. I was very blessed to work with some great nurses and physicians that were encouraging me along the way. After I graduated, we talked about really trying to become the best person and nurse I could be, whether it was trying to better my IV skills or EKG interpretation, whatever it was, fastest triage person, that inherently put some stress on you in trying to get that knowledge and that overload there. So probably maybe, maybe after two years straight at the bedside and seeing some really traumatic cases, that really, again, on the drive home, it was more than a few times that I would pull over and maybe kind of just really break down over some of the stuff that I’d seen the 12 hours before.

[00:08:57] And then, eventually, and in addition to wanting more and really wanted to focus on community and public health, you know, deciding to leave the emergency department, I did feel like a weight was off my shoulders and the burnouts have been less since then. But definitely my times in the emergency department were both physically and emotionally kind of taking a toll on me.

[00:09:15] Dr. JB: And so how did you recuperate from those experiences of burnout?

[00:09:19] Will Harvey: I think probably the best way that I could think to say it, that will probably be the most relatable to your audience, is just putting things in context. I’m not saying it always comes with age but as I sit here today in my mid thirties, I don’t think I have the same perspective as I did in my mid twenties, right? I understand what’s a bit, not only more what’s important, but how I fit into the overall goal. And when you’re not trying to overextend yourself and do too much and put too much on your shoulder, you kind of keep things in context and understand when you fit. Ten or so years ago when I was at the bedside and really just, “oh, you know, we’re, we’re shorthanded on a front,” like I’ve already worked like three twelves, I’m ready to be done, I’m walking out and they’re saying, “Hey, we got a couple of call-outs for tonight, can you do it?” Me now would be like, you know what, I’m sorry, I understand you’re short, but I can’t do it. Me ten years ago, it was like, all right, I’ll see you in 12 hours. Right? It’s just, I learned, you learn your limits. I think the strength of any man or woman is not knowing your strengths, it’s knowing your limits. And I think as I sit here now, knowing my limits prevents me from putting myself in a situation where I’m overextending myself and then leading to more burnout.

[00:10:27] Dr. JB: Okay. And so, in the news, we’re hearing a lot of talk about seas of nurses leaving the field of medicine. What do you think is contributing to that?

[00:10:40] Will Harvey: So many factors. I mean, I know most of your audience is most likely– and obviously you’re an emergency physician, you know this firsthand, but the nursing shortage is well-documented, even before the pandemic, for so many reasons, not just pay or lack of teachers to actually teach the new crop of nurses to come into the field, but scarcity in nursing schools, they’re not popping up on every corner like some vocations, so that was already an issue before the pandemic. Now that we’re two full calendar years basically in the pandemic, at first, nurses were heralded as heroes, and all the nurses I believe are, every emergency physician, every physician, every allied healthcare professional is a hero in their own. From the radiology tech to the custodian helping in the night shift. And that was really put front and center in the beginning days and weeks and months of the pandemic. Since then though, I would say easily over the past 18 months, I think it’s hard for any healthcare professional, especially one who dedicates themselves to education and staying abreast of what’s going on around them, to ignore the rancor and vitriol that has surrounded the profession of nursing. Basic rudimentary science and that we’ve all learned and adhere to and believed in is down being questioned by, let’s just say those that it’s hard to understand why they’re questioning it. And so, if I, a seasoned nurse, or a seasoned physician, it’s one thing to withstand that barrage and to kind of stay focused.

[00:12:05] But how does all that negative toxic rhetoric affect those who are on the fence of joining this profession? Right? Like if I was a new, just doing some undergrad work, a bio major at the University of Maryland, somewhere, I don’t know what I want to do, a quick Google search on the perspective of nursing right now, “maybe I’ll just shy away from that profession.” Right? There’s not a lot of positivities still around us and believing in our abilities to help humanity. And as much as a big like statement it is, that’s literally it. When we get sick, we are fortunate enough to live in our country, we can walk into any ER, urgent care, and to get treatment. And the only way that we’re able to get that is by the people in those scrubs good help us when we need it. And if those people start dwindling down, we’re in a lot of trouble. So, I hope that sooner, rather than later, we can kind of turn the tide and prop this profession up the way that it should be, because without it, our entire ecosystem, if you will, is pretty much going to crumble.

[00:13:11] Dr. JB: And so how could we turn those tides around?

[00:13:13] Will Harvey: I mean, I want to say that it starts with us, but I mean, as you and I talk today, I think we know our value. I still work with fantastic physicians and nurses. It has to be wider. It has to be some of those injecting this toxicity into society to come to some type of realization. Like, I don’t know if people say this type of thing for it to be sensationalized and to grab a headline, but at some point we need to put those egos aside and realize the damage that is being done as society at large. I’m not sure if this is more of a political movement, if it’s more of grassroots, but there needs to be more advocacy for nurses. I mean, the Obama administration did a lot for nurses and allied professionals, obviously our current administration does what it can when it can to kind of shout out to the nurses and physicians, but it needs to be more widespread at a local level to promote kind of more community activism to get into our profession because that’s typically what happens. I mean, I live in Baltimore County now, you enter the Baltimore County School of Nursing, typically when you graduate, you will treat Baltimore County residents. It is typically on a local level. So we can kind of start that positivity, I guess, more on a grassroots, and hopefully it would pay dividends on a national level.

[00:14:28] Dr. JB: But what about retention of the ones that currently are, because if you feed people into the system, but you can’t keep them in there, then is it beneficial?

[00:14:36] Will Harvey: That’s a fantastic point. So retention is big. And I was talking with a colleague just last week, because I’m not sure if you follow some of the big trends in this as far as travel nursing, but if you’re like a staff emergency nurse, somewhere downtown, you may make 60, 70, $80,000 a year. If you’re a travel nurse and willing to go from Maryland to Minnesota, or to California, to Florida on a whim, you could probably make a hundred thousand dollars in six months. Pay, salary’s always going to be a driving motivator and it’s hard for somebody to say loyal to an organization that they’ve been with for five or ten years making the same salary, when this nurse coming from Maine can make double their money in 13 weeks.

[00:15:19] So I think first you have to make people right financially. Then it’s, what other things do you offer to handle? Like we were talking about burnout before, there are still some as organizations that don’t necessarily realize the impact, the psychological, the mental impact that being in this profession takes. The ones that do, kind of invest in that. So giving the opportunity for mental counseling, free of charge, to help employees through these hard times. Financial planning and services, obviously talking about benefits and healthcare, like you have to invest in a person kind of holistically, but honestly what really speaks, or what I’ve seen even anecdotally, is the pay. I think as a whole, with as important as a physician’s job is, the nurses, or any allied healthcare professional, they’re has to be a rise in overall pay to drive that retention of those people who we rely on every day.

[00:16:12] Dr. JB: Seeing how much people are able to make as travelers, with how it’s like two to three times, how much would the pay have to increase for the whole traveling nurse system to dwindle down?

[00:16:26] Will Harvey: I mean, think about what the cost is if it doesn’t. Well, if we don’t invest enough to get new people into this profession, because I can’t speak for you, but I know I don’t plan to work forever, right? There’s a finite time on every healthcare professionals like career period, whether it’s you get burnt out, you physically can’t do it, or you simply want to do something else, you want to get into, I don’t know, flipping houses or something. So, we’re talking, depending on the market and the population, we’re talking pay increases of 10, 20, perhaps even 30%. I mean think of some of the sign on bonuses. Literally, not just this morning, a hospital system in Pennsylvania, I won’t say the name, sent me a text message because I was on their mailer, a offer for registered nurses to come on for a salary plus a $20,000 bonus. Okay? For a one year commitment. Ten years, three years ago, that was unheard of, absolutely unheard of when I first signed on, in my first emergency department, there wasn’t a sign on bonus. It’s like, there’s the bathrooms, here’s your badge, are you ready to work? There was nothing. There was absolutely nothing. Now, you can get 20 grand for a one year commitment. You couldn’t do that. I think if we’re doing that for new hires, retention bonus equal or greater than that should 100% be on the table because healthcare as you know, as much as we need new folks to come in, it is the older, the senior, the vets there that are in charge of kind of really bringing them on, really taking what they learned in the classroom and applicable to the bedside. It has always been. I’ve learned from some of the best vet nurses in my career, I’d be nothing without them. And it’s going to be the same thing from generation to generation. So retention bonuses, increasing their pay is one of the first major steps to get people to stay where they are.

[00:18:09] Dr. JB: Yeah. And then, along the lines of whole care of your employees, I think some healthcare systems would say, well, we already have that. We have employee assistance program.

[00:18:19] Will Harvey: Sure. And a lot of places do, even in home health, and I worked for a couple of national companies, they do. But if you really ever needed them, I don’t know if you’ve ever been in a situation where or in a company where you’ve actually had to take that on, there are limits right there. Even for the last company I worked for, which will remain nameless, we had an EAP program, which was great, but there was a limit on how many counselings that you could fit. So just off the bat, think about, I don’t know, times through severe mental health challenges or just going on something in your personal life, do you think that could be solved in three conversations? Absolutely not. And of course, they’re going to refer you, and this, that, and the other, but for me, if you’re establishing a rapport with someone and you’re really working towards something, turfing them after a few sessions, to me, doesn’t seem to make a lot of sense. So again, I think some of these EAP programs and employee engagement programs can be expanded so that there doesn’t seem to be such a, I guess, finite timeframe on them. Like if we really want people to stay with us, you know, forever until the sun burns out or they decided to retire, then the benefits that we offer should provide that type of stable, concrete support as well.

[00:19:25] Dr. JB: Very, very valid points. And so now you’ve transitioned out and you are working in the home health care arena, what’s that been like for you?

[00:19:34] Will Harvey: Initially, it was a culture shock. It was just different because as you know, emergency medicine is very much a place of instant gratification or instant failure. Like I resolve this problem now, or I’m going to fail in two minutes, that’s it. Whereas home health is there’s longer-term goals, which I really like, in the sense that you can see somebody progress, whether it’s over a few weeks, you may have them or 30 or 60 days, like a certification period, like you can see somebody freshly coming out of the hospital, with a total knee or total hip replacement and be a part of a team that is really going to get that person back to functionality. Or anybody from wound care to IV therapy to anything, you can see them, ideally, fully integrate back into the society that they want to be in, instead of necessarily in the confines of a hospital. So that has been really affirming after I kind of learned some of the ins and outs of home care. Now, being in charge of an agency that serves a very wide dynamic of folks and I’m proud to say most of the employees that I serve are from the West, Central, Southern African region, so that cultural understanding of not only my employees, but how it integrates with those that we serve, it’s been fascinating. And I’m a huge advocate for home health, just because of the cost of our healthcare system in which– we get down that rabbit hole… Home health is the way to go for somebody to heal and age in place, that’s kind of the next biggest wave of healthcare, if you ask me.

[00:20:57] Dr. JB: And do you find that, through your services, you’re able to prevent them from having to come back to the emergency depart?

[00:21:04] Will Harvey: Absolutely. Nothing is foolproof, right? Somebody is, unless you’re truly by 24 hour care, which is always some barriers to that, certain insurances don’t pay for it, the patient may not be able to pay for it, all this other kind of stuff, so you can’t prevent everything. Somebody’s gonna inadvertently put down their walker the wrong way, trip and fall, something’s going to happen, but yes, with that type of diligent, hypervigilant type of care, you can– and with highly trained staff, that’s another thing that we can talk about with continuing education– you can 100% get any agency’s rehospitalization rate down to 5%. And think about, keeping that simple, if you had 10 agencies in a county treating a substantial portion of seniors and all of their rehospitalizations rate were 1, 2% you, you’ve inherently pretty much kept a large subset of the population out of the emergency department, safe in their homes, compliant with their medications, fed, clean and dignified. So rehospitalization programs and ways to prevent it are a huge subsect of what I do.

[00:22:06] Dr. JB: And in terms of the home health care. I’ve heard a variety of things in terms of the services that are provided to individual patients. Could you speak more about that?

[00:22:16] Will Harvey: Sure. So it really just depends on what avenue of home health, so for instance, to keep it super simple, there’s skilled care, which is typically a Medicare-certified agency, somebody coming in for a short, comes to you with a short need, like wound care, maybe stage three that we’re trying to heal and you would have them for a couple of months. You maybe need a nurse, but depending on where the wound is, maybe there’s some mobility issues, so you get physical therapy involved, maybe occupational therapy as well, and you slowly but surely progress them and try to handle the most acute issues that they’re dealing with. And then of course, they’d ideally heal, get back into society, good to go. Then there’s more long-term on the other side, like what we call kind of private duty nursing, those are typically paraprofessionals, CNAs in most states, Virginia does personal care assistants, either way, they’re typically trained for helping with ADL’s, homemaking, preparing meals, medication compliance, depending on their licensure, and that’s more I think of a preventative side of it too. Like skilled care, something has already happened that we’re trying to fix, to keep it super simple, private duty, we’re trying to prevent you from going into the hospital. So you’ve got a 45-year-old male, elderly mom, he’s got to work 60 hours a week, can’t be everywhere, mom lives with him, he’ll hire a private duty aid for 8, 10, 12, maybe 24/7, to help with his mom, and in doing so to kind of assist where he cannot, we keep them out of the hospital, keep them safe. So those are kind of the two big silos that exist, and then it kind of goes on from there with IV therapy, speech therapy, other kinds of things at home.

[00:23:51] Dr. JB: And do you find that insurance normally covers these services or is this more out-of-pocket?

[00:23:56] Will Harvey: For private duty, there’s a lot of out-of-pocket, for skilled care insurance does, typically after acute care hospitalization or with a physician referral, will cover a portion of home care. If you’re a Medicare recipient, Part A does cover a bit after acute care hospitalization. If there is no acute care hospitalization, Part B does cover to some extent. But typically for private duty, the preventative side which is what I think kind of drives public health, and not just from an elderly standpoint, I mean, preventative, as far as like all of us, no matter what your age, getting your physical, then the whole nine yards, insurance has not really caught up to that yet. So the majority of the clients that I serve at my agency are private, private pay.

[00:24:37] Dr. JB: And so if somebody were of a lower socioeconomic status, are there any resources for them to be able to tap into to help fund?

[00:24:45] Will Harvey: There are, but that’s where I think we as healthcare professionals and public health advocates can really kind of champion it for them because there are resources. But even speaking from my seat, they are a bit convoluted. I worked for a nonprofit that truly, we have teams, and true teams, that not only apply for a grant on behalf of the agency to give those funds to those in need, but help those and connect those of a lower socioeconomic status with social workers for the sole purpose to navigate some of the bureaucracy that exists state by state to get either Medicaid dollars or funding and grants that are available to them to pay for services. So in order to really evolve this, we need to develop constructs whether it’s state by state or on a federal level to make access to funding a bit easier. But some of the hurdles that one has to jump through are very tough without a professional. And if you, add the complexity to how to navigate that system for somebody with, it could be a cognitive deficit or maybe perhaps autistic or any type of traumatic brain injury or any type of functional immobility, it becomes that much harder and it’s practically impossible to do it on their own. So they will reach out to an organization like mine for help and guidance. But as much as we have a team of people always willing to help, we are far outnumbered, as far as those that we physically can get to help and those that need the help. We need help, if you will, to make this process easier so that we can kind of get our services to everyone who needs it.

[00:26:14] Dr. JB: So, when you began your journey in healthcare, did you ever imagine that you’d be doing what you’re doing right now?

[00:26:20] Will Harvey: To do exactly what I’m doing? No, because I would never, you know, never pretend that I could predict the future, but I am, everything that I’ve done up until this point has been affirmation of why I chose this path. In the emergency department was some of the greatest times of my career and gave me a good foundation and I knew I was helping my community, but I looked at it more as like, I was just putting out a fire within my community. There was an emergency, I reacted, okay we’re great. And then another ambulence rolls in, you do it again, bam. It was like that type of thing. And now in this setting, I look at it like I just kind of said, in a preventative way. So I’m actually happier if you will, if I can use that word, that I’ve gone this path, because I feel like the reach that I have and the impact that I have in my community is far greater. And ultimately when I first started as a nurse, that’s what I was trying to achieve. I didn’t know what it was going to look like at that point, but now as I sit here today, I’m very much proud of the work that me and my team have been able to do in this community.

[00:27:15] Dr. JB: And you’ve been really successful in terms of climbing up the leadership ladder.

[00:27:19] Will Harvey: Yes, yes, very fortunate. I tell my team all the time, I think I’m allergic to complacency. Like, I just can’t do it. So, when I started as an RN, like, I’m sure when you started as a physician, you’re just really just trying to get your feet underneath of you, so God bless the people that come straight out of school, start their job to go right back into school. I couldn’t do that. I just had to, you know, I wanted to really get some of the tenants of emergency medicine under my belt, but once I felt comfortable in going back for my bachelor’s, that was of course the next step, most of our nurses that I’ve worked with, yes, that’s logical. And thank God for online classes where you can do it two in the morning, three in the morning, seven at night, that kind of thing, to progress as well. But after I entered home health, I was fortunate enough to go to Texas and help run an agency there and really started to understand more of the business part and sit in some real high level conversations about how the money allocation and resources allocation plays a huge factor in how much you could impact your community, the business aspect was just calling to me. So I was fortunate enough to get my MBA and really bolster my business acumen, so I could have a bigger seat at the table and all the while still working on my doctorate for human and social services.

[00:28:30] And the reason that I went through that kind of route is just kind of really wanted to be well-rounded. At that point, I was already in community health, and I’ve seen some of the roadblocks that exist for those that, and it’s not going to get us there, but I’ve seen some of the roadblocks that those who just stay on one track, I’ve met and worked with some of the greatest nurses in my career, but those that strictly go RN, BSN, MSN, for whatever reason when they are in boardrooms or in high-level conversations, some of the powers that be, you don’t think that they can have a true business conversation. I think that they have their heart on their sleeves and purely addressing this from a nursing aspect, and I’ve seen their opinions get shut down, and I just thought I don’t want that to happen to me. So, I went the nursing track, developed my business acumen and got my degree to quote unquote, prove that, and then community and public health has a lot to do with battling the social determinants of health. So getting a terminal degree where I felt I could master that and understand it as best as the academia could teach me, that’s how I figure I can do what I can to make sure that I’m really contributing in the role that I am in. And then with that, to go back to your central question, with that has typically come a promotion or recognition from the organization I’m in and they’ve allowed me to lead.

[00:29:48] Dr. JB: And do you have any concerns about the advancement of nursing and clinical executives being affected by the current pandemic?

[00:29:56] Will Harvey: I do, just because I think about my own journey, in a sense that, starting out in my early twenties and I never really, like I said, I didn’t know where my path was going to fully go, but I was able to be encouraged and poked and proded along the way to get to where I am. Now, if we have less and less people even entering this profession, that’s less and less people that are going to encourage that younger nurse to keep kind of going through. And then, what the pandemic kind of highlighted bright and center that we’ve all known for years is how dependent our healthcare system is on the service of those people of color. And if those people of color are not only discouraged from entering this profession, but financially not able to even enter this professional or advance in it, yeah, you’re not only going to have less and less people in the field in general, you’re going to have less and less representation in some of these high level meetings that help dictate funds or resources, or allocations that will get more and more people in the profession, if that makes sense. It’s almost like we are purposely bottle-necking what we’re going to be able to do as far as impacting our community. So I mean, yeah, I’ll do whatever I can to support this locally, but that’s where that needs to start. We need to start advocating whether it’s at a middle school, high school level, the benefits of a service in medicine, so that we can really bolster our numbers.

[00:31:15] Dr. JB: Why do you think people of color are being discouraged to enter into the field of healthcare?

[00:31:20] Will Harvey: That’s a really, really good question. I think it’s some of the same reasons that all of us are a bit discouraged. I mean, in going through the pandemic the two full calendar years, even beforehand, and seeing how the perception of health has changed just in a few short years, and some of the yelling and screaming, no one wants to deal with that. No matter what your color is or what your background or ethnicity, nobody wants to deal with that. But if you think of a race or even religion or ethnicity that has been so disenfranchised already before there was such thing as the coronavirus, why would you then purposely want to sign up for more headache? Your life has already been hard enough, coming up maybe properly in the inner city, maybe not having enough food on the table, or maybe not sure of shelter, and then you’re now going to enter a profession, where as noble and humble as it is to serve another human being, you’re wondering in the back of your head, when I go to work every day, am I going to spit on or kicked in, like I’m trying to give simple medical advice and they’re telling me that the science isn’t real. Like who is it, it’s we friended in certain aspects of the media where signing up for this is signing up for a lot of headache and that didn’t always use to be the case. Nursing still is, and I see it in other aspects of medicine, but as a nurse then that’s what I’m going to advocate for too, you know, being, being a nurse is truly one of the greatest joys I’ve ever had in my life and I want other people to experience that, but as much as I’ve been called so many words at the bedside that are probably not appropriate for your podcast, I wouldn’t want that on somebody else either. But I think we have to, respect is a trigger word these days, but I think as a society, we need to get back to respecting the profession and then maybe we can draw more people, not just of color but of all races, back to it.

[00:33:07] Dr. JB: But what you say in terms of your experiences at the bedside, this is pre-pandemic.

[00:33:11] Will Harvey: Very true. It’s always been there, it’s just, I think it’s gotten worse. I think that some of the negativity and vitriol around the vaccine and the virus has just given those types of naysayers and those types of those who feel comfortable treating those with disrespect and prejudice and bias, it’s given them another arrow in their quiver to attack this profession. And I’m one very much of a mindset of bend, don’t break, but sometimes when you’re truly attacking like the science and the stuff that really supports our profession and allows us to treat people as efficiently as we can, that might be the straw that broke the camel’s back at some point. It’s one thing to attack me whenever at the bedside for my color, okay, I’m still going to help you. I mean, you’re an– you’re a blank, but I’m still gonna help you. But then when you’re really just attacking who I am and what I believe in as a clinician too, on a daily basis, that’s just really hard to get over.

[00:34:10] Dr. JB: And these experiences are different in home health care?

[00:34:15] Will Harvey: No, because as long as we’re dealing with people, you know people are inherently flawed, but I have certainly found– granted I’m only just comparing the emergency department to home health– I’ve certainly found those recipients that we’re dealing with in home health, whether it was skilled or now in private duty, much more receptive. I mean, I can’t even count on a weekly basis how many thank you cards or calls of appreciation, “so-and-so helped my mom, I’m so glad that we chose your agency.” ” I couldn’t do this before and now it’s four months later, I can do X, Y, and Z, thanks to this nurse or that PT.” I got to tell you, and you’d probably would maybe think the same, I don’t remember too many thank yous in the emergency department. It is a thankless job, I mean, that’s what we sign up for to some extent, but I don’t recall too many of those, when you’ve helped somebody who’s maybe done a bit too much cocaine or maybe was kind of like tripping out on this day, usually are not getting those accolades. So just that appreciation can help someone, especially if they’ve been in this field for as long as I, come back the next day and keep doing a good job. Everybody, no matter what you do, whether you are putting together sandwiches at a Wendy’s or whether you are in the world’s biggest healthcare system, everybody wants to get a feel valued for what they do.

[00:35:32] Dr. JB: And even if you don’t get that appreciation from the patients, which is true, in the emergency department, you don’t get a lot of “thank you.” The person comes in unconscious when they arrive and they get discharged later, they don’t know what happened, they don’t realize they came through the emergency department and what the ED team did for them, but getting that appreciation somewhere. So if it’s not coming from the patients, then coming from administration, but genuine appreciation.

[00:35:56] Will Harvey: Correct. Yeah, not just “we ordered a couple of pizzas for the night shift and they’re in the break room,” but true, genuine appreciation where, and that’s– to go back to kind of the affirmation, I guess on where this is, I find that now, and maybe it’s I’m in management, maybe I just have a different perspective, but I’m able to talk and connect with my caregivers, my nurses, my staff a little bit more, and in doing so and building that bond and trust with them, I get to find out what actually is driving their “why,” their motivation, and I can adapt my leadership style or things that I plan for the team to them. And then I would hope that makes them feel more appreciated and then come back to work. So there just is, and granted you can’t compare, I love the team I had in the emergency department, I will always, I’m still friends with them to this day, but being at home health and having that kind of arm in community and public service, there’s a different type of family, there’s a different type of synergy, that really supports one another.

[00:36:55] Dr. JB: And why do you think you’re able to better connect with them?

[00:36:58] Will Harvey: I mean, we have more time. Time is the biggest thing we can’t control and probably the most valuable thing on this planet. In the emergency department, it is rush– and rightfully so, it’s an emergency, right? I mean, they’re not all emergencies, but in general, it’s an emergency. There’s time. There’s there’s algorithms you’re following. You’re really doing things methodically and quickly to get that goal to save that person’s life. So, that is the job, but when you’re in home health where things are a bit slowed, you not only have time to take care of the patient, you have time to take care of the nurse. They’re a human being too. Just like we began our conversation, they’re maybe are going through things in their personal life that are going to distract them from day to day. And in the course of any 8 to 10 to 12 hour day, I have the time to connect with my staff on a personal level, find out what’s going on in their life. And before I maybe fly off the handle of why these hours are down or why this was charted this way, I can connect with them and find out what their motivations are, what’s distracting them in their personal life, what kind of gets them up in the morning, and like I said, tailor my thoughts and actions to them as anyone should when they truly respect those they work with.

[00:38:03] Dr. JB: How does your experience as a bedside nurse affect your leadership?

[00:38:09] Will Harvey: That’s a very, very good question, and I know the story that I’ve told many times so, I think it’s all in the people that I’ve met, not necessarily in the experience, the experiences I will remember forever, but unfortunately there are folks outside of medicine that have had horrific experiences that have altered to change or improve their lives. The people that I work with at the bedside are probably my biggest influencers. There was a nurse that, she has since passed, but she probably one of the greatest influences in my life. Her name was Jean Smith, who was probably the best charge nurse, I’ll go toe to toe with anybody, the best charge nurse I’ve ever worked for and arguably in the planet. She knew it all, but it was not with any type of hubris or arrogance, she just knew it all. And when she trusted you, when she put you in the code room or said you’re taking triage, you instantly just got a boost. You’re like, she thinks I’m ready for this? Okay, then I can do it. And building up that type of reputation and knowledge base, that’s what I aspired to be as a leader so that when I put those in charge, then I don’t need to micromanage and I’m giving them the autonomy, autonomy to sink or swim, they are boosted by the confidence that I have in them because that was impactful to me. Just her words of, our code room was called room six, everybody does it a little differently, when Jean looked at me or if it was on the schedule, Will, you’re taking room six, oh, wow, okay, I’m ready for prime time now. I want that same type of gravitas, but the only type of way that you can do it is with humility and experience and knowledge, then ideally the day that I get to kind of tap somebody and give them that power, I’m hoping that they feel the same confidence in themselves that I did.

[00:39:48] Dr. JB: That’s some high praises for her.

[00:39:49] Will Harvey: Yeah. She was awesome.

[00:39:52] Dr. JB: So, in closing Dr. Harvey, do you have any final words of wisdom for my listener?

[00:40:00] Will Harvey: Honestly, aside from the golden rule, I would honestly just ask everybody who listens to this, I know hopefully you have like a wide array of listeners, both medical and nonmedical, I really just encourage people before they act– I tell this to my staff all the time, so if they end up listening to this, like, okay, here he goes again– I really think it’s important for those, before you act, before you pick up the phone, before you send an email, before you go order something at a fast food restaurant, think about for two seconds, what the other person has potentially gone through in their lives, that your energy doesn’t have to negatively match theirs. That it’s okay to be humble and appreciative and respectful and to say, thank you. And now as broad as that is, I truly think if we adopted that in all aspects of our lives, but especially adopted that in medicine and especially over the past two years, I don’t think you would see some of the articles and studies that have come out talking about the decline in doctors and nurses that are projected over the next five or 10 years.

[00:41:07] Simple thank you’s, and thank you for helping me, thank you for helping my mom. I know this is hard on you, sharing a cry together, things of that nature can get people to truly believe in why they chose to do what they do. So, that’s how my mother kind of raised me, that whole treat others how you want to be treated, it’s the oldest line I think in the world, I think if really people took that to heart and to mind, and maybe we could save some careers in addition to saving some lives.

[00:41:35] Dr. JB: Yeah. Who says a doc can’t rap, D O C T O R J B. The greatest doctor to ever touch the mic. The greatest podcast ever broadcast at are prerecorded. Come learn some, each one teach one. I’ve done.

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