Vic intern blog

Four Lessons: From Bedside to Boardroom

Author: Ren Cazar

Date: 6 May 2018

Lesson 1: It's like learning how to walk again

When I started my career in nursing a few years ago, I remember watching clinicians on placement and keenly observed how they worked. Nurses, doctors and allied health staff would move with such grace and intention. So sure of themselves and the care they provided. From their clinical dexterity, to how they spoke to their clinical teams or the patients... to even how they wrote their progress notes. I would watch these people, these amazing clinicians and would be in awe of the calibre and skill they displayed every day. 

And as a student, I remember telling myself "I wanted to be that good". 

I found inspiration from them and later on from my colleagues in cardiothoracics. No saying is truer from my experience than "when the student is ready, the teacher appears." There will always be people in your field, who are experts in their craft willing to teach and take you under their wing. Find those people willing to invest in you, sit at their feet and listen. Emulate them, even copy them. I wanted to become more like them. I wanted to match their skill. That was my goal. I would take notes about what I thought made them great clinicians: the words they use, how they assess patients. I would then research and practice and practice and practice. I worked hard on my skill as a nurse, always trying to learn and better myself to match the calibre and skill of my peers. Then I remember one day, a student who I was teaching at the time told me, "I want to be as good as you." One day without even realizing, you'll reach the skill of your peers, and others will awe at your own skill. 

Now fast forward, here I am working in Clinical Operations in one of Victoria's fastest growing regional hospitals. Far-flung from the cardiothoracic high dependency unit I have been accustomed to. No more drains, or infusions. The 0800 am ward round is now a Clinical Operations boardroom meeting or a committee meeting. 

And just like before, I awe at the skill of the health service managers around me. I have come full circle and have started that journey again, from novice to expert to novice again. It is like learning to walk again. But just like before, I have found those special people to help guide me on that road to mastery. 
 

Lesson 2: Be a good investment

I am thankful for those who see my potential and are willing to put time and effort into my learning. Not only am I thankful, I hold it with utmost respect and care. They are investing in me. So, I make sure I am a good investment. A good investment to me means you grow and learn but also give back. 

I have come to the conclusion it's not just about smiling and having a pleasing personality. Bribing people with food will get you only so far. It's those individuals that work hard, are persistent with their goals and are willing to put the time and effort into developing their skill. Being open about your weaknesses, displaying a willingness to learn, actively seeking opportunities to grow and importantly putting it into practice. It all starts with small steps... (and it probably starts with Google too!).

Time is money, and other people are investing their time in you. Respect their time and respect their knowledge. Observe and learn, put in the hard work. Ensure you are a return on their investment. 
 

Lesson 3: Meeting the challenge

Transitioning into a leadership role as a clinician is a new and exciting challenge. But with mixed motivations and obvious knowledge gaps, navigating the role of a leader can be jarring. 

Literature suggests there are gaps in skill/competency of clinicians transitioning into leadership roles. Leaders use different skill sets than those by the bedside. The Kings Fund (2015) state that: 

“...due to their non-managerial background and strong technical expertise, clinicians are often reluctant or ill-prepared to take up leadership position” 

There is a great focus both in Australia and internationally to develop programs to strengthen a leader’s competency. The evidence is clear on the link between leadership and a range of important outcomes within health services, including patient satisfaction, patient mortality, engagement, turnover and absenteeism, and overall quality of care (Veronesi, Kirkpatrick & Vallascas, 2012). 

Therefore, being resourceful with your knowledge and identifying gaps and addressing them is key. Being open and conscious of what you know, addressing the gaps where you don’t know, and the knowledge to new experiences has been my focus and challenge. 

Financial management is certainly not my strong point. But I am working at it. What surprised me is how much knowledge I have about it without even realising. I was certainly no math genius but in high school, my parents would get me to do payroll for their small business. I learnt about payslips, purchase orders, tax tables, and invoicing became one of my teenage chores as a sixteen-year-old. I enjoyed particularly the small "pay rise" in my allowance per week. But I stored that away never to be used again once I embarked on my nursing journey. Little did I know that experience as a bookkeeper would be an important learning for my career in health service management. Little did I know that experience it would be my "foot in the door" in managing a large public contract and engaging in key negotiations in my placement years later. 

So, the lesson is, be conscious and resourceful! Knowledge is power, and if you’re willing to identify your knowledge gaps, use what you know, then fill in the gaps, you will come out the other side a much better-informed leader.
 

Lesson 4: It’s all about the patient

Many of my friends and colleagues ask me... do you miss nursing? The short answer is yes... but I still am one. 

I miss it because the work you do by the bedside is so visceral. The effect of your care is tangible and instant. When I was a nurse, every day as I walked through the doors of the hospital, whether tired from a late shift or from the melodrama of my own life, I would think about the opportunity to improve my patient’s lives that day. I think about the patients who I would look after that day. I would take a deep breath in and was ready for the shift ahead of me, leaving all the baggage at the door. Cardiothoracic nursing was my platform to make a difference. What I did as a clinician mattered, it mattered to the patient and their families. That's what inspired me every day. 

Finding inspiration as a health service manager is different. In some ways very different. The projects and programs we develop as a team have an abstract effect. There sometimes is no seemingly causative or direct relationship between the work I do and the patient. My office is far flung from the critical care bedside, far from the infusions or drains or patients. And sometimes it is easy to lose sight of what drives you, especially if for many years the gratification you drew from was almost instant. 

Pursuing a career in health management enables me a new platform to break ground. While I am not providing the hands-on care for my allocated patients that day, I have the ability to intrinsically change the delivery of healthcare as a whole. The gratification is no longer so instant, but now is more of a slow burn. The projects I have worked on may run for months, much longer than my 10-hour night shift! (that is something I don't miss honestly). But the opportunity to change and alter the trajectory of an entire health service is immense. My impact is not only about the patient I looked after that day, but now every patient entering our health service. This affects families and communities. This ripples across towns, regions and across the state. That opportunity excites me.

What I now know for sure and what inspires me every day is still the same. The patient.
 

Reference

West, M., Armit, K., Loewenthal, L., Eckert, R., West, T. and Lee, A. (2015) Leadership and Leadership Development in Healthcare: The Evidence Base. London, Faculty of Medical Leadership and Management and The Kings Fund. Retrieved from https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/leadership-leadership-development-health-care-feb-2015.pdf

Veronesi, G., Kirkpatrick, I., & Vallascas, F. (2012). Clinicians In Management: Does It Make A Difference? Leeds University Business School. Retrieved from http://www.cihm.leeds.ac.uk/new/wp-content/ uploads/2012/05/Clinicians-and-Boards.pdf