Ep 11: How to coach and support nurses through difficult times. A conversation with Jackie Dominick

Posted January 30, 2023

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Show Notes —

Being in a healthcare team is a tough job and even more when you stand as the leader. You have to be someone your team members can rely on especially during the most difficult times.

It’s not enough to have the courage and strength of a leader. It is most important to keep the compassion that you had since the moment you entered this line of work to keep an open and honest culture for everyone’s well-being.

In this episode, Nathan Illman has a conversation with Jackie Dominick, the head of nursing for a hospital in the UK. They talk about many different topics about leadership. Jackie shares the principles and philosophy that have guided her leadership for years.

Listen and learn in this episode.

KEY TAKEAWAYS FROM THIS EPISODE

Leaders need to try to have a different persona at work and check on themselves first to be able to do their work well.
You must not lose the compassion that you have along the way.
You can’t lead on the phone. You have to be with people. You have to be visible.
You have to be strong as a leader and you have to say no to unimportant tasks or demands.
Your gut instinct takes you a long way. If you can articulate your gut feeling, they will respect your opinion and they will think that you know what you’re talking about.
Always have an honest relationship with your team members.
If a team member makes a mistake, take it slow but get them to talk about what led up to that incident, understand it, and make a conclusion.
If you want an open and honest culture, in healthcare, you have to create an environment where people feel safe to tell you their mistakes.
Coaching means letting people come to a solution for themselves, say very little, reflect back with them, and come up with a conclusion together.
If you always tell people what to do, they won’t learn and you are not developing future leaders.
If you have a team that pulled together and solves problems together, that’s a great team.
You spend a lot of time at work, enjoy it.
As long as you’d say it in the right way, you’re compassionate and caring, you can say anything to anybody. Don’t be frightened to tell someone when you’re not happy with what they’re doing.

Today’s Guest:

Jackie Dominick has been a nurse for 30 years and is now the head of nursing for a hospital in the UK.

Website: https://www.nursewellbeingmission.co.uk

Facebook Group: https://www.facebook.com/groups/nursewellbeingmission

Transcription —

Nathan Illman 00:00

Welcome, everyone. It’s Nathan here. Well, oh, well, I’m so excited about this episode, I had such a wonderful conversation with my guest, Jackie Dominic, who is a nurse with many decades of experience. She’s the head of nursing for a hospital in the UK here. And we talk about leadership and how to support staff in difficult times. We cover so many different topics around leadership. And it was just such a pleasure to hear Jackie’s principles and philosophy that guide her leadership, and enable her to be a strong leader that is able to face adversity, and lead with a sense of kind of courage, and strength, but also how she is so driven by compassion and connectedness. And leading from the heart, it seems like to me. The conversation is littered with practical takeaways that anyone who is a nurse leader or aspiring nurse leader can listen to and draw things out of this and think about your own practice and what you’re doing when you’re working with your colleagues and other staff. perhaps think about changes you might want want to make. I think Jackie’s approach to leadership is clearly conducive to enhancing the overall well-being of the teams that she works in the teams that she bought supports, and overall the organization. So there is much to be learned here. And I really, really enjoyed this conversation. I think Jackie and I have a lot of similarities in our approach to our philosophy around leadership, even though we come from different disciplines. So this call was actually a live podcast episode that was advertised to our free nurse wellbeing mission community members. If you’d be interested in joining one of these calls, we hold them as special events every now and then with a live q&a, then head over to our website and sign up at nursewellbeingmission.com. There are plenty of exciting events planned throughout 2023. And these are entirely free for you to attend. And also, why not head over there and check out the learning content that we have on our website now? So we’ve got a bunch of free courses to help better prepare you for the emotionally challenging work that you may be doing as a nurse or midwife. And we’ve got a bunch of other resources on our website too. So head over to nursewellbeingbeingmission.com to find those. So without further ado, let’s dive into this conversation about coaching and leadership with Jackie Dominique.

Nathan Illman 02:56

Welcome to the nurse wellbeing mission podcast hosted by me Nathan Illman. This is the place where the nurse and midwife’s well-being are at the top of the agenda. Each episode aims to help nurses and midwives around the world flourish through informative, inspiring, and practical content and conversations.

Nathan Illman 03:20

Jackie, welcome to the nurse well-being mission. Thank you for being here with me. Just tell us a little bit about who you are. And a bit of context about where you’ve come from and what you’re up to at the moment.

Jackie Dominic 03:30

Lovely. Thank you. Yeah, I’m Jackie. I’m at the moment. I’m head of nursing for the summit just hospital and we’re in a hospital, which is part of the University of Sussex hospitals trust. We managed about a year ago after being joined with them for a couple of years unofficially. So that’s been quite a turbulent and interesting time getting to know new people etc. So I’ve been a nurse for about 30 years, did my training in Chichester, and loved it here. pleased to say that they’ve just started a new school of nursing Chipster which is brilliant. So we’ll start to get around students coming through you know, more local, etc. So I started my career as a regular nurse, loved it, really enjoyed being with patients, and worked my way up to a band six deputy board, sister post, and then assistant post. And I did a couple of comments along the way. So I’ve worked in practice development, which I absolutely adored. Works with student nurses, which will be universities teaching, looking after them when they’re on their placements, making sure they had a good experience sorting out any issues they had along the way. I also worked in recruitment for a while. We had an issue with trying to get nurses through the system it took was taken far too long. So they wanted a clinical nurse to go in and really project manage that and try and get the nurses through the system quicker. So that was really, really interesting. And I learned a lot from that. So I’ve done lots of different things along the way. I’ve been in a leadership role now for quite a long time, as a matron before this, and had a lot of experience looking after wards, Ward sisters, supporting them, and trying to really keep them going, because it’s a really, really hard job in Ward sister. And I really enjoy that coaching side of things and trying to help people come up with their own solutions, rather than me just telling them what to do. Because that’s not right. And, you know, I’d like them to come up with their own solutions. Think about the issues, and talk to their staff, we have in the hospital, we have what we call a patient-first approach. And that’s about problem-solving. And it’s about looking at the root cause of what we’re trying to deal with, rather than just jumping to conclusions, because we all think we know the answer straight away. Actually, that’s not always the answer. And if you involve your staff, and they’re involved in it, and they own the solution, they’re more likely to get on with it and do it, and it’s more likely to be sustainable. So that’s kind of how I go about what I do every day. At the moment, my job is really trying to help nurses and leaders through what is really such a difficult time and has been hasn’t really for the last couple of years with COVID and things thing. So a lot of my job is supporting staff and trying to help them to support their staff in turn, because, you know, we all know, don’t worry if the nurses aren’t happy, they don’t give good care. And so trying to keep them happy and motivated. That’s a big part of my job now.

Nathan Illman 06:51

Such an important part of the role, isn’t it? Current sort of healthcare context?

Jackie Dominic 06:55

Yeah, yeah. And I think there are so many people that feel a bit burnt out now, and really tired and exhausted. And we’ve got a lot of shortages of nurses, you know like every other hospital has in the country, and trying to keep people going in those same circumstances, it’s really hard because though they are exhausted, and we wanted more and more out of them every day, we want them to do more hours, because we need to fill the shifts, and the patients are really sick nowadays, you know, patients don’t get past any do that anymore, unless they’re really, really sick. So rewards are very, very high. So that’s really tough on the nurses at the moment.

Nathan Illman 07:38

That was actually a point I was gonna start off this conversation, we’re going to question to you was going to be to ask you sort of where you feel your nurses are at in your organization. I guess you kind of just answered that I had a personal sort of family experience recently, which was, it was really sad, but one in which I have because, you know, I’ve sort of understand what’s going on when nurses because of this work that I’m doing is, unfortunately, my grandma just had some really bad experiences in hospital recently, she was hospitalized for about seven weeks or something. And, you know, whilst there were moments of lovely compassionate care, her overall experience as she felt a bit neglected at times, and at times actually felt the nurses were mean to her, and a bit nasty. And, you know, everyone has their breaking point, right? When you’re feeling burnt out, and you’re stressed. And I guess to me, I sort of understood it as being probably reflective of the current situation that many nurses face. So you’ve obviously got a challenging role, I imagine because of the prevalence of all this stress that is going on post-COVID. In lay said there’s increased acuity, there are lots of different factors, isn’t it and making the role harder. On top of that, you know, the current difficulties with, say, difficulties, unfairness, I guess, with pay and those sorts of things, I guess people listening to this are probably looking for some really practical, you know, hands-on kind of advice and guidance. And I’d love to sort of steer us towards that. So I’m really curious. You know, on just a day-to-day basis, what’s your sort of approach? How do you go about supporting your junior staff or even your, you know, peers?

Jackie Dominic 09:16

Well, I think, first of all, you have to look after yourself, you know, if I’m going to work and I’m not good, I’m not going to be able to do that very well. So I have to really, really try to, I have this persona, I guess, that I have at work which might be different from the one that I have at home. You know, no matter how stressful something might be at home, I have to leave it at home. I can’t take that with me. And, you know, I try and compartmentalize that and leave it at home. And then I walked through the door and I’m Jackie the head of nursing. I’m not Jackie, the wife, the mom, the person that’s trying to train an eight-week-old puppy not to pee on the floor, you know, a different person. And I know that if I’m not that person when I go to work, I can’t give my best to everybody else. And I think that’s what leaders have to do. They have to get themself in that place, no matter how they do that. And, you know, I do that by looking at the positives. And I think, you know, what can I do today that’s gonna make someone’s life better, whether that’s the patient, a member of staff, you know, a colleague, anybody who I come into contact with, maybe the person in the shop, you know, the person in the little shop in the hospital, that might be having a bad day, I might just stop and have a chat. Or if somebody’s looking lost in the corridor, or we’re upset, they’re crying, I’ll stop, and I’ll talk to them. And so I think, how can I make sure I can do that every day? And that’s by me being a positive person. And I’m not saying that I’m like that all the time because I’m a human being. But I have a safe place. I have my office, and I share an office with some matrons. And we know that we go back there, and that’s our safe place. And we can say whatever we want, and we can offload to each other. But as soon as we walked back out there, we’re that person again, who’s got to encourage everybody and be positive. And it’s not easy as it’s not easy to do that. But if we don’t do it, then other people won’t do it. You know, and I think I said to you before about my analogy about an air hostess, you know, if I say this to nurses, you know, people look at you, like, if you’re on a flight, and there’s turbulence, everyone looks at the air hostess, and they look at them to think, are they worried? Are they really stressed? Because if they’re stressed, I’m going to be stressed. But if they’re walking along with their trolley and offering people drinks, then people relax a bit more. And I say that to people, you know, everyone’s looking at you for their lead if you like. And if you look stressed, and you’re anxious, and you think you can’t cope, and you think it’s all too much, then they will as well, does that make sense?

Nathan Illman 12:01

It does. Yeah. So there’s something about what you said before about this, I guess this professional identity and the kind of strength that comes with that and having to sort of live into that each day. And the reality of when you’re in a leadership position of actually having to be the kind of rock, the foundation for others. And especially at times like this actually does call for kind of being unwavering in certain situations. It also sounds like and I remember from our, when you and I spoke before, something you do, and I’d love to sort of dig into this a bit more as it sounds like you really make an effort to build a connection with people you just mentioned, you know, even though you’re the head of nursing, you know, one of the most senior people, you will still walk down the corridor. And if someone’s crying, stop, and you know, basically just give them the time of the day like see what’s going on. So you obviously go out of your way to build a connection with people, you’re not just this armored-up sort of tough woman who just walks around a kind of very robotically delivering orders or commands, you’re this identity, which is being strong and being, you know, brave and courageous in the face of stress and everything. And there’s this for want of a better expression, like a softer side, which is like stopping and building a connection with people and being a human being as well. Does that sound about right?

Jackie Dominic 13:25

Yeah, it does. And I think it’s a compassion that you went into nursing for in the first place. Hopefully, you don’t lose that along the way. And that’s what I see. You know, as much as everybody is stressed and short-staffed, I still see that compassion every day. And you know, when you said about your gram, that makes me really sad. Because I think, even though you’re really stressed, you can still be kind. And if you can’t do that, then you shouldn’t be at work. You know, I come across people who just can’t do it anymore. And I say to them, you don’t you shouldn’t be here, you’ve got to be able to be that compassionate person who can be kind, even when all hell let loose around you. You still got to find time to make a cup of tea for a patient to give them an extra blanket to talk to their relatives. And if you can’t do that, then you shouldn’t be here because they can’t get enough of you in that situation. And I think it’s about being genuine as well. You know, we can all, you know, put on this compassionate air about us, but people can tell if it’s genuine or not. And, you know, and yeah, you do have to go out of your way. You know, it’d be very easy for me to sit in my office all day, and be in teams meetings all day. You know, that’d be very easy for me to do, but I’d hate it. I’m out there talking to people and, you know, I like nothing better than you know the other day. One of our wards is really, really short of nurses. And one of them frankly up in tears saying she couldn’t do it anymore. You know, one of the nurses was threatening to walk out. So I just went to the ward, and I got my hands dirty, and I washed to let patients. And it was totally different by the time I left, and I’m not saying that was because of me, and I’m wonderful, but it’s just that role modeling of it will be alright, we can do it, come on, let’s pull together, we just have to prioritize, we won’t be able to do everything, but let’s make sure our patients get the care that they deserve. And it will be all right. And it was alright. But you know, I like nothing better than that. And again, speaking to patients, I go to a lot of complaint meetings as well, unfortunately, where, you know, relatives have a tough time with a family member has you know, I like to think that we might not be able to turn the clock back and make it better. But at least someone cares about what happened. And that we try and make it better for the next person. So I’ve gone off on a tangent, then

Nathan Illman 16:06

That’s great, you know, this is all relevant stuff. Something that I’d love to kind of come back to is the complaints thing because I think that there’s probably something really interesting to explore there about other staff that has been involved in complaints and how you work with that, to support them, and maybe coach them. But I’d love to just sort of quickly reflect on what you just said. Well, you’re basically you’re saying you lead by example, right? You’ve got one of your staff is saying they’re just overwhelmed, overloaded, they’re really not coping, and rather than just tell them what to do, or reassure them, or, you know, just give them some advice, you get down there, and you go back to basics and lead by example, and you don’t just say everything’s gonna be alright, you actually demonstrate that by your actions, you get involved with them, and you show them, you know, it’s just such a great way to lead, isn’t it? It’s when people see, okay, if she’s doing it like that, then I can do it as well.

Jackie Dominic 17:11

But you can’t lead on the phone, you can’t lead, you know, remotely, you have to be, and it sounds like a cliche, but you have to be with the people, they have to see you have to be visible. Because otherwise, you’re just some manager in an office somewhere, who doesn’t understand what they’re going through. And I won’t be that person at all, even though a lot of my time gets taken up by that stuff, which is also very important. You know, there’s a lot of strategic stuff and developmental things that I get involved with, which are really, really important, but they’re not as important as patient care. And making sure the nurses and all right, so often, I’ll cancel off, you know, much to the annoyance of my boss or whoever else, right, justify that, you know, patients come first.

Nathan Illman 18:04

Wow, it’s such an incredible guiding principle, philosophy, or value that I think a lot of leaders don’t necessarily have people get swept up in the bureaucracy and the administrative side of senior leadership, don’t they? And they sort of might forget where they came from. And actually what is most important,

Jackie Dominic 18:26

It’s easy to do that though because there’s so much pressure, there’s a lot of pressure to meet deadlines, or go to meetings or, you know, do all these things that as I say are important, but there’s so much pressure on leaders nowadays to do everything.

Nathan Illman 18:42

Yeah.

Jackie Dominic 18:42

Sometimes you can’t do everything. You know, some days in my diary, I have four meetings at the same time. I have to choose one. And I choose the one that I think it’s going to make the most difference. But that’s what it’s like now in the NHS, and everybody’s doing more than one person’s job, unfortunately, stretched so thinly, that you have to make decisions like that every day, I look at my diary and I just despair some days, I think, Where’s all this stuff come from? But it’s really I don’t go to a meeting if I don’t think it’s important. It’s all important.

Nathan Illman 19:15

I guess what sort of drawing like a tangible like leadership lesson from this, you know, this is all about how can we support coach junior staff or your staff. I mean, it sounds like a real discernment and a willingness to say no to certain things and be boundaries around your time in order to do those activities that you know are going to help the other staff are going to help those teams that are on the ground doing the actual clinical work.

Jackie Dominic 19:43

Okay, you have to be strong and you have to say no to stuff. And if I think it’s something that’s a complete waste of time, and energy, so I’ll say I’m sorry, but that is not worth my time. I’ve got more important stuff to be doing. And I’ll say it and you know I get myself into trouble sometimes. But I think that it’s the right thing to do. I’m not gonna sit in some meeting, that’s a waste of time, when I know there are people out there that I need to support or coach or, and you know, you can’t go and work on the board every day is impossible. And I could do that every day, because every day, they’re short-staffed, I could go and work clinically all the time. But then I wouldn’t be doing my role as well. So there’s a balance isn’t there to have around, you know, how important is it and that day, it was really important, really important, and I could have not done it. It just pulled me to my heart and was just pulled to the ward, and those nurses and the patients. And actually, we had a really good morning, we had a really good time, we had a bit of laugh, a bit of banter with the patients. And actually, it turned into quite a nice morning. But it could have been very different, you know, if that nurse had walked out and would have made it even worse, the deputy sister that was on that day that was in tears on the phone, if it had gone differently, she may have lost all their confidence. She on rubbish, I’m a rubbish leader, because I couldn’t cope with it. And so it has a lot of knock-on effects, not acting has effects, doesn’t it on other people and their ability to lead? I think,

Nathan Illman 21:27

Yeah, 100%, I think it can be quite insidious as well. Like, For if, over time, it might not be an immediate person leaving the role or something, but because of that erosion of their confidence and their self-esteem, and then, of course, that will then affect the way they are interacting with their team. And it’s just sort of spirals that don’t it over time. So over the course of several months, it’s so yeah, the sort of choice you took at that moment was, I mean, it has just such a massive impact, doesn’t it? But it sounds like it’s that it’s not a one-off for you. Like that’s a guiding principle of yours, which, yes, you kind of do that every day. But you’re quite discerning about when to do it. And you’ve got a bit of, you said I was following my heart. I love that, you know, I’m a big believer in sort of the following kind of physical, well, I interviewed gut feelings and following her heart, you know, I think there really is something to be said about that.

Jackie Dominic 22:21

Yeah. And if you do that you don’t normally go wrong, it’s normally the right thing to do. And you know, you have to do that in nursing, that’s part of being a nurse, isn’t it? Your gut instinct takes you a long way in nursing, you know, when a patient’s not well, even though the ropes are okay, and everything else is fine. You know, in your gut, there’s something wrong with that patient. And, you know, that takes you a long way in nursing, it takes you to the respect that you gain with your medical colleagues, you know, if you can articulate that gut feeling, and say that I know that looks okay, I know that everything else looks alright. But I know that something’s not right with this patient, because blah, blah, blah, whatever it is. And then they then respect your opinion as a senior nurse. And the next time you ask them to come and see a patient, they go, yeah, she knew what she was talking about a bit ago.

Nathan Illman 23:13

Right. So something I’d like to sort of turn us towards now is where you mentioned previously about some of those complaints meetings that you have to go to. So trying to sort of formulate what I want to ask you, I guess what I wanted to get at is every leader at some stage is going to be working with staff who, for one reason or another, it could be because they’re burnt out, it could just be they’ve developed an unhelpful behavior pattern. And they’ve learned from somewhere else that they’ve they might be difficult to manage in some way. Or something, you know, they’ve done something wrong, they made a mistake, and they made an error or something. What is your approach to working with people like that, or supporting the people who support those people? Do you see what I mean?

Jackie Dominic 24:04

Well, generally, I would say people, don’t come to work to do a bad job. Yeah, they don’t work to do a good job. I think some of it goes back to what I said before about people that can’t leave stuff away from work, and they are so unhappy or burnt out that they don’t have the capacity to do that anymore. And my philosophy is always to be honest. If I’m working with somebody who’s not performing in whatever way, whether it’s their attitude or their skills, I will tell them that I’ll do it in a compassionate way. So whenever I start to manage somebody, if I take on a new team member or new team, I always start off right at the beginning. I say to them that you will get 100% support from me. I expect the same from you. And I expect us to have a really honest relationship. So If I feel that things aren’t going well, I will come and tell you. So right at the beginning, they know that they’re going to get that level of challenge from me. If things aren’t going well, it makes that conversation so much easier, because if you do happen to end up in that situation, and you go back to the first stage, you remember when you first started, and we had that conversation about, right, I was going to come to talk to you, well, unfortunately, we need to have that conversation. And it makes it so much easier because you err on the ground. So not, you know, I can do that with the people that I manage. Obviously, there are a lot more people than that, that I come into contact with. But I’ll try and use the same approach. And I would try, I would sit down with that person and try and understand what’s going on for them. You know, is it something that can be changed? Is it a circumstance that’s making them out that way? Or, unusually, it’s whether they’ve got any insight or not have insight into what they’re doing, you’re onto a winner because you can help them. If they have no insights. It’s really, really hard. Yeah. So it’s trying to get that person to see to hold a mirror up to that person, say, this is where you’re coming across, this is what you’re doing. Some people can never get that. Yeah, unfortunately, going down a formal route with them, because is the only way you can do it. But I try and avoid that at all costs. Because most people do know, most people do have insight, and then you can help them because they didn’t start off as if something has happened. And generally, if people make a mistake is a mistake. Most nurses don’t do things, you know, on purpose. So don’t go into giving the wrong dose of something, somebody or you know, they do it because that the human factor stuff, because they’re distracted, because they’re busy, because they’re trying to do 10 things at once. Because they’re thinking about how on earth am I going to staff tonight? How am I going to stop tomorrow, you know, all that stuff’s in their head, and it takes a split second, and for all the holes in the cheese to line up for a mistake to happen. So if a mistake does happen. So for example, a few weeks ago, one of the nurses gave a large dose of a sedative drug, and the patient was luckily okay. But it could have been disastrous. So what we’ve started to do now, instead of doing root cause analysis, and reports and things into incidents, which they will write in their own way, but they don’t really help the people that made the mistake, because someone else is writing it. And also, you know, we find every time we write a report, it’s the same old stuff coming out, it’s about communication, or, you know, it’s the same things are coming out all the time. So we’re not really changing stuff. So we started now with an approach that we call an after-action review. So if there’s an incident, a serious incident, where a patient’s been harmed, or it’s a near miss, and that would have the potential to cause a lot of harm. What we do now is we get all the people together, that were involved, and we meet with them quite soon afterward. And we talk about what happened. So not only do we get to the crux of what happened, and what we’ve learned from it, but we’re debriefing them at the same time. So it’s really, really powerful. And we had, with this particular incident, we had a very junior nurse, a very junior doctor, we had at the meeting, we had myself aboard a deputy system that was there, we had our chief of medicine there, someone from a pharmacy because that was it. So try and keep it quite small, but actually, get them to talk about what led up to that incident. And what happened and really understanding it is really powerful. And then we just use that in our as an incident report. We don’t waste our time writing reams and reams of paper, because you’ve come to the same conclusion. In fact, you’ve come to a better conclusion by doing this.

Nathan Illman 29:19

Yeah.

Jackie Dominic 29:20

The nurse, the junior nurse that made the mistake, after the incident went off sick of the stress. And we set the meeting up and she was still upset. So I said to the nurse, you must make her come if you can because if you don’t she put it’s going to be worse for her because she needs to talk about it. And she came and came straight back to work.

Nathan Illman 29:43

Wow.

Jackie Dominic 29:44

And she was like, Oh my God. You know, we all said at the meeting, we’ve all made mistakes. We’ve all done these things. We’re all fallible. But the important thing is that you learn and you get back out there and you teach your colleagues as well so that they don’t do it as well. So that kind of approach I think, is just really, really powerful. And, you know, the junior doctor, she wouldn’t say boots for the goose, this poor young woman. And her confidence was just she had made such a mistake. And she didn’t. She didn’t understand why she’d made it, none of us could understand why they did what they did. There was no logical reason for it. It was just, you know, loads of circumstances that came together to answer what you are asking.

Nathan Illman 30:30

Yeah, no, I love that. I mean, I was hoping that we’d get onto this because I think, from conversations I have, and, you know, I do a lot of this work around self-compassion, and clinical error is that something that all nurses, there’s going to be some mistake in your career isn’t there, whether it’s when you’re training or later on and, and this is shown by the research literature as well, but also anecdotally, from talking to people is, the moment after some sort of clinical error or mistake medication or whatever it is patient safety incident, the immediate aftermath is crucial, vital for that person, their psychological well being later on. I spoke to one nurse several months ago, who experienced nurse as she had been working 25 years or something told me that a mistake she made when she just come out of her training, where she felt it was completely accusatory. And there was blame and it was all about finger-pointing. She’s talked about the initial contact she had with her, whoever was kind of supervising him and mentoring her if there was no compassion or empathy, no trying to understand it. It stayed with her for her whole career, this thing was my fault. And she can never let it go. Because it felt like it was her even though like you just said, there’s always a series of events, there’s never one person or very rarely one person involved in something. So I love that it really sounds like you come from the perspective of people are inherently good. And it’s a set of circumstances a bigger context that leads to someone either making a mistake or their behavior being, you know, whatever it is, it’s offended a patient or something that needs some kind of discussion. And it’s lasered, it’s more effective in terms of your actual data that you get to prevent things from happening. But you also help prevent unnecessary distress for the person who’s done it. And the whole team will feel good about that as well. It makes it I suppose, it probably creates a culture in which people actually feel okay to acknowledge or be candid when they’ve made a mistake as well.

Jackie Dominic 32:40

Yeah, absolutely. If you want people to be honest, and hold their hands up to make no mistake, you’ve got to treat them well when they do it. Because otherwise, people aren’t that, you know, that’s a human instinct, isn’t it? Oh, my God, I’m gonna get into trouble. So I’m not going to tell anybody and be detrimental to that patient. Because if you don’t tell someone then you can’t remedy whatever it is that you’ve done. So yeah, absolutely. If you want an open and honest culture, in healthcare, you have to create an environment where people feel safe to tell you and you know, yeah, it’s different if they’ve done something maliciously, obviously, that’s different, different, and that’s criminal acts. But that’s very small, isn’t it in terms of, you know, the percentages, the statistics are tiny. Those sort of people, most people do not do that, maliciously, they do it because they’ve genuinely made a mistake. You know, that approach to complaints is the same. If I have a complaint that comes in, a lot of them we deal with, by writing a response back, but some we do meet with the relatives or the patient. And most meetings that I’ve been to, because somebody has been bereaved, and we haven’t dealt with it very well. We have indicated as a team, to that family member. But there’s usually bereavement involved in it somewhere. And these people, you know, I met with somebody a little while ago, their mum died two years ago. And they still can’t move on. Because they’ve got all these questions in their head, about what happened. So in those circumstances, my main goal is to help that person move through the bereavement stages, and get on with their life, because they’re stuck because they’re so angry or they’re so upset, they can’t move on. So I always say to them at the beginning, you know, my aim for you is to help you to come to terms with what happened and to move on from it. I mean, we don’t always do you know, some people can’t, but generally, generally, we do and people will thank us at the end usually because we listen and we listen with compassion and like we care about what happened. It’s not just the tip. It’s an exercise for me, you know, meeting somebody because I have to because I genuinely want to help them. But we tend to protect, our board sisters and our medics quite a lot, though. So I will meet with complainants with perhaps the Chief of Medicine. And I don’t know how I feel about that, because I feel that the people involved should be there. But often the people are so angry that it would not work. So I get a bit torn in those situations because I’d like them to learn how to handle the situation.

Jackie Dominic 35:35

Yeah.

Jackie Dominic 35:36

But it can’t. Because if they’re there, it makes it different dynamically with the family. So it’s really really difficult for me because I know when I started doing complaint meetings, I hated them. I absolutely dreaded it. I used to get so nervous and think, Oh, what if I make it worse? But over time, I’ve learned the right things to say. And I’ve learned the right things not to say and when to shut up, when to just listen, and all that sort of stuff. But you learn by trial and error, unfortunately. And I really wish that there was some way. I mean, you can do simulations and all the rest of it. But it’s not the same as being in a real situation is that I can’t think of a way of doing it, which really frustrates me.

Nathan Illman 36:21

We would all love the fast route when we like done you’ve seen the film The Matrix where they’re like downloading how to speak a language and a few seconds or downloading how to do karate also be easy if it but unfortunately, life’s not like that. Is it? And we do have to fumble our way through sometimes. Yeah, I guess in an as prepared as we can be. Gosh, yeah. I mean, when I think back to some tricky situations, I’ve tried managing in the past, like when I was a bit more junior, you know, it makes you cringe a bit. But you get through it, and you have to have the willingness to go back and try again and get feedback.

Jackie Dominic 36:57

And yeah, you have to get force. Even if you’ve really mucked it up with the first complaint meeting I did, I cried. I mean, how ridiculous this poor lady was in front of me, looking for help and support. And I cried because we’d done such a terrible job with her husband. And I couldn’t help myself it was also and the person I was doing it with thought I had a really bad cold. They said to me afterward, so you’re all right. I’m really upset.

Nathan Illman 37:26

Yeah,

Jackie Dominic 37:27

You don’t need that deed. You know, if you’re upset relative, you don’t need somebody sitting for you crying about it. And that makes as you say, it makes me cringe when I think about it.

Nathan Illman 37:38

I think it’s really helpful you share that though because I think people listening you know, it shows that you’re not perfect. And you know, you haven’t got to where you’ve got to buy just know, you noticed, like bypassing the just really tricky and embarrassing or just, yeah, hard experiences, like you’ve had to go through that to get to where you are.

Jackie Dominic 37:58

I’m not paying you everything single day from somebody. And I always tell them, I said, You’ve taught me something today, you know, I didn’t know that. Or I wouldn’t have thought of doing it that way. I always like to try and give people that feedback. Because otherwise, you’re just giving people bad feedback or something. You know, I like people to hear when they’ve done a great job. And if someone tells me Oh, so and so did a really good job. I said go and tell them to go and tell them to let them know that kind of refit job because they need to hear it. Especially. And, people aren’t very good at taking compliments. Are they? You know, they’ll get oh, no, it’s just what I do or what? I say no, it’s no, he didn’t go the extra mile. You did a really good job. You should be really proud. And they go away all night. I don’t know what the word is just really full of confidence, I guess.

Nathan Illman 38:50

Yeah, I totally agree. I’m on board with that. I think it’s very easy to sort of not do that, you know, in your head almost, oh, that was great. Or that person did a good job. And to not really just take a moment and just really be very specific about what they did. And here’s why as well. And just it sounds like you really sort of coach people to receive it right? Like, let that sink in. Don’t just brush it off. Because people can just deflect it karma. And then it’s almost as if it wasn’t said, If you help people to really receive it, it really does make a difference.

Jackie Dominic 39:25

Absolutely. Because we’re very quick, aren’t we to deflect that sort of stuff? Because I find it a bit embarrassing, I guess.

Nathan Illman 39:32

Yeah,

Jackie Dominic 39:33

You know. I do mean it. I really mean it. You need to accept it for what it is. It’s not just me saying it. I really do think you did a great job.

Nathan Illman 39:44

So I want to ask you, with the time we have left, let’s talk about coaching. Because you’ve talked about we’ve sort of briefly touched upon it. I mean, you have been talking about some ways that you coach people anyway, but let’s be a bit more specific about it. What does coaching mean to you? Yeah, let’s just start with that question, certainly nice and vague, and what does it mean to you?

Jackie Dominic 40:02

Well, I guess it means how can people come to a solution for themselves, and I’ve had to learn over the years how to coach because I’m an activist by nature. So I’ve jumped right in there go, you need to do this. This is what I would do. I’ve done this and it worked, blah, blah, blah. So I’ve had to learn over the years to shut up to sit there and say, Okay, so tell me what the problem is. And so get them to explain what that problem is, keep sort of reflecting back with them. So they can see that you’re listening to what they’re saying. And you’re actually listening. You’re not just thinking, Oh, my God, I’ve got to go to another meeting in a minute. And so reflecting it back to them saying, so. Okay, so you’re telling me that this is your problem, then? So what have you thought about so far? To try and deal with it? Get them to talk again? So I try and say very, very little.

Nathan Illman 40:58

That’s when I go, but aren’t you just gonna tell me what to do?

Jackie Dominic 41:03

Surely you know what to do. Yeah, I might know what to do in some circumstances, but not all circumstances. I don’t know everything. So I’m going to help you to come to some sort of conclusion. So get them to talk about what they thought about doing already. So what have you done so far? Well, I’ve done this, I’ve done that. Okay. So how did it go? Did it work? Did you get a good outcome from it? Yes, or no, then you start talking about it a bit more. And I like to get people to go and try things. So you know not to come to an absolute solution. That is, is, that’s the only way of going about it. So I’ll say, Well, if you want to go and try it, try it. As long as you’re not going to kill anybody goes and try. So if you want to try a new process, if you want to try a new way of inducting, your staff, if you want to try a new way of doing the observation round, whatever it is, go and try it, try it for a day, you don’t need to try it for 10 months, but we used to do in the NHS, you know, go and try it for a day, you’ll know after a day if it’s going to work or not. And then we’ll meet up again tomorrow, and you can tell me how it went. And then just kind of step by step really? Okay. All right, it didn’t work. So what else could you do then, I’m often coaching, it feels like they want you to take the problem away from them. But you can’t do that as a leader because you end up saturated. And I’ve made that mistake in the past, where I’ve I’ve been like a sponge and taken everybody’s problems on. And because I felt that was the right thing to do. Because it makes them feel better.

Jackie Dominic 42:37

But learning anything, because I take the problem away, try and deal with it often, maybe do maybe don’t. But they’re not learning, they’re not learning how to deal with it next time. So you actually you’re creating a rod for your own back, and you’re not developing leaders for the future, and you become saturated and overwhelmed. So you can’t do that you have to get people to do it themselves. And to develop those leaders, you know, if it’s a ward system, you’re developing the next matron that’s going to come along that someone one day is gonna go to them and ask them the same problem. So, you know, try trying to get them to learn and think and not just take the easy route. You know, I say to people, they usually know what the right answer is. But usually, the right answer is more difficult. And said, you know, doing the right thing is usually the harder route. Everyone can do that easy thing. But it’s not always the right thing. For example, we had some deputy sister interviews once, and the ward sister, they were all internal. And one person had been doing the job longer than the other, she felt obliged that this person felt that they were going to get the job. And so she spoke to me about it afterward. And I said, well, what is the right thing? Who is the right person for this job? Is it the one that thinks she’s gonna get it? Because she’s been there longer? Or is there someone else that you think is going to do a better job? And she said, Actually, yeah, there is said, but that’s a person you have to do. And you have to take the hard route. And if there’s a flap that comes with it, that’s fine. But you can’t just do the easy thing, because it won’t work in the end. So, you know, I think it’s about that as well, you know, trying to help people to be brave, to make decisions to not always do what’s the easiest thing? I guess.

Nathan Illman 42:37

Yeah

Nathan Illman 44:32

I think one of the great things about coaching people rather than giving advice because I guess that’s the difference, that the alternative isn’t it is falling into the advice trap. Someone comes to you with a problem and they’re looking for advice, and you just give it like you said it piles up. There are a couple of things that I guess these indirect ways actually contribute to people’s well-being that we’re giving people a sense of mastery and autonomy, aren’t we by enabling them and it’s empowering people and when we feel empowered. And we feel like we’ve come up with the answers. And we’ve gone off and tried a new system or process or whatever it is, we feel good about ourselves. And then that if you’re doing that with a few different people in a team, then like you said, it’s a skill set that they can pass on to others. And it’s, I suppose it’s a sort of communication style, which can be embedded within the practice isn’t it doesn’t. I think, from my experience, people get put off by these things because they see them perhaps as soft skills or things like coaching. Because they think, well, I haven’t got the time to do that. But actually, the amount of extra time it might take to ask someone to think about it for themselves is not that much longer in reality, as I’ve what’s your experience with that,

Jackie Dominic 45:44

in the long run? It isn’t, I think it’s a lot easier just telling the answer.

Nathan Illman 45:49

Yes. Yeah.

Jackie Dominic 45:51

I think when you invest that time, in the beginning, in the long run, you save yourself time because as time goes on, they won’t keep coming to you with these problems. There’ll be thinking about them, you’ll set themselves there’ll be developing themselves. So yes, at the moment, it’s quicker to just tell them, but not in the long run. So I really believe it’s worth investing that time, at that time, to help to coach them to learn a new way of thinking, because we’ve programmed I think, to look for the easy answer. And what we’re trying to do, as you say, is empower those people to go away and, and think about it for themselves to go and talk to their team and say, Look, guys, we’ve got this issue. What can we do about it as a team? Because they’ll, they’ll own it, they’ll embed it, and it’ll be sustainable. If I tell them the answer. They’re gonna try it, and it won’t just be sustainable. In a month’s time, the problem will still be there.

Nathan Illman 46:46

Yeah.

Jackie Dominic 46:47

Because they won’t own it.

Nathan Illman 46:49

Yeah, that’s why there’s that ownership component is really important, isn’t it? And also,

Jackie Dominic 46:53

you’re right, you know, it’s their health and well-being as well, because it’s the difference between their feeling of success or failure. You know, if they’ve gone away, and they’ve solved it, they’re they feel like a success. Yeah, it’s got to be told, then they feel I should have known that. I’m a failure. And they’re not. But that’s how they feel.

Nathan Illman 47:13

Yeah, I was told to do this. And then there’s always self-judgment, isn’t there? Like, I can’t do this thing. Right. I was told to do it. And that would have been things would have gone, well should have gone? Well, if I’d done this just only done this thing.

Jackie Dominic 47:26

Yeah. Fine line, though, to be honest. I mean, there are some times when you if it’s really, really urgent or really, really important, as in patient safety staff. And sometimes you do have to do that. Sometimes you do have to take the lead and go, actually, we’re gonna do it this way. But I try really hard not to do that unless I’m really pushed into it.

Nathan Illman 47:49

So managing that impulse, because there is we all have that impulse, don’t we?

Jackie Dominic 47:53

Yeah. Yeah.

Nathan Illman 47:54

An impulse to provide advice or give a quick, quick answer to something

Jackie Dominic 48:01

That Wayne Kline personality was, like I am, you know, I’m one of these people that hates loose ends and can’t bear it. I like to have a problem tied up sorted out done and dusted. So this way of doing stuff for me feels quite uncomfortable sometimes. But I have to just bear with it and let it go. And because I know it’s the right way to do it.

Nathan Illman 48:26

I’m really seeing that as a theme with everything we’re talking about Jackie is even though sometimes things are difficult or uncomfortable, actually, if it’s the right thing at often, I suppose doing the right thing is when is met with some sort of discomfort, isn’t it, there’s just like anxiety about something or Yeah, uncertainty, there are difficult emotions that we have to kind of press that acknowledge and press through to get to the other side, which is the right thing. And that ultimately will make us feel better about ourselves and contribute to the team and patient outcomes and all the rest of it.

Jackie Dominic 48:59

Absolutely. And if you’ve got a team that pulled together and they solve problems together, that’s a great team. Usually, they work well together as good teamwork as the communication, they give good care to their patients at the end of the day, because they have that sense of community about them, you know, this is our award, we’re going to make it the best ward that can be and this is how we’re going to do it together. You know, it’s obvious, isn’t it, that they’re going to be giving really good care, because they’ve got that sense of ownership and pride in where they work. And I love to see that I love to go into a ward and see you know, the teamwork and the banter with the patients and you know, having a bit of a laugh together, you know, say to them, you know, you don’t come to work to be miserable. Patients don’t want to see you miserable, they want to see you happy because otherwise, it makes them feel even worse than they really do. You know, have a laugh and a joke with them. You know, obviously, be professional but you know, have fun at work. There’s nothing wrong with having fun at work.

Nathan Illman 50:04

I love that. Yeah, it can all get very serious, can it? And I guess you talked about that idea of the professional identity. So the professional identity, yes, maybe there’s some stoicism, which a good dose of that can be helpful for stress. But actually, we can bring it a sort of that more human that humor fun side of us as well, right? Because otherwise, how do we connect with people at the end of the day, we’re working in healthcare, we’re working with other human beings. And we connect through Yes, things like empathy, and compassion, but like humor and fun.

Jackie Dominic 50:35

Yeah, and we spend a lot of time with the people we work with, you know, we spend more time at work than we do at home sometimes, you know, you’ve got to be able to enjoy it, you’ve got to, hopefully, look forward to going to work, you know, I can count on one hand that the number of days that I haven’t wanted to go to work, and I’m not some sort of, I don’t know, I’m not an overly optimistic person, although I am optimistic. But I always think, well, I’m going to do something good today, even if I’ve got something horrible to do, but hopefully something good will come out of it. But you know, I say to people, you spend a lot of time here, enjoy it. You know, please get, you know, make sure you organize some nights out and some social things because they’re really important.

Nathan Illman 51:23

Yeah.

Jackie Dominic 51:23

You know, years ago, when before everyone got so serious. We just used to dress up on Christmas Day and wear funny hats. And, you know, it’s a bit frowned upon nowadays. And I’m

Nathan Illman 51:34

such a shame.

Jackie Dominic 51:36

You know, I think God let the patients have a lot. You know, obviously, if there’s something going on on the ward, that’s very serious. If there’s someone dying or whatever, then obviously you wouldn’t wear those things. But you know, let people have a laugh and a joke.

Nathan Illman 51:50

Yeah. Yeah, that’s I love that. What I just said, it’s a shame that that doesn’t happen.

Jackie Dominic 51:55

It does. under the radar.

Nathan Illman 51:57

Yeah,

Jackie Dominic 51:58

they’re not around. They do it. I hope they do.

Nathan Illman 52:04

I look, I don’t want to go too much longer. Because obviously, it’s both of our evenings, and we both have leisure time, you’ve got a puppy to go and attend to probably I love that last question. For you. There are going to be some aspiring nurse leaders listening to this and people who are already in leadership positions. We talked about all the things that you do and that you are currently you say sort of, I suppose positive practices to support teams and individuals. What are few like absolutely no notice that you would impose people against things that maybe things you’ve seen recently, or in the past, that they can be serious or funny not to say or things not to do with your junior staff?

Jackie Dominic 52:44

Oh, my goodness. Gosh, I think a serious one would be not to let anything go by, you know, not to commit something you don’t agree with. Because you do it once people think it’s okay. Yeah. You know, what do you permit yourself to promote? You know that is a really powerful thing to tell leaders. You know, don’t walk past if you go into a ward, and a patient’s hanging out the bed, don’t walk past it, and go and get a nurse to deal with it. Deal with it yourself. If you walk past the nurse who is wearing false nails and massive earrings, don’t go and tell the sister to tell them to take them off. You tell them you say that’s not beautiful, you know, that sort of thing? I think the worst thing you can do is to permit something like that as a leader. Because it undermines you as a leader as well. I can’t think of anything else.

Nathan Illman 53:41

That’s right. That’s so, I love that one. That’s so great. Yeah. And it’s again, it’s hard, isn’t it? In those moments, I think it just feels easier that someone else can deal with that. But again, it’s just such a valuable principle, I think to have as again, leading by example isn’t a difficult conversation.

Jackie Dominic 54:02

I would say don’t be frightened, to be honest with people.

Nathan Illman 54:06

Yep.

Jackie Dominic 54:07

As long as you’d say it in the right way. As long as you’re compassionate and caring. You can say anything to anybody, so don’t be frightened to tell someone when you’re not happy with what they’re doing. Or they’ve done something wrong. Just be brave and go for it. Because actually, you’re going to be doing them a favor in the long run. And your patients a favor.

Nathan Illman 54:31

Yeah. I mean, I won’t go into this. Now. It’s a bit of a long story. But I’ve got such a great story about this out. Well, I could if I had this on someone else or someone I sort of read, read her work and stuff it that clear is kind and it’s kind of guessing at what you said, and it’s this experience of like, yeah, euphemisms being used around death and stuff like that and just being just not really being clear about things and I’m actually going to be either probably doing a podcast episode specifically about having difficult conversations and doing some training around that. Because it is a skill set. I think it’s, I totally agree with what you’re saying. You do just need to be clear and honest with people. But I think people struggle to know what to say they think they may think that being clear is, is actually not being kind. And it’s, it’s being too direct about things. But actually, that’s all we all really want don’t really, it’s hard to hear something sometimes, but at least when the person is there are not loads of unnecessary words, used in a sentence, and they’re just delivered in a way that’s really clear about what you’ve done wrong. You know, okay, that’s it. I know that person feels that way, and I need to do something about it.

Jackie Dominic 55:51

Yeah, absolutely. There’s no point beating around the bush. You’ve just got to say it.

Nathan Illman 55:57

Yeah. Jackie, so thank you so much for your time. I really enjoyed this conversation. I knew I would. I love talking bout all this stuff. And it’s been really great to get to know you a bit more and hear more about your leadership, which sounds amazing. I’m sure the people that work with you. Yeah, well to do in your hospital. We’re really valuing your presence. So thank you for everything that you do.

Jackie Dominic 56:19

Thank you. Okay, I hope so.