Building Great Nursing Teams

Podcast Transcript

Carol Pehotsky:

We all know a good team when we see one, and we all know a bad one when we see one of those two. But neither of those happened by accident. I'm joined by Shannon Kunberger today to talk about how nurses of all tenures can and must contribute to a highly functioning nursing team.

Hi, and welcome to Nurse Essentials, a Cleveland Clinic podcast where we discuss all things nursing, from patient care to advancing your career, to navigating tough on-the-job issues. We're so glad you're here. I'm your host Carol Pehotsky, Associate Chief Nursing Officer of Surgical Services Nursing.

Welcome back everyone. The topic of today is teams and teamwork, and how that really lives and breathes in a nursing world. You know, growing up, I wasn't a huge fan of team sports, which is probably good because my athletic ability (laughs) did not match a team sport anyway. And for me, in my perception, the pressure that come with Casey at the bat, and what if I strike out, what if, what if, what if, and I let the whole team down? And so, for me, I instead gravitated towards team events that were different, band, choir, speech and drama, those things where it was a team effort where, in my humble observation, it was about lifting everybody up together. And not that sports aren't like that, but for me, there were less pressure points, especially growing up.

So here I am now though in nursing, which is very much a team sport. There are times when there's pressure, there are times where, as the nurse, I'm the only one that has the information and has to speak up. But there are also plenty of times where I lift up the team together, and I have a role that's important as everybody else's, and we all rise and fall together. So, we're gonna linger on that topic, today's episode, and I'm so thrilled to be joined today by Shannon Kunberger. Shannon is the Chief Nursing Officer at Cleveland Clinic Euclid Hospital.

Shannon, thank you so much for joining me today.

Shannon Kunberger:

Well thank you, Carol. I'm actually very excited to be here on my very first podcast.

Carol Pehotsky:

That's right. The first of many hopefully. So, you're very passionate about teams and teamwork, and your role as a CNO in lifting up the nurses you lead. So, can you tell us, to start, a little bit about your story about teamwork and why you're so passionate about it?

Shannon Kunberger:

Yeah. Thank you for that, and I love hearing about how your humble beginning was about teams and what you participated in. And mine was probably the polar opposite.

Carol Pehotsky:

Okay.

Shannon Kunberger:

As a young child and going into the career of ballet, I was a in partner dance.

Carol Pehotsky:

Yes, okay.

Shannon Kunberger:

And so, when you dance with a partner, it is absolutely everything about a team.

Carol Pehotsky:

For sure.

Shannon Kunberger:

If I mess up, he messes up. If he messes up, I mess up.

Carol Pehotsky:

Yeah.

Shannon Kunberger:

So, it was really important.

Carol Pehotsky:

Literally going down together.

Shannon Kunberger:

Literally going down together.

Carol Pehotsky:

Yeah. Wow.

Shannon Kunberger:

And I never really put that concept together of how that helped form who I am today as a nurse leader. And fast-forward through all of the young memories that I have, going into nursing as a new grad, I went right into the ICU as a new grad. So, at that time, you really feel like, "Oh my gosh, how am I gonna know everything?"

Carol Pehotsky:

Sure.

Shannon Kunberger:

"I have to know everything."

Carol Pehotsky:

There's a lot on the line, yeah.

Shannon Kunberger:

"It's me and this patient one on one." I wasn't really good at applying the teamwork concept at that time, as a new grad.

Carol Pehotsky:

It's hard when you're first, yeah.

Shannon Kunberger:

It really is.

Carol Pehotsky:

You think you; you have to solve all the problems.

Shannon Kunberger:

Well, you feel like you got a little imposter syndrome, you feel like you're gonna let people down,"What if I harm somebody?" So those thoughts go through your head as a new grad, a new nurse, and they really tell you you're not gonna feel comfortable for many years and I said, "No, that's not true. I'm gonna figure this out."

Carol Pehotsky:

Did you?

Shannon Kunberger:

And, no, I didn't. I absolutely did not. It wasn't until about five years after, the beginning of my career, that I decided to go down the path of the emergency department.

Carol Pehotsky:

Okay.

Shannon Kunberger:

And when you get into the emergency department, it's like a three-ring circus sometimes and you're wondering, "Who's in charge?" And there's all these moving parts. But it all comes together.

Carol Pehotsky:

Yes.

Shannon Kunberger:

And so, getting teamwork down to its basic core concept just to simplify it, it's a bunch of people doing a bunch of processes and actions into one goal.

Carol Pehotsky:

Mm. Sure.

Shannon Kunberger:

And what is our goal in healthcare? It's taking care of the patients.

Carol Pehotsky:

Yeah.

Shannon Kunberger:

Or whatever the situation may be. So, trying to simplify that really taught me back in the emergency days of how to work and function in a team as a team member.

Carol Pehotsky:

Sure.

Shannon Kunberger:

Now, of course that changes as we go into the leadership journey, but my next journey after the emergency department was as a flight nurse.

Carol Pehotsky:

Oh, wow.

Shannon Kunberger:

And working in the flight industry, you really work so closely as a team that you don't even have to use words.

Carol Pehotsky:

And there, and talk about things being on the line, right, your own life as well as the patients in the air.

Shannon Kunberger:

Absolutely.

Carol Pehotsky:

Whoo.

Shannon Kunberger:

So, when we're talking about delivering quality, safe care and being a high reliability organization, I can really think that back to when I was on a helicopter, when you only have three bodies in the inside the aircraft, and you have to make a lot of decisions and using your voice, you have to speak up a lot.

Carol Pehotsky:

Yeah.

Shannon Kunberger:

And that's really where I learned about just culture, was learning how to see something and say something, "You know what? Those clouds look a little low today."

Carol Pehotsky:

Mm. Oh, sure. Not just about the patient, but about your true environment. Wow.

Shannon Kunberger:

Right, just truly everything really doing a scene, situational awareness about what's going on with the patient, what's going on with the aircraft and talking to each other without looking at each other.

Carol Pehotsky:

Right.

Shannon Kunberger:

Or looking at each other and not talking.

Carol Pehotsky:

Sure.

Shannon Kunberger:

So, it's all about communication and safety.

Carol Pehotsky:

Wow.

Shannon Kunberger:

And so that's really what launched my passion about, we have to be humble we have to be part of a team, and it's developing the culture. So that translated into the leadership side of things.

Carol Pehotsky:

Okay.

Shannon Kunberger:

So, when I try to lead a team, whether it's an existing team or a new team, I really try to humble myself and when caregivers or team members see that a leader is willing to be humble, and willing to say "I don't know everything I might make a mistake."

Carol Pehotsky:

"I need you to speak up."

Shannon Kunberger:

"I need you to speak up."

Carol Pehotsky:

"I need you to keep me honest." Yup, mm-hmm.

Shannon Kunberger:

"I need you to keep me honest." And opening that culture for people to just talk freely and not be fearful that they will say the wrong thing, or they're gonna get in trouble, when you create that kinda culture, then communication becomes even stronger. And that's how the team starts working together.

Carol Pehotsky:

Sure.

Shannon Kunberger:

Allowing them freedom and grace. Take the personal emotional stuff out of it. If it is about quality or safety, anything with a patient experience, when we sometimes are working in an environment, uh, in a team environment, and we feel real passionate about something, is it really your passion or your emotions that are taking over your decision-making, because you feel convicted? Right?

Carol Pehotsky:

Are you accurate in your conviction?

Shannon Kunberger:

Are you accurate in your conviction?

Carol Pehotsky:

Yes, yeah.

Shannon Kunberger:

And it really does take time to learn about yourself.

Carol Pehotsky:

Sure, you have to be comfortable in your own skin.

Shannon Kunberger:

You have to be comfortable in your own skin which we know, you know, some newer graduate nurses, or even people who've been a nurse a long time, and they ch- change different disciplines we have to be humble to say we don't know everything and lean into people who do. And so, when we're willing to put ourselves out there as a leader, I think people can really see that genuinely that it's okay to make a mistake if you're doing it for the right thing, it's okay to speak up.

Carol Pehotsky:

It's more than okay, yes.

Shannon Kunberger:

Right.

Carol Pehotsky:

For sure.

Shannon Kunberger:

And so, once you get that foundation of speaking up and communications, teams are gonna function better, because the root of teamwork is communication.

Carol Pehotsky:

Absolutely. And when you think about teams that come together, everybody brings their own road and journey to then.

Shannon Kunberger:

Right.

Carol Pehotsky:

So, I think that's a great point about, as a leader in humbling yourself, because you may not ever embrace a hierarchical situation, but you could be surrounded by teammates that are used to more hierarchical control and command, and "I'm the boss, what I say goes." And so, they walk in with that preconceived notion and are gonna pipe down until you say. And, and obviously that has a lot of resonance for me in a perioperative space. Yes, the surgeon has met this patient before and none of the rest of us have, but we have to come to and say that we each have a role to play and a voice to be shared to create that team that's really seeking the betterment of the patient.

Shannon Kunberger:

Right? Yeah, absolutely. And, you know, I try to think of it in an environment, every person has a sum of what they do. Right?

Carol Pehotsky:

Yeah.

Shannon Kunberger:

We have our own strengths, our own opportunities but when you put all those sums together, it creates a team.

Carol Pehotsky:

Absolutely.

Shannon Kunberger:

So, it's really recognizing people that you work with every day in your environment, what are their strengths? You know, what are your strengths?

Carol Pehotsky:

And amazing things. Yes.

Shannon Kunberger:

And, you know, when you start doing a lot of reflection, you start to think about your own strengths and, and opportunities you become a better people reader.

Carol Pehotsky:

Mm. Sure. Reading the team, reading the patient.

Shannon Kunberger:

Reading the team.

Carol Pehotsky:

Sure.

Shannon Kunberger:

I might have seven patients right now, and I've got all my stuff organized, and I'm ready to go and I've stayed on track, but do I have the ability to pause for a second, and think about the bigger picture of the unit?

Carol Pehotsky:

Mm. Sure.

Shannon Kunberger:

"My friend Carol, I'm okay, but is my friend Carol, okay?” And when you start offering help, it starts going well for everybody.

Carol Pehotsky:

That's right.

Shannon Kunberger:

It really having a big picture. And we as nurses, we're really good at helping, but we're also not good at asking for help.

Carol Pehotsky:

That's right.

Shannon Kunberger:

Right?

Carol Pehotsky:

That's right.

Shannon Kunberger:

And so, becoming a reflective, introspective reader of other people, we start bringing teams together.

Carol Pehotsky:

Yeah.

Shannon Kunberger:

"That person just smiled at me; she could tell I was struggling. Hey, could you just get me a cup of ice while I focus on this medication?" You know, something like that when we start doing that for each other, the team becomes more cohesive.

Carol Pehotsky:

And it's not a failure to ask for help.

Shannon Kunberger:

It is not a failure.

Carol Pehotsky:

It's, it's imperative to ask for help.

Shannon Kunberger:

Yes, it's, it's humble to ask for help. You're gonna have so much better outcomes. We may have spread this book, or we may not, you know, The Five Dysfunctions of a Team is a very popular book, we know when teams are not working, and we know when teams are.

Carol Pehotsky:

It's easy to spot when it doesn't go well.

Shannon Kunberger:

It's easy to spot when it's, when it's not going well. But w- you know, what does a good team look like?

Carol Pehotsky:

Sure.

Shannon Kunberger:

I'm asking the host a question but, you know, everybody has a different perspective of what does good teamwork looks like?

Carol Pehotsky:

Right.

Shannon Kunberger:

And from the seat that I get to sit in now and serve as a leader of many teams is, I have joy in the workforce. I have low turnover. I have high engagement, I have people raising their hands that wanna try new things, wanna learn new things and they're not shying away. Um, you know, when I look at teamwork, everyone at the end of the day can say, "That was hard, but we're done."

Carol Pehotsky:

"And we did it together."

Shannon Kunberger:

"And we did it together."

Carol Pehotsky:

Right.

Shannon Kunberger:

"And the sun is gonna come up tomorrow."

Carol Pehotsky:

No matter what, yes.

Shannon Kunberger:

No matter what.

Carol Pehotsky:

Yes.

Shannon Kunberger:

But, you know, I, you know, going back again to a little bit of that flight industry, one of the, and I said key components is communication, debriefing is a real critical component of a team.

Carol Pehotsky:

Sure.

Shannon Kunberger:

And we just don't do it enough. And I say that myself even as a leader.

Carol Pehotsky:

Yeah.

Shannon Kunberger:

Our leadership teams don't debrief enough.

Carol Pehotsky:

So, tell us a bit more about that like what works?

Shannon Kunberger:

What, what works, debriefing? It usually starts off with more like a template and we may have heard those questions, "What worked well? What didn't work well? What could've been better?" You know, very simple questions, but even then, that simplicity, if you are talking after an event with the people that were involved in the event, things are gonna come up.

Carol Pehotsky:

Right.

Shannon Kunberger:

"You know, I didn't know what you were saying when you said, "Get me that bougie."" Which is a tool for an airway, right?

Carol Pehotsky:

Yes, right.

Shannon Kunberger:

But maybe that new grad in the room didn't know what that was.

Carol Pehotsky:

Right.

Shannon Kunberger:

And so, when you debrief the situation of what did go well what didn't go so great? How could we have better talked about it? Could, would we have changed anything? And if you do that on a pattern of repetition with your teams again, your culture's going to form of speaking up and feeling comfortable about what they know, what they don't know, and how things could've been better.

Carol Pehotsky:

And, and you raise a fantastic point, which is that you don't just do it at prescribed times, right?

Shannon Kunberger:

Right.

Carol Pehotsky:

When I think about a perioperative or procedural space, there is the sign-out, we're supposed to be talking about these things. Do we get deep enough to really talk about those, those exact same things? "I didn't know where this piece of equipment was. It wasn't working when I went to get it." What are we giving teams to do with that?

Shannon Kunberger:

Right.

Carol Pehotsky:

Okay. So, I did that thing didn't work, now, how do we as a team help take that information out of the procedural space and say, "We need to get that taken care of?" Or an event happens and we're debriefing but how do we debrief at the end of a day, at the end of a shift, making it part of that standard work that says, "How did we do today?"

Shannon Kunberger:

Absolutely. And we do a really good job of huddling at the start of a day right? Here we go, team, this is what we need to know for the day, and when it comes to an event, or the end of the day, we don't do so good.

Carol Pehotsky:

People splinter off, yeah.

Shannon Kunberger:

Yeah. They just wanna hightail it outta there, they just wanna get home.

Carol Pehotsky:

There's something to be said for that, but yes.

Shannon Kunberger:

And, you know, I'm no mental health expert, but I've m- many will say the debrief process and creating a culture of debriefing is really gonna help unload and disassociate from events that happen in your day. And they could be very minor.

Carol Pehotsky:

Right.

Shannon Kunberger:

They could be major, and they could be minor, but they will eventually start to build up if you don't know how to decompress and debrief.

Carol Pehotsky:

Absolutely. There is no closure, and there's no release, no outlet.

Shannon Kunberger:

Right.

Carol Pehotsky:

People who truly understand 'cause they were there.

Shannon Kunberger:

Yeah, and then they build resentment, like "That nurse wasn't very nice to me," you know? Things like that. Where if we're talking out loud to each other, and sharing it unemotionally, like "Help me understand what, what you meant by this. Why did you do it that way?" really can help create a better relationship within a team.

Carol Pehotsky:

Absolutely. So, we've touched on a few things specific to the new nurse. Right? So, we hope that we have people listening everywhere from folks who are somewhere in nursing school to folk's sort of at the end of, or mid-career in terms of their nursing life. So, let's linger on that nursing student or that new grad for a moment. So, we were all there at one point in time, you know, we were all part of nursing schools, some of us longer than others, so what are some things, some advice you would give to that new nurse? Lots of other things, like you said, a lot of us walk into our first nursing job thinking, "I'm not good enough. I don't know enough," or, "I have to figure it all out." So specific to teamwork, what would you say to nurses that are coming on to their first licensed shift?

Shannon Kunberger:

Well, as I often tell any new grad, or new hire quite honestly, when they decide to change fields, what I typically tell new nurses is to find people. And it's not always necessarily the charge nurse. It's not always necessarily your manager. Find a buddy.

Carol Pehotsky:

Yes.

Shannon Kunberger:

Like interests. Somebody you might admire. Also, find people that you don't admire. And that's when you start to do reflective thinking.

Carol Pehotsky:

Why not?

Shannon Kunberger:

Exactly.

Carol Pehotsky:

Yeah.

Shannon Kunberger:

"That, that's something I don't wanna do. I'm watching this person, and I would probably do that differently."

Carol Pehotsky:

Sure, and, "Why do I have that, and what can I learn from that?"

Shannon Kunberger:

"What can I learn from that?"

Carol Pehotsky:

Yeah.

Shannon Kunberger:

You know, having a mentor, or having a buddy, however you wanna label it having a go-to person, again, takes that fear away.

Carol Pehotsky:

Yeah.

Shannon Kunberger:

Sometimes as a new nurse, we're too afraid to let our managers, our supervisors, our directors know that I might not know something or I'm uncomfortable about something. I don't want them to think, "I'm not capable" or they made a bad choice.

Carol Pehotsky:

Yeah.

Shannon Kunberger:

But stay humble and ask a lot of questions. "Did you ever feel this way?" We usually take the word "feel" out.

Carol Pehotsky:

Right.

Shannon Kunberger:

Not so tactical, "How do you put this nasogastric tube in? How did you feel when you had to put a tube up somebody's nose for the first time?"

Carol Pehotsky:

Right. Right. That's a great place to put the feeling in there. Yeah.

Shannon Kunberger:

Right, it's a great place to, because that's usually what the root is. You can learn the tactics out of a book.

Carol Pehotsky:

Yeah.

Shannon Kunberger:

Right? But what does it actually feel like.

Carol Pehotsky:

It's, it's the first time shoving a tube in someone's nose.

Shannon Kunberger:

What does that feel like? And so you know, having people, and it might not even be in your work environment, it might be from a different environment you know, reaching out. I always tell people they need someone to talk to decompress their day somebody to ask a lot of questions of in a safe space and then somebody that inspires you that can help push you forward.

Carol Pehotsky:

Mm. Nice.

Shannon Kunberger:

Somebody that can help push your talents.

Carol Pehotsky:

Sure, versus just they're my sounding board and they say, "Yeah, that was terrible."

Shannon Kunberger:

Yeah.

Carol Pehotsky:

Yeah.

Shannon Kunberger:

Because we don't want collusion either, right?

Carol Pehotsky:

Right.

Shannon Kunberger:

So, we really want people out there, and again, mentoring is not for everybody, but, man, there's a lot of great mentors and they don't even realize that they are.

Carol Pehotsky:

Sure, they're going about their daily work and, yet they're all these people.

Shannon Kunberger:

"Do you realize you do this job so great? Next time, when we have a new grad, take them along with you when you do this XYZ, and let them see how you do it, your comfortability the way you talk to a patient." But really, I tell the nurses, "Learn about yourself. When you are not comfortable, ask questions."

Carol Pehotsky:

And, "What makes you uncomfortable?"

Shannon Kunberger:

"What makes you uncomfortable?"

Carol Pehotsky:

Yeah.

Shannon Kunberger:

"And it's okay to be uncomfortable."

Carol Pehotsky:

Mm-hmm. Absolutely.

Shannon Kunberger:

"You will not know everything."

Carol Pehotsky:

And it isn't necessarily your assigned preceptor. Sometimes it is.

Shannon Kunberger:

Right.

Carol Pehotsky:

Right, sometimes you, you create that bond, and that's a person you go to, you know, forever or for a really long time. It can also be somebody else to challenge you, to provide a different way of thinking, and so to our newer nurse listeners, challenge yourself to look beyond your preceptor perhaps or beyond the nurses right there in your circle, and "Who else can challenge my thinking or teach me another way to say something? You know, what do they say, you fake it till you make it, right? So, "I may not feel comfortable speaking up yet, but I just love the way Shannon did that so I'm gonna kinda make a note of the actual words she said, I'm gonna talk to her about it afterwards."

"How did you come up with that, and how did that feel to say that?" and then I'm literally gonna say those words the next time I need to speak up."

Shannon Kunberger:

Yeah. Language is probably the hardest thing to teach people. And you really learn it from listening. And we talk about when we're with patients and our doctors are in the room with us, and they're saying things to the patients in, with all good intentions and but you as the nurse have been with that patient for 12 hours and you can tell by the look on their face, they have no idea what they're talking about.

Carol Pehotsky:

They're glazing over, yes.

Shannon Kunberger:

They're glazing over. So, our job as the nurses and the teammate to the doctor, the teammate to the patient is to really help interpret, "What did he just say? But maybe if I say it in a different way, they're gonna better understand it."

Carol Pehotsky:

Or it opens the door to them to ask a question, yeah.

Shannon Kunberger:

Or it opens the door for more questions, right? So it's, again, going back to communications and really being an observer. Especially as a new nurse.

Carol Pehotsky:

Yeah.

Shannon Kunberger:

"How did the doctor just say that word?" Or "How did that other nurse practitioner say that to a patient? Did I understand it?"

Carol Pehotsky:

Right. Yeah.

Shannon Kunberger:

"If it's not making sense to me, it might not make sense to them."

Carol Pehotsky:

That's right.

Shannon Kunberger:

Right? So, asking a lot of questions and being brave to ask questions.

Carol Pehotsky:

Yeah.

Shannon Kunberger:

I think people will feel way more respected when they get their confidence. Confidence is not easy as a new grad, but it's really having a mindset of self-efficacy. The belief that you can.

Carol Pehotsky:

There you go. Whoo.

Shannon Kunberger:

Right? It's one of my favorite topics, 'cause there is a big difference between confidence and self-efficacy. And self-efficacy is just the belief that I can do.

Carol Pehotsky:

That feels like a whole separate episode.

Shannon Kunberger:

That's a whole separate episode.

Carol Pehotsky:

We will save that one for another time.

Shannon Kunberger:

Yes.

Carol Pehotsky:

But so we've, lots of great tips for that new nurse, to, to be humble, to ask questions, to observe around them, and to, and be able to ask for help, and that makes them a better member of a team, right, because they're more effective and they're learning team skills from those around them. So, I wanna pivot then to the sorta other end of the spectrum. For our seasoned nurses you know, sometimes it feels like, "Oh my gosh, there's so many new nurses. I'm so sick of precepting," right? Or et cetera, et cetera.

Shannon Kunberger:

Yeah.

Carol Pehotsky:

We hope nobody feels that way, but there are times where you just want to do your job, but not have to explain and coach somebody through it. So, for folks who might be in that space, what does a team approach do for them? How can they learn additional skills and, and be a better nurse?

Shannon Kunberger:

Yeah. And I feel like I'm in the middle of that being of the age that I am. I'm not a new nurse. I'm not towards retirement, and I'm somewhere in the middle. Maybe closer towards retirement if you really think about it.

Carol Pehotsky:

We can all dream.

Shannon Kunberger:

We can all dream, but I actually have these conversations a lot with my very seasoned nurses, I'm blessed to have nurses who've been there since the day they graduated and are still there to this day.

Carol Pehotsky:

That wonderful.

Shannon Kunberger:

And so I'm really fortunate that way. But we talk a lot about accepting new cultures, yes. Yes, you can teach an old dog new tricks.

Carol Pehotsky:

We certainly hope so, yeah.

Shannon Kunberger:

Because our cultures are changing.

Carol Pehotsky:

Yes.

Shannon Kunberger:

Our patient population.

Carol Pehotsky:

Technology's changing. Yeah.

Shannon Kunberger:

Yeah. Technology. And how are we embracing that change? And it really is lifting them up because people are looking to them and they don't realize how uh people are admiring them. Just 'cause you've been a nurse for 20 years; does it make you an expert? No. There's a lot of opportunity to learn and grow, but how you're going about that change that being a change agent is really gonna inspire newer people.

Carol Pehotsky:

And how often do we hear, I know I hear it all the time, "I was just doing my job," right? Except just doing their job was inspiring somebody else. Somebody else was saying "Oh, that was so seamless, the way they did that, how they anticipated that, how they lifted the team up."

Shannon Kunberger:

Right. Right, I think we have to remind our veteran nurses, I'm just gonna call it that, or well-seasoned nurses, of, of what they have to offer, and how inspiring they can be. And it is hard when we have a lot of challenges with our staffing, and we have lots of new grads and how are we sharing that wealth? Sometimes these newer people, the younger people, really teach us a lot of new things.

Carol Pehotsky:

Well, everybody has something to share, right? Exactly.

Shannon Kunberger:

Everybody has something to share.

Carol Pehotsky:

Yes. "I need you to know about this work list in the EMR that I can show you how to use."

Shannon Kunberger:

Right.

Carol Pehotsky:

Anything that, how can we learn from each other and then the teams, all the team members are better for it?

Shannon Kunberger:

You know, and as an organization, we always support, you know, be curious, ask questions and have no fear to speak up. We need that from our seasoned nurses more than anything.

Carol Pehotsky:

Absolutely.

Shannon Kunberger:

Because they have been around the block once or twice, they have seen things come full circle, such as team nursing.

Carol Pehotsky:

Right.

Shannon Kunberger:

We had it once, it went away, and now it's back, and, you know, they've lived through those experiences, and really having them in- be empowered about what they have to offer, and they're not there just for a job, I think is really critical. And how can they learn? They feel like they can't learn, but you can learn.

Carol Pehotsky:

Absolutely.

Shannon Kunberger:

We all can learn.

Carol Pehotsky:

Our patients are counting on it.

Shannon Kunberger:

Our patients are counting on us to pivot every time there's a change in technology, or healthcare, or how we deliver certain medicines we have to pivot and change. And I think that's the one thing nurses are used to; is we are always changing.

Carol Pehotsky:

It's true.

Shannon Kunberger:

Yeah, but to really make sure that the seasoned nurses are feeling valued, and why they're valued, and what they have to offer is important to help build the team.

Carol Pehotsky:

Absolutely. So, to wrap up this conversation a little bit, we're all coming together as a team, it's the start of a shift, et cetera, how do we clarify roles and responsibilities so that we're all clear on what, what the next step is, and what the ne- the 12th step is, for example?

Shannon Kunberger:

That's actually my favorite question.

Carol Pehotsky:

Okay.

Shannon Kunberger:

Yeah, it's really my favorite question because we're talking about teamwork and communication but before you do anything, you have to set a foundation of what does it looks like? What are the expectations? What's my role? So, when we're doing any activities, I have my patient assignment, I've got my nursing assistant to help me I have a unit secretary to help me, and this is in the acute setting by the way.

Carol Pehotsky:

That right.

Shannon Kunberger:

And then all of a sudden, a code blue happens.

Carol Pehotsky:

Right.

Shannon Kunberger:

What happens next? How does everyone know what to do? And it's really through repetition, and practice of understanding what's your role.

Carol Pehotsky:

Sure.

Shannon Kunberger:

Identifying your roles.

Carol Pehotsky:

And saying it out loud.

Shannon Kunberger:

Saying it out loud.

Carol Pehotsky:

Don't assume.

Shannon Kunberger:

Clearly communicating the expectations moving forward. And that comes from the leadership side too. Even if it's just a day where there are no code blues, which, knock on wood, I hope that always happens right, but as a leader, what do I expect from you as a bedside nurse in your role?

Carol Pehotsky:

Indeed. Yeah.

Shannon Kunberger:

I expect you to do XYZ, I expect you to speak up, I expect you to say. "Thank you." You know, setting up those roles and expectations early on, "Who's on your team? Oh, today you have a charge nurse."

Carol Pehotsky:

Indeed. Yeah.

Shannon Kunberger:

"Today, you don't have a charge nurse."

Carol Pehotsky:

Right. "This person is floating in."

Shannon Kunberger:

Yeah.

Carol Pehotsky:

"Everybody, say hi to Carol. Hi, Carol."

Shannon Kunberger:

"Hi, Carol."

Carol Pehotsky:

"She's not from this unit, but here's what, where she's from, and here's what she knows."

Shannon Kunberger:

Exactly.

Carol Pehotsky:

Yeah.

Shannon Kunberger:

So, there usually has to be somebody that's setting the stage over the shift, of the department, over the whole hospital depends on what it is, but really setting what those expectations are, and helping people understand, "What's my role? And when my role's good, how can I help others?"

Carol Pehotsky:

There you go.

Shannon Kunberger:

And we talk about it out loud. And then it's practice, practice, practice.

Carol Pehotsky:

That's right.

Shannon Kunberger:

It's really doing simulation, and we know studies have shown doing actual hands-on physical simulation really does help home in those communication skills.

Carol Pehotsky:

Sure. Goes back to that safe space.

Shannon Kunberger:

Safe space.

Carol Pehotsky:

Yeah. All right, everybody, well, you have a little bit of homework, which includes asking questions, no matter what tenure of nurse you are, and remembering that you have something to offer the whole team and sharing it. So, with that, we'll pivot to our speed round.

This is where our listeners get to learn a little bit more about you as the lovely human being you are, Shannon.

Shannon Kunberger:

Oh, thank you.

Carol Pehotsky:

So, what's something you do for you to recharge?

Shannon Kunberger:

Something I do to recharge. I actually do quite a few things.

Carol Pehotsky:

'Kay.

Shannon Kunberger:

I am one of those people that always has to have something going on. It's really hard for me to do anything that is just one thing at a time. So, I can tell you right now, I am knitting my first scarf.

Carol Pehotsky:

Oh, fun.

Shannon Kunberger:

I listen to lots of books.

Carol Pehotsky:

Okay.

Shannon Kunberger:

I'm making a piece of art.

Carol Pehotsky:

Oh.

Shannon Kunberger:

And I'm taking classes.

Carol Pehotsky:

Oh.

Shannon Kunberger:

So, I do lots of different things.

Carol Pehotsky:

And this is a woman who just finished her doctorate, by the way, folks.

Shannon Kunberger:

Yeah, I did finish my doctorate a few months ago, and I thought, "What am I gonna do with my time?" Well, I just filled it back up.

Carol Pehotsky:

And then some.

Shannon Kunberger:

And then some. But I would say that my most favorite decompressing type of experience for me is listening to a book.

Carol Pehotsky:

Okay.

Shannon Kunberger:

Or reading a book. I really love to separate myself. It's very hard, my mind goes on lots of fires at one time. Overdrive. I can h- think, be thinking about 10 things at one time, but when I start to go into a book, I can separate.

Carol Pehotsky:

Sure.

Shannon Kunberger:

Yeah, and it's one thing that I really love to do. And I love anything physical activity so, I love kayaking.

Carol Pehotsky:

I'm still trying to get her to join my dance class.

Shannon Kunberger:

Yes.

Carol Pehotsky:

So, if you can help me pressure her.

Shannon Kunberger:

I love to dance, if those of you have seen me try and tap a little bit, I can still pull it out. It's one of those skills you never lose, I think.

Carol Pehotsky:

That's right.

Shannon Kunberger:

Like riding a bike. But, yeah, really one of the best things I do as a nurse leader for decompression, when the executive side gets a little stressful for me, I just get out of my office, and I go to the floor.

Carol Pehotsky:

Sure.

Shannon Kunberger:

I go right to the floors, and I talk to my teams, and I go back to my roots, I pass out waters you know, give 'em a blanket. And when, as soon as I do that, my cup fills up.

Carol Pehotsky:

There you go.

Shannon Kunberger:

So, I actually have it built into my schedule, my secretary would tell you it's built in my schedule, when the time I arrive, I've got a half an hour in the morning to do two units and then at the end of the day, before I leave, I go visit some more units.

Carol Pehotsky:

That fantastic.

Shannon Kunberger:

Because it's a good way to start the day of why I'm there, and it's a good day to end my day of why I'm there.

Carol Pehotsky:

There you go.

Shannon Kunberger:

So those are things I like to do.

Carol Pehotsky:

Well, this question may be related to that, but we ask all of our guests, what brings you joy?

Shannon Kunberger:

What brings me joy? I would say right now, outside of my personal life, my joy in my workplace is when I see others fulfill something they didn't think they could do. I've a current leader right now that is being challenged to step outside of her comfort zone and do something different. And one of those is public speaking.

And she had taken part of a class, and they had to do a project, and she had to speak in front of the entire nursing executives of the Cleveland Clinic, and she was extremely nervous. And when she was done, she said, "Oh my gosh, I was so nervous." But we talked about it ahead of time we prepped, we got her ready, and she did so wonderfully. And it honestly, it just brings me joy when I get to mentor others to do things that they didn't think they could do.

Carol Pehotsky:

Keep filling up that cup.

Shannon Kunberger:

Filling up that cup. I love to see others achieve great things, and so I just, yeah, that's what brings me joy in the workplace. 

Carol Pehotsky:

Fantastic. Well thank you, and thank you so much for joining me today, Shannon.

Shannon Kunberger:

Yeah. Well, my pleasure, and I hope to come back some day. Thank you.

Carol Pehotsky:

As always, thanks so much for joining us for today's discussion. Don't miss out, subscribe to hear new episodes wherever you get your podcasts. And remember, we want to hear from you. Do you have ideas for future podcasts or want to share your stories? Email us at nurseessentials@ccf.org. To learn more about nursing at Cleveland Clinic, please check us out at clevelandclinic.org/nursing. Until next time, take care of yourselves and take care of each other.

The information in this podcast is for educational and entertainment purposes only and does not constitute medical or legal advice. Consult your local state boards of nursing for any specific practice questions.