CNO Roundtable Allows Nurses to Speak Up and Be Heard

Podcast Transcript

Carol Pehotsky (00:04):

We've spent several episodes of Nurse Essentials talking about speaking up, and we know that at the bedside, in the moment, there's often a sense of urgency, but how do we as nurses need to modulate and moderate our voice and our intent when we're afforded the opportunity to be at the table with stakeholders up to, and inclusive, of our chief nursing officers? How do we make sure that our words are heard, along with the passion with which we have to deliver it?

(00:31):

I'm joined today by Shannon Pengel, Chief Nursing Officer of Cleveland Clinic main campus, to learn more about her CNO round table with her bedside nurses, and to learn more about its incredible impacts on the nurses, our patients, and the organization.

(00:48):

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.

(01:08):

Welcome back, everyone. I'm going to be spending today talking about opportunities for nurse leaders and clinical nurses to have conversations, and what each party gains from that, and how you set up successful scenarios to do that. And preparing for this episode, I thought about my baby steps into leadership and where I found myself sitting at a table, and for me it was, I had the great opportunity to be my unit's shared governance chair. That was really my first baby step into leadership, and all of a sudden, I found myself at a very influential table of all the unit-based council chairs, being led by a leader in the organization who I respected and admired greatly, and sort of feeling out of my depth.

(01:48):

I want to speak up and not be quiet, but I don't want to over talk, and the nerves that go along with that, and thankfully, I've grown a lot since then. I've had incredible mentors, and other opportunities, where leaders have helped me learn how to make sure that what I'm saying is heard. I can still be passionate about making sure that comes across. And, and what do you do when you have a seat at the table? And so it's my great pleasure to introduce you all to Shannon Pengel. Shannon is the Chief Nursing Officer of Cleveland Clinic main campus.

(02:17):

Shannon, thank you for joining us today.

Shannon Pengel (02:19):

Thank you, Carol. Thank you so much for having me.

Carol Pehotsky (02:21):

Of course. So, before we get to the really great things you're doing to provide opportunities for nurses to have that seat at the table, can you walk us through a little bit about your nursing journey? You have a fantastic and fascinating career.

Shannon Pengel (02:33):

Well, thank you.

Carol Pehotsky (02:34):

Yeah.

Shannon Pengel (02:34):

I hope it's fascinating.

Carol Pehotsky (02:35):

You... Absolutely.

Shannon Pengel (02:36):

Uh, so interestingly enough, I started at Cleveland Clinic, as a bedside nurse, 27 years ago.

Carol Pehotsky (02:42):

Which is crazy, because you're only 27.

Shannon Pengel (02:44):

Yeah, of course.

Carol Pehotsky (02:44):

(laughs)

Shannon Pengel (02:45):

I mean, not a day older. But I worked in a cardiothoracic surgery step down unit for the first couple of years of my career. Like many, had a family. Ended up working straight nights for about three years after that, with two very young children, and one day, similar to you, I had a mentor as well. Dr. Kelly Hancock was our, I think they called them clinical coordinators at that time.

Carol Pehotsky (03:10):

Oh, okay.

Shannon Pengel (03:11):

And she said, "Hey, why don't you think about coming off of night shift and being an assistant manager?" And I thought, "Wow!"

Carol Pehotsky (03:18):

(laughs) Are you sure? Me?

Shannon Pengel (03:22):

Either they're really desperate, or... And so Kelly kind of described, you know, "You're in charge all the time. Clinically, you're exceptional. You really should think about doing this." So, for me, it worked out well. With young kids, I could have somewhat of a, a set schedule, which happened to be the weekend.

Carol Pehotsky (03:38):

(laughs)

Shannon Pengel (03:38):

Nursing schedules are not always ideal, but it worked for me. And that was really my start into leadership, and I was an assistant nurse manager for many years, a nurse manager. As Kelly stepped into the director of the Heart and Vascular Institute role, I took on assistant director and got to learn all about the cardiac areas at Cleveland Clinic's main campus. Eventually, I took over in the director role, and then had an associate chief nursing officer role where I had HVI plus pulmonary critical care and digestive disease. And then, eventually, in 2020, the year of COVID-

Carol Pehotsky (04:13):

Just a few things going on, including-

Shannon Pengel (04:14):

Yeah.

Carol Pehotsky (04:15):

(laughs)

Shannon Pengel (04:15):

I stepped into the chief nursing officer role for main campus, which was definitely the honor of my lifetime, to be in a role at the same hospital I started at, and went into it with a lot of energy and a lot of enthusiasm, and then discovered that this wasn't so easy. To lead such a large hospital through, notably, was the most difficult time within our nursing workforce and our nursing profession.

Carol Pehotsky (04:41):

And so, just to give folks a bit of scale, ballpark, how many beds and how many nurses are part of this main campus?

Shannon Pengel (04:49):

So, of the main campus proper, we have about 1400 licensed beds for inpatients only. But we also care for, what would you say, Carol? Around 200 surgical patients a day?

Carol Pehotsky (04:49):

Average. (laughs)

Shannon Pengel (05:01):

And we have an amazing ambulatory footprint on this campus, where we see 8,000 to 9,000 patients a day in our ambulatory spaces. All of those spaces have nurses, and all of those nurses report up through me, so it is quite a few. I think you could honestly say, I do not know all 8,000 nurses.

Carol Pehotsky (05:21):

(laughs) I'd be very impressed if you could start rattling off names.

Shannon Pengel (05:23):

I'll be talking with people, and they're like, "Oh my, my neighbor's daughter works at Cleveland Clinic. Do you know her?" I'm like, "I'm sure I do, but..." So that's probably one of the biggest challenges of having a campus so large, is just being able to connect with caregivers. And as I started in this role, that was one of the things that I really struggled with, because it's hard to influence and motivate and inspire when you don't have the opportunity to connect with every single caregiver that works on this campus.

Carol Pehotsky (05:49):

And so leading perfectly then into, you've built this wonderful innovation, the Chief Nursing Officer Roundtable. I'd love you to tell us a little bit more about how that started, where that idea came from? How it began?

Shannon Pengel (06:03):

So, it really began as, I would say, an output of our workforce shortages during COVID. It was a really difficult time for our profession, as you remember.

Carol Pehotsky (06:12):

Mm-hmm.

Shannon Pengel (06:12):

There was a lot of nurses that were experiencing emotional distress from COVID.

Carol Pehotsky (06:18):

Yeah.

Shannon Pengel (06:18):

From what they were being asked to do, from what they were seeing, and our workforce was changing. At Cleveland Clinic's main campus, we had never had an agency nurse or a travel nurse on this campus for as long as I can remember.

Carol Pehotsky (06:31):

Same, yeah.

Shannon Pengel (06:33):

And with the number of nurses that were leaving bedside nurses and going to travel, it left the Cleveland Clinic main campus with a very significant vacancy, and we had to bring in agency nurses. And this was different.

Carol Pehotsky (06:33):

Yeah.

Shannon Pengel (06:46):

And our nurses had a hard time responding to that. And it was a different way to provide care. It was a mix of your own caregivers and agency caregivers. And so, really, it was the employee engagement, retention, and morale that kind of drove me to say, "We have to do something different," and what better way to lead than from up front? And I thought it would be a great idea to really try to connect with every single nurse, and again, as I said, that's nearly impossible.

Carol Pehotsky (07:15):

You're getting there.

Shannon Pengel (07:17):

So, I thought, "Well, why not have a representative from every unit that's an informal leader, that's not afraid to raise their hand, that's gonna tell me the way it is, and help be a part of the solution, and help lead us through this really unprecedented time in healthcare?" And so that's what really started it. I had no idea what it would be like when I had my first meeting. It was intense.

Carol Pehotsky (07:38):

Yeah.

Shannon Pengel (07:39):

It was very intense. You have to be pretty vulnerable as a leader to be in front of 40 or 50 people that have no problem telling you everything that you're doing wrong, or that they think that should be done differently, but it was great to hear. I needed to hear it, because we were dealing with a different workforce-

Carol Pehotsky (07:39):

Mm-hmm.

Shannon Pengel (07:55):

... and different problems, and we needed different solutions. So, that's kind of how it started, and then it just kind of snowballed from there to something that I look forward to connecting with our caregivers every month now.

Carol Pehotsky (08:06):

So, I was going to ask you if you had to do anything to get people to speak up, but clearly, you didn't.

Shannon Pengel (08:11):

Mm-hmm.

Carol Pehotsky (08:11):

Those individuals were selected (laughs)-

Shannon Pengel (08:11):

Yep.

Carol Pehotsky (08:13):

... for those talents. How did you, and how do you continue to manage that onslaught, if you will, of, "Here's all these things that we don't love." How did you manage that in the moment, and then what do you do after the meeting? Basically, I... We've now handed you 50 ideas. Go.

Shannon Pengel (08:28):

Yeah. I was really cognizant of that, and I felt overwhelmed after the first meeting because I didn't want anybody to feel that way. Because how many meetings have we been in where you air your grievances and nothing ever happens? And so I really took time after the meeting to list everything that I heard in kind of three different ways. "What is some low-hanging fruit that we can do today?" That, that I can impact the way that you do your work and the challenges that you face? "What are the things that we absolutely could work on in the future," and that was a whole separate slide. "These are gonna take a long time, these are gonna take different resources. This may impact things beyond just main campus, but it's a good idea." And then we had a slide of, "We can't touch this."

Carol Pehotsky (09:12):

(laughs) It's not even a parking lot.

Shannon Pengel (09:16):

Yeah, it's not even a parking lot.

Carol Pehotsky (09:17):

It's a "do not enter" zone.

Shannon Pengel (09:18):

"I heard you, I documented it on the slide, but this is outside of our control as nurses here at the main campus." And those were more global things, like, "Go tell the government this is ridiculous." So yeah, I... That's not going to happen.

Carol Pehotsky (09:31):

Yeah. (laughs)

Shannon Pengel (09:31):

But we did take some of those ideas and then form different speakers to come address their concerns.

Carol Pehotsky (09:37):

Oh.

Shannon Pengel (09:37):

So, for example, with some of the government relations issues that they brought up, we had government relations come and address those specific concerns that they had. And it was kind of news to them that we actually are having these conversations, but it's just not as easy as flipping a switch-

Carol Pehotsky (09:52):

Right.

Shannon Pengel (09:53):

... in the government. So, I thought that was a really good example of something that is out of my control and out of our control here at Cleveland Clinic, but we actually do have a voice, and we are trying to use it to make change.

Carol Pehotsky (10:04):

What a lovely way to acknowledge, "We've heard you. Let's help other people hear you," so... Yeah. That, that awareness that says, "I can't necessarily do anything, but here's what's happening in the meantime."

Shannon Pengel (10:15):

Right.

Carol Pehotsky (10:16):

That's lovely. So, how'd that second meeting (laughs) go then? You've got sort of your slides. How did that go, and tell us a little bit more about what you accomplished with those low-hanging fruit?

Shannon Pengel (10:26):

So, the, the second meeting was, A, just making sure that everybody knew that I heard everything that was said, so I think people were skeptical at that second meeting. Like, "Okay. You took time-

Carol Pehotsky (10:37):

We had a second meeting. (laughs)

Shannon Pengel (10:38):

Yeah, "You put it on some slides." And what I really tried to focus everybody at the end of that meeting is, "In the next six months, we are going to focus on this low-hanging fruit."

Carol Pehotsky (10:47):

Okay.

Shannon Pengel (10:48):

We're not going to fix the things that are long term in six months, but I can help. And some of those things were around safety and wellness, for example.

Carol Pehotsky (10:56):

Okay.

Shannon Pengel (10:56):

And one of the things we discovered very early on is not every unit had a panic alarm available.

Carol Pehotsky (11:02):

Oh, gosh.

Shannon Pengel (11:02):

Or, maybe it was there, it didn't work. Maybe it was there and nobody knew it was there. So that was low-hanging fruit, right? We can send a team out and do a survey and, and get this inventory improved. So, we kind of separated it like that, and I really focused the group on, "There's maybe 15 things on this slide, and I need help fixing these 15 things, so I also need some of you to volunteer to be on groups to help us identify what the best strategy is to solve this problem."

Carol Pehotsky (11:31):

I mean, it's the ultimate continuous improvement, right? Like, how do we get the people who are doing the work to help solve the problem?

Shannon Pengel (11:36):

Yep.

Carol Pehotsky (11:37):

So, how did the structure then evolve then to make sure that those working groups had the right people, had what they needed, could move things forward?

Shannon Pengel (11:45):

So, one of the things we did right in the beginning, you know, you kind of mentioned how was that second meeting?

Carol Pehotsky (11:45):

(laughs)

Shannon Pengel (11:51):

We also discovered that we needed leaders of this group, so we decided pretty early on that we needed a chair and co-chair.

Carol Pehotsky (11:58):

Great.

Shannon Pengel (11:59):

So, we had the team elect their chair and co-chair. They all submitted their nominations, talked a little bit about themselves, why they thought they would be good in this role, and we kind of charged them with overseeing work groups. So, I mentioned safety and wellness. That was definitely a work group that this team felt very passionate about. And so we solicited volunteers. We solicited some of our leaders to help guide the groups, because we thought that was important. That, at every level, we had a voice in creating this solution. So, the chair of our committee is Vince Trusani, and our co-chair is Ashley Collins, and they have been incredible partners for me. Over time, we evolved their leadership to also sit on my leadership team for the Cleveland Clinic main campus nursing institute.

Carol Pehotsky (12:45):

That's fantastic.

Shannon Pengel (12:45):

So, they come to all of our decision-making meetings. They're a part of that conversation. They understand the why behind why a lot of decisions are made and, but yet they go back to their units and talk with their caregivers, and that really spreads kind of like wildfire. So, we structured the w- work groups to have a chair or co-chair on that group, a director or manager to help assist, and really, we've accomplished so much in, in just a few years. And I think now when I hear nurses talking about struggles or barriers that they're facing, they'll frequently say, "Well, let's take it to the CNO Roundtable-

Carol Pehotsky (12:46):

Hurray!

Shannon Pengel (13:19):

... and we'll let them solve it."

Carol Pehotsky (13:21):

That's amazing. Well, and just to reflect a little bit, what a great technique to bring leaders into it. And that may not be always the purest form of shared governance, but I can't help but think without that Sherpa there (laughs)-

Shannon Pengel (13:33):

Mm-hmm.

Carol Pehotsky (13:34):

... you know, the likelihood of that team coming up with a solution that wasn't executable-

Shannon Pengel (13:38):

Right.

Carol Pehotsky (13:38):

... is higher.

(13:39):

So, did they have to help navigate some of that, "We want to do this," and sort of-

Shannon Pengel (13:43):

Mm-hmm.

Carol Pehotsky (13:43):

... yes, and here in our current structure, or what we have to work with sort of moderating those ideas to make them within the guardrails, so to speak?

Shannon Pengel (13:53):

Yeah, exactly, and I think that's why their participation in those work groups is so important. You know, we may have a grandiose idea that is wonderful-

Carol Pehotsky (14:02):

Yeah.

Shannon Pengel (14:02):

... but our frontline caregivers don't always have all the resources or know those resources to make it happen. And so, one of the directors I'll call out is Stephanie Neff and Jocelyn Meyer, who heard all of the concerns that were being brought up by the teams, and instead of trying to have, like, for example, six different in services on six different topics, they brought those six different leaders and hosted our first caregiver safety and wellness fair.

Carol Pehotsky (14:27):

Yes, that's right.

Shannon Pengel (14:27):

So, I think that's just one example of, you know, there's great ideas, but then the directors and the managers were able to help them bring those ideas to life.

Carol Pehotsky (14:35):

That's fantastic.

(14:37):

So, you mentioned that you had some future buckets and some longer term things. What sort of things have come out of that longer term project, and what are some wins even if you're still on the journey?

Shannon Pengel (14:47):

Well, I think, again, caregiver resilience and morale is definitely one of them, and that's just an evolution in process. I'm sure almost every hospital has workplace violence committees where we're talking about this, and that's just going to be an ongoing thing, but we were able to accomplish a lot long term. So, one of the things that this team brought up is, "We feel uncomfortable with the amount of people that are here that we don't know if they're supposed to be in our hospital or not, at night."

Carol Pehotsky (15:13):

Sure.

Shannon Pengel (15:14):

And so if you remember, during COVID, we were really good about screening people that came into our hospital, but we had kind of lost sight of that, and they actually were the ones that brought this forward. We took it to our Cleveland Clinic police department and partners, and we were able to reinstall the badging system at night. We were able to lock down some of our exterior doors, and that took well over a year to accomplish that. So again, longer term project, very important, but just took a little bit more planning and coordination and, of course, impacted more than just nursing. So-

Carol Pehotsky (15:47):

All for the better, absolutely.

Shannon Pengel (15:48):

Right. Right. So, it's been a very good story to tell. Similar with the panic alarms, very good story to tell. That was just a little easier to implement. (laughs)

Carol Pehotsky (15:56):

(Laughs) A little more scalable.

(15:58):

What sort of improvements or ideas have come through related to patient care?

Shannon Pengel (16:02):

I've s- watched a number of nurses grow in their leadership, and again, that voice at the bedside, as you mentioned. Every nurse is a leader, right? It doesn't matter what title that you have. I've watched nurses who are charge nurses in our ED develop a bigger voice, if that's possible?

Carol Pehotsky (16:03):

(laughs)

Shannon Pengel (16:20):

But, you know, these were caregivers that were not afraid to speak up, but now speak up in a way that helps people see the bigger picture.

(16:27):

I've watched some nurses decide that, "Hey, maybe I do want to get into leadership, which was not my goal at the beginning," but there have been a couple of nurses that have stepped into assistant nurse manager roles as a result of this, their participation. I think one of the co-chairs, Ashley, had come to me one day, and you know, I think we've all had this epiphany, you know, "I'm not really sure what I want to do when I grow up in nursing."

Carol Pehotsky (16:49):

Sure.

Shannon Pengel (16:49):

"What do, what do you think? What do you see in me?" And I think it was, it was really a nice opportunity for me to say, you know, "Ashley, you have to do what brings you joy," and I think, you know, she thought about leadership. You know, I had never really thought about that before joining this group before. So, I think it- it's been amazing to see people, I like to say, find their voices sometimes. We often talk through clinical situations in this group, and I think it's been fascinating to stand in front of a group of 40 and 50 nurses and say, "This is what I would say if I were in this situation."

(17:24):

And I think they've learned, you know, it's one thing to speak up, but it's very different to speak up in a way that brings attention to a situation and shares your concerns, especially when you're talking with providers, and you know that very well, working in the operating room.

Carol Pehotsky (17:39):

(laughs)

Shannon Pengel (17:39):

It's hard to speak up sometimes, and to do it in a way that focuses the attention that you need on the safety of the patient, I think, is something our nurses struggle with sometimes, and this is a great opportunity to role model.

Carol Pehotsky (17:51):

I want to linger there a little bit longer, because, at least in my specialty, sometimes we hire people preferentially who are not shy of speaking up, and you had a committee at the start that was hand selected for their-

Shannon Pengel (18:03):

Mm-hmm.

Carol Pehotsky (18:03):

... comfortness speaking up.

(18:04):

But sometimes that... Again, in my setting, like, we have people that will put their hands on the sterile table and say, "You have broken sterile technique. We can't proceed." That doesn't happen often, but we encourage them to be as bold as they need to be to stop the line. How do you help nurses perhaps transition from that, "I need to speak loudest, I need to speak boldly, I need to speak urgently to stop the line."

Shannon Pengel (18:25):

Mm-hmm.

Carol Pehotsky (18:26):

To take that same passion, but channel it into a way that the message is heard when you are at the table? Whether it's a round table, or another opportunity where a nurse has the opportunity to sit at that table with decision makers and make sure that my passion is there, but that passion isn't overriding the words I have to say?

Shannon Pengel (18:44):

Yeah. I think one of the things that I learned early on was, our nurses really are great at understanding the problem, but they don't always have all the information that they need.

Carol Pehotsky (18:53):

Okay.

Shannon Pengel (18:54):

So, a really simple example: one of the first meetings was, "Why don't you just hire more nurses?"

Carol Pehotsky (19:00):

Oh, yeah, why not? (laughs) All great and well-intended.

Shannon Pengel (19:04):

(laughs) Yeah.

Carol Pehotsky (19:04):

Yes, exactly.

Shannon Pengel (19:04):

I would love to hire more nurses-

Carol Pehotsky (19:05):

Yes, please.

Shannon Pengel (19:06):

... they're just not there.

(19:07):

And so, you know, that led us down this whole series of education for this group around, really, what are the national trends in healthcare? What are the national trends within nursing? How many nurses actually graduate from nursing school in northeast Ohio every year?

Carol Pehotsky (19:21):

Yeah.

Shannon Pengel (19:22):

You know? So, just giving them that information, and you can almost watch the way they present challenges change-

Carol Pehotsky (19:28):

Okay.

Shannon Pengel (19:28):

... when they have the right information, and when they have the data and they have the facts. And I think a difference in my leadership before starting this group and after, is I'm much more transparent in what I share. I used to think sharing data with some of our frontline nurses was a bad thing, and now I'm very transparent about vacancies, how many agency nurses we have here, what our quality outcomes are. All of those things. Ratios.

Carol Pehotsky (19:56):

Knowledge is power.

Shannon Pengel (19:56):

Just so they have that information, so that when someone walks up to them and says, "Why doesn't Shannon Pengel just hire more nurses," they can say, "Hey, do you know, there's a national shortage of not only healthcare workers, but particularly nurses," and, and really share the whole story and the whole why. So...

Carol Pehotsky (20:13):

That's fantastic.

(20:14):

So, I'm sure it isn't always roses and sunshine.

Shannon Pengel (20:17):

Mm-hmm.

Carol Pehotsky (20:17):

And you probably have voices at the table that have different opinions or different perspectives on the same issue.

Shannon Pengel (20:23):

Mm-hmm.

Carol Pehotsky (20:23):

How do you foster that, or how do you help your chairs foster that level of healthy debate to make sure that it's staying productive, but that all voices are being heard?

Shannon Pengel (20:34):

I think the power of the group kind of speaks to that.

Carol Pehotsky (20:34):

Okay.

Shannon Pengel (20:36):

So, you know, obviously when we started, and even today, uh, there are a lot of emotions that sometimes are fostered up when talking about these issues. They're very passionate about the care they provide. But I think the group kind of keeps one another in check.

Carol Pehotsky (20:52):

Okay.

Shannon Pengel (20:52):

They're very respectful of each other, and very respectful of me. I think that I take the time to spend with them, to hear them, and sometimes, like I shared with you in the beginning, the messages are sometimes difficult to hear, but I need to hear them. I, you know, typically thank everyone for their participation. But I think what I've seen is when people do get a little too animated, the group actually gets them kind of back into line, to say-

Carol Pehotsky (20:52):

Wow.

Shannon Pengel (21:20):

... you know, "That, that that really wasn't the way you should have presented yourself," and I have had a number of situations where the, the group has actually corrected things. So, I feel pretty good about that, that this group has been together long enough that they trust each other. They trust that what they say is really gonna spark change if it's possible.

Carol Pehotsky (21:39):

Well, that didn't happen just because it was clearly your, your coaching and your intention to really get that group to be so cohesive that they-

Shannon Pengel (21:45):

Mm-hmm.

Carol Pehotsky (21:46):

... govern themselves. That's amazing.

Shannon Pengel (21:47):

Yes. I wish my kids did that.

Carol Pehotsky (21:49):

(laughs)

Shannon Pengel (21:49):

(laughs)

Carol Pehotsky (21:51):

Well, we all learn skills that we can transfer elsewhere, right?

(21:54):

So, what are some of your favorite moments from, or things that came out of this group, or where you said, you know, I can really look back and say, we made a big difference, even if it was in a very specific situation or in something broader?

Shannon Pengel (22:07):

One of the greatest opportunities that I had with this group, I think, is dealing with a lot of the events that we've had to face in healthcare, particularly workplace violence events have been very difficult to manage.

Carol Pehotsky (22:23):

Yeah.

Shannon Pengel (22:23):

Nurses don't come into work expecting to be hurt by patients or families, and unfortunately, it happens. And, you know, it happens at the, the main campus, just like it happens at every other hospital around the country. We've also used these sessions to be very open and transparent about things that have happened on our campus. I'm not sure about how it works in other hospitals, but here, one incident happens, and then that story grows legs.

Carol Pehotsky (22:49):

Everybody knows.

Shannon Pengel (22:50):

(laughs)

Carol Pehotsky (22:51):

But they know a version that probably isn't true. (laughs)

Shannon Pengel (22:52):

Right, so we've been very intentional about talking about those events, talking about the facts. Talking about how it made us feel, especially, you know, I think me as the leader standing up and saying, "I feel vulnerable." You know, I, I have to go walk into that unit too. So, I- I think that's been almost like a healing process-

Carol Pehotsky (23:13):

Mm-hmm.

Shannon Pengel (23:13):

... for this group as well, that we can share some of these things, come up with ideas, come up with strategies.

(23:19):

One of the ideas that we're currently working on is a process in which we can send different caregivers to units to relieve a group of caregivers that maybe was involved in a workplace violence event-

Carol Pehotsky (23:31):

Oh, wow. Yeah.

Shannon Pengel (23:31):

... or a traumatic outcome.

Carol Pehotsky (23:33):

Mm-hmm.

Shannon Pengel (23:33):

And that's, again, an idea that came from the group. Like, "Sometimes, we just need five minutes, and we can't."

Carol Pehotsky (23:38):

Yeah.

Shannon Pengel (23:38):

"We, we don't have five minutes to step away."

(23:40):

So, I think that's just one example of something that's come from those discussions that, again, we didn't really talk about before, and we certainly didn't allow ourselves to be vulnerable as leaders to say, "This is something that keeps me up at night, too."

Carol Pehotsky (23:54):

And when it's fully implemented, we'll have you come back to talk all about it.

Shannon Pengel (23:56):

Yeah, exactly.

Carol Pehotsky (23:58):

(laughs)

(23:58):

So, I'm confident you've inspired so many listeners today, so perhaps for the nurse who says, "Boy, I wish I had an opportunity to talk to my CNO or my nursing director," and also for leaders who are listening, thinking, "This is fantastic, and I want to do the same thing." What advice would you give those groups in terms of how to create those listening sessions, and how to create the opportunity to really speak and be heard?

Shannon Pengel (24:24):

I think, as a leader, you have to be able to listen without that reaction that you innately want to give, right? We're, we're problem solvers as leaders.

Carol Pehotsky (24:24):

(laughs)

Shannon Pengel (24:34):

We want everybody to be happy at the end of the day, and that's just not the reality. The reality is: we're dealing with thousands of people, thousands of patients, and thousands of problems, and not one of us has the best solution. And so I think just that active listening, really being authentic. T- These... All of our caregivers, no matter what job you have in healthcare right now, it is hard, and acknowledging that, I think, sometimes is hard for us as leaders. Just to say, "You're right. This is really hard, and I don't have a great answer."

(25:06):

As a leader, that doesn't feel wonderful to say, right?

Carol Pehotsky (25:06):

Right, right. (laughs)

Shannon Pengel (25:09):

You're supposed to have all the answers, right? You're supposed to be the leader. But that's just not the reality that we have in healthcare today, and I think being vulnerable and saying, "You know, I, I just don't know."

Carol Pehotsky (25:18):

Right.

Shannon Pengel (25:18):

"I don't know. What ideas do you have?"

(25:20):

And I think i- if I had advice to give to our frontline nurses, or nurses entering the profession, is kind of what you said, Carol. You know, we want everyone to be bold and speak up, but make sure you have all the information and learn.

Carol Pehotsky (25:20):

Mm-hmm.

Shannon Pengel (25:34):

Learn the information, ask questions, seek out your leader. I always tell p-... You know, in the Roundtable and other places, "Text me, email me, whatever you want." We're all very available now as a result-

Carol Pehotsky (25:34):

Yeah. (laughs)

Shannon Pengel (25:46):

... of COVID as well.

(25:48):

But I think having those one-on-one conversations with people is something that is just so beneficial, and them getting to know me as well. I think one of the things I struggled with, I mentioned it in the beginning, coming into this role in the middle of COVID, trying to connect with people was really hard. I feel like I have a really strong connection, at least with this group of caregivers, and I feel like they're going out and hopefully talking nicely about me.

Carol Pehotsky (26:12):

They're ambassadors, yeah.

Shannon Pengel (26:13):

Exactly. So, I think that's been a great way to reach, you know, hundreds of people as opposed to just, you know, the four or five that you round on, on a nursing unit.

Carol Pehotsky (26:22):

Right.

(26:23):

It's been an amazing journey. So much great work has come out of it, and like I said, we'll have you back when you can share even more amazing things that have happened since. Thank you so much. You- You've shared so many great tips that anybody could take to create a, a better listening and shared governance culture.

(26:38):

Before we call it a day, I'd love it if you could share a little bit more about what an amazing human being you are, in addition to the amazing nurse leader, so it's a speed round time. Can you share with us, hmm, something about you that surprises people?

Shannon Pengel (26:52):

I think one of the things that is something that people don't recognize about me is I am an incredibly introverted person. When you take that scale of, like, you know, one to 10-

Carol Pehotsky (26:53):

(laughs)

Shannon Pengel (27:04):

... I'm like negative 10 on the introversion scale.

(27:07):

I would much prefer to sit at home by myself in the quiet than go out and talk to people. But obviously, in this role, I've had to adapt my leadership style greatly, and it is possible, I think. Hopefully, I'm living proof of that. But you do have to adapt, you do have to put yourself in uncomfortable situations. I can remember that my first town hall in Bunts Auditorium, which is, probably houses about 300 people at a time-

Carol Pehotsky (27:08):

Yep.

Shannon Pengel (27:34):

... would you say, Carol? I was terrified (laughs), but that's something you have to get through as a leader. And I'm able to do it now, but it is certainly not my favorite thing to do.

Carol Pehotsky (27:44):

I would offer that, as someone who's known you for years, you don't come off as an introvert. And what I would say to people who are thinking about their future, you don't have to be an extrovert to be in leadership.

Shannon Pengel (27:55):

Yes.

Carol Pehotsky (27:56):

You have to be willing to listen and speak up, and you're a shining example of how that works.

Shannon Pengel (28:01):

Mm-hmm.

Carol Pehotsky (28:01):

So, related to that, my next question for you is: what do you do to recharge (laughs), then, after a long day of extroverting (laughs)?

Shannon Pengel (28:07):

Yes. Yes, it is hard when you have to talk to people all day. But I think one of the things that I really took up during COVID was running. Running gives me great peace probably, because I can't think about anything other than, "When can I stop running?"

Carol Pehotsky (28:21):

(laughs)

Shannon Pengel (28:21):

But it is something that I do very routinely just to really shut off my mind, because otherwise, you're just thinking all day about, and all night, about the problems that you have to solve or the events that happened, and that's definitely something that clears my mind. And I can run in my neighborhood, but I choose to drive somewhere else (laughs). I live very close to the Cuyahoga Valley National Park, so I always drive down there and take nice, long runs down there. So, I'm very intentional about taking that time away, and I think if I could encourage every nurse, regardless of what you do, take that time for yourself. You need to develop that resiliency to be able to work in an environment like this.

Carol Pehotsky (29:00):

Beautifully said. Thank you so much for joining us today.

Shannon Pengel (29:02):

Thank you so much, Carol.

Carol Pehotsky (29:07):

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.

(29:41):

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.