Setting the Foundation for a Positive Patient Experience

Podcast Transcript

Carol Pehotsky (00:05):

We see and hear so much on social media and other channels these days about customer satisfaction, or the customer always being right. But when it comes to healthcare, that isn't always exactly true. Sometimes we need to challenge patients to adopt new or different behaviors for their own health. Today, I'm joined by Dr. Kelli Saucerman-Howard to talk about how nurses can impact and help shape patient experience.

(00:29):

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.

(00:50):

Welcome back, everyone. As I reflect on my own nursing career, and my journey as sometimes a patient, uh, so much has changed in respect to our topic today, which is patient experience. I can certainly speak to the fact that being on the other side of the operating room table from where I normally am, definitely informed me as a caregiver, really when I think about what my experience was, the fears that I had even though I knew exactly what was happening. I was one of the more informed patients, and yet being in that situation and being that vulnerable, and not being able to know exactly what's going to happen really changed me as a caregiver, and I hope makes me a better nurse. But we also don't want nurses to have to have (laughs) inpatient or surgical experiences to provide outstanding patient experience care.

(01:43):

So, with that, it's my great pleasure to welcome our guest today, Dr. Kelli Saucerman-Howard. Kelli is our Chief Nursing Officer at Cleveland Clinic Akron General. Welcome, Kelli. I'm so glad to have you today.

Dr. Kelli Saucerman-Howard (01:52):

Thank you. I'm so glad to be here.

Carol Pehotsky (01:54):

So, we'll let our audience in on a little secret. (laughs) So you and I were talking about, you know, you have a really rich nursing career, you've been to other places besides the Cleveland Clinic. I hope we can get into that, as well. And so, we were bantering about in terms of what topics we should talk about, and you went right to, "I'd love to talk about patient experience." Can you let our audience in on why you're so passionate about that?

Dr. Kelli Saucerman-Howard (02:15):

Absolutely. So, I think for me, similar to your story, when growing up, I always knew I wanted to be in healthcare.

Carol Pehotsky (02:24):

Mm-hmm.

Dr. Kelli Saucerman-Howard (02:24):

And I have a physician in the family-

Carol Pehotsky (02:24):

Mm-hmm.

Dr. Kelli Saucerman-Howard (02:28):

... so automatically, I went to I want to be a physician.

Carol Pehotsky (02:32):

Sure.

Dr. Kelli Saucerman-Howard (02:32):

And actually, specifically, I wanted to be a surgeon.

Carol Pehotsky (02:35):

Oh, how about that? (laughs)

Dr. Kelli Saucerman-Howard (02:36):

Exactly. So, I was set on that path-

Carol Pehotsky (02:37):

Mm-hmm.

Dr. Kelli Saucerman-Howard (02:40):

... and two really prominent life experiences changed my path.

Carol Pehotsky (02:45):

Okay.

Dr. Kelli Saucerman-Howard (02:45):

First, I was a young, healthy 16-year-old competitive-

Carol Pehotsky (02:50):

Mm-hmm.

Dr. Kelli Saucerman-Howard (02:50):

... athlete and had to have surgery.

Carol Pehotsky (02:51):

Oh.

Dr. Kelli Saucerman-Howard (02:52):

Overnight surgery, our great colleague who was a friend of the family, orthopedic surgeon-

Carol Pehotsky (02:59):

Okay.

Dr. Kelli Saucerman-Howard (03:00):

... did my surgery.

Carol Pehotsky (03:01):

Mm-hmm.

Dr. Kelli Saucerman-Howard (03:01):

It was great. And woke up and went to my room.

Carol Pehotsky (03:01):

Mm-hmm.

Dr. Kelli Saucerman-Howard (03:06):

And my parents stayed for a while, of course, and left.

Carol Pehotsky (03:09):

Sure.

Dr. Kelli Saucerman-Howard (03:09):

I didn't know what questions to ask-

Carol Pehotsky (03:09):

Oh, gosh. Yeah. Mm-hmm.

Dr. Kelli Saucerman-Howard (03:12):

... uh, what to think about. So had my foot in a cast elevated all night.

Carol Pehotsky (03:18):

Oh, jeez.

Dr. Kelli Saucerman-Howard (03:18):

And had to get up in the morning and wanted to brush my teeth-

Carol Pehotsky (03:21):

Yeah.

Dr. Kelli Saucerman-Howard (03:21):

... and all of that kind of thing. The nurse who came in probably contributed to my path.

Carol Pehotsky (03:27):

Okay.

Dr. Kelli Saucerman-Howard (03:28):

She was not near as understanding and communicative-

Carol Pehotsky (03:33):

Oh, dear. Okay.

Dr. Kelli Saucerman-Howard (03:34):

... as my night shift nurse.

Carol Pehotsky (03:35):

Yeah, yeah.

Dr. Kelli Saucerman-Howard (03:35):

So, any-

Carol Pehotsky (03:35):

Mm-hmm.

Dr. Kelli Saucerman-Howard (03:36):

... of us who know, your foot's in a cast and elevated-

Carol Pehotsky (03:38):

Yeah.

Dr. Kelli Saucerman-Howard (03:38):

... you go to turn-

Carol Pehotsky (03:39):

Hm.

Dr. Kelli Saucerman-Howard (03:40):

... and all of a sudden, it goes dependent-

Carol Pehotsky (03:42):

Boom, yeah.

Dr. Kelli Saucerman-Howard (03:42):

... and lots of pain with that.

Carol Pehotsky (03:42):

Mm-hmm.

Dr. Kelli Saucerman-Howard (03:44):

So that was my first experience thinking, you know, the tears-

Carol Pehotsky (03:48):

Hm.

Dr. Kelli Saucerman-Howard (03:48):

... calling my mom-

Carol Pehotsky (03:49):

Oh, for sure, yeah.

Dr. Kelli Saucerman-Howard (03:49):

... saying, "Okay, there had to (laughs)-

Carol Pehotsky (03:50):

Yeah.

Dr. Kelli Saucerman-Howard (03:52):

... have been a different way to do that."

Carol Pehotsky (03:54):

Mm-hmm.

Dr. Kelli Saucerman-Howard (03:54):

Fast-forward quite a few years, I was able to do a shadowing experience.

Carol Pehotsky (03:54):

Okay.

Dr. Kelli Saucerman-Howard (04:00):

And during that time, I was able to spend time with some ICU nurses.

Carol Pehotsky (04:01):

Ah (laughs).

Dr. Kelli Saucerman-Howard (04:07):

And they were amazing.

Carol Pehotsky (04:09):

Mm-hmm.

Dr. Kelli Saucerman-Howard (04:09):

How they communicated, the knowledge that they had-

Carol Pehotsky (04:13):

Mm-hmm.

Dr. Kelli Saucerman-Howard (04:14):

... it was so impressive to watch them with patients and families and obviously this-

Carol Pehotsky (04:22):

Yeah, gosh.

Dr. Kelli Saucerman-Howard (04:22):

... probably the worst time-

Carol Pehotsky (04:22):

Some of the most challenging times, yeah.

Dr. Kelli Saucerman-Howard (04:22):

... um, for patients and families. And the way they conducted themselves really was amazing.

Carol Pehotsky (04:28):

Mm-hmm.

Dr. Kelli Saucerman-Howard (04:29):

And I thought, "Wow, two very opposite experiences."

Carol Pehotsky (04:32):

Yeah.

Dr. Kelli Saucerman-Howard (04:32):

So that prompted me to go-

Carol Pehotsky (04:35):

Put a nursing... Yeah.

Dr. Kelli Saucerman-Howard (04:36):

... to nursing school. And that hooked me right then and there.

Carol Pehotsky (04:39):

(laughs)

Dr. Kelli Saucerman-Howard (04:39):

Throughout my nursing career, then, I was able to be influenced by some really great individuals in the patient experience realm.

Carol Pehotsky (04:49):

Okay.

Dr. Kelli Saucerman-Howard (04:49):

Quint Studer. I had a lot of great mentors-

Carol Pehotsky (04:49):

Okay.

Dr. Kelli Saucerman-Howard (04:53):

That were part of the patient experience. So that was really what sent me on that path.

Carol Pehotsky (05:00):

So, start from your own personal experience but grew from there.

Dr. Kelli Saucerman-Howard (05:03):

It did.

Carol Pehotsky (05:03):

Excellent. So, you know, so many things we could talk about. We'll, we'll start with this, you know, in most of our hos- uh, well, in all of our hospitals and in most healthcare organizations across the country, there's work in this area, right? Committees are termed patient experience, but we know that their patients are often impacted by experiences of their loved ones who visit. So, we're actually going to start with our visitors and families first.

Dr. Kelli Saucerman-Howard (05:26):

Mm-hmm.

Carol Pehotsky (05:27):

So, uh, because sometimes those are the folks who, who remember the most-

Dr. Kelli Saucerman-Howard (05:30):

Absolutely.

Carol Pehotsky (05:30):

... about the operating rooms, for example. So how can nurse's interactions with family members help build that rapport with the patient?

Dr. Kelli Saucerman-Howard (05:37):

I think first and foremost, it's just setting a foundation of trust and transparency.

Carol Pehotsky (05:45):

Okay.

Dr. Kelli Saucerman-Howard (05:45):

Communication feels like a buzzword, but it's-

Carol Pehotsky (05:46):

Mm-hmm.

Dr. Kelli Saucerman-Howard (05:48):

... something that is so important.

Carol Pehotsky (05:51):

Mm-hmm.

Dr. Kelli Saucerman-Howard (05:51):

Just think about how you want to be communicated to-

Carol Pehotsky (05:52):

Right.

Dr. Kelli Saucerman-Howard (05:55):

... no matter where you are, whether you're waiting for your loved one post-surgery, whether it's at a restaurant, or-

Carol Pehotsky (05:56):

Mm-hmm.

Dr. Kelli Saucerman-Howard (06:04):

... a business. How you are communicated to about what's happening-

Carol Pehotsky (06:11):

Sure.

Dr. Kelli Saucerman-Howard (06:12):

... really-

Carol Pehotsky (06:13):

Mm-hmm.

Dr. Kelli Saucerman-Howard (06:13):

... sets the foundation for your experience. And so, families have no idea what to expect.

Carol Pehotsky (06:21):

Right.

Dr. Kelli Saucerman-Howard (06:21):

And when their loved one is either in an ICU or-

Carol Pehotsky (06:21):

Mm-hmm.

Dr. Kelli Saucerman-Howard (06:26):

... back in an ER being triaged or in the OR, they can't readily see them all the time.

Carol Pehotsky (06:31):

Sure, so there's an anxiety that even just comes from that.

Dr. Kelli Saucerman-Howard (06:32):

Absolutely.

Carol Pehotsky (06:34):

Yeah.

Dr. Kelli Saucerman-Howard (06:34):

And so, what does your imagination do?

Carol Pehotsky (06:36):

(laughs) Oh, boy. Yeah.

Dr. Kelli Saucerman-Howard (06:37):

So, I think that's the biggest thing is really build that rapport with that family-

Carol Pehotsky (06:42):

Mm-hmm.

Dr. Kelli Saucerman-Howard (06:42):

... by going in and saying, "My name is Kelli. I'll be your nurse.

Carol Pehotsky (06:47):

Hm.

Dr. Kelli Saucerman-Howard (06:48):

And I will take care of your loved one."

Carol Pehotsky (06:52):

The whole unit.

Dr. Kelli Saucerman-Howard (06:53):

So, this is something that I think can really put families at ease.

Carol Pehotsky (06:53):

Mm-hmm.

Dr. Kelli Saucerman-Howard (06:56):

Ask me questions. If I don't know the answer, I'll get you the answer.

Carol Pehotsky (07:01):

Sure, yup.

Dr. Kelli Saucerman-Howard (07:02):

Just really communicating and putting them at ease from the get-go.

Carol Pehotsky (07:06):

And really thinking about the fact that, yeah, it's, it's the family unit, whether they're family or not-

Dr. Kelli Saucerman-Howard (07:06):

Mm-hmm.

Carol Pehotsky (07:11):

... it's that unit of people that are surrounding the-

Dr. Kelli Saucerman-Howard (07:11):

Right.

Carol Pehotsky (07:12):

... patient that really needs that care, too.

Dr. Kelli Saucerman-Howard (07:14):

Right. And that, we all know the healing aspects-

Carol Pehotsky (07:18):

Mm-hmm.

Dr. Kelli Saucerman-Howard (07:18):

... of having family and loved ones around.

Carol Pehotsky (07:20):

Mm-hmm.

Dr. Kelli Saucerman-Howard (07:20):

So, we want them to be there, and we want them to be as involved in the care as the patient and family want to be. But that's our foundation.

Carol Pehotsky (07:30):

Sure. And when you think about just four years ago, there, you know, in the middle of a pandemic, we didn't-

Dr. Kelli Saucerman-Howard (07:31):

Mm-hmm.

Carol Pehotsky (07:36):

... have family at the bedside. And I remember talking to newer nurses that were a little nervous about, uh, you know, not having interacted with families very much during that phase, and what it would look like to welcome families again. What did you see from your vantage point in terms of how that impacted nursing care going from having visitors and family to not, and then back to-

Dr. Kelli Saucerman-Howard (07:58):

Sure.

Carol Pehotsky (07:58):

... what the new normal was?

Dr. Kelli Saucerman-Howard (07:59):

I think that is the time we realized the true impact of-

Carol Pehotsky (08:05):

Hm.

Dr. Kelli Saucerman-Howard (08:06):

... family-

Carol Pehotsky (08:06):

Sure.

Dr. Kelli Saucerman-Howard (08:06):

... and friends on patients and healing.

Carol Pehotsky (08:07):

Yeah.

Dr. Kelli Saucerman-Howard (08:10):

So, look at how creative we became.

Carol Pehotsky (08:13):

Hm, yup.

Dr. Kelli Saucerman-Howard (08:13):

I mean, it was the most amazing thing to watch people use technology to help communicate and really get our families connected.

Carol Pehotsky (08:24):

Mm-hmm.

Dr. Kelli Saucerman-Howard (08:25):

We used cell phones and-

Carol Pehotsky (08:25):

Right (laughs).

Dr. Kelli Saucerman-Howard (08:25):

.. iPads-

Carol Pehotsky (08:25):

Yeah.

Dr. Kelli Saucerman-Howard (08:29):

... and, and everything-

Carol Pehotsky (08:29):

Anything we get our hands on, yeah.

Dr. Kelli Saucerman-Howard (08:30):

... anything we could-

Carol Pehotsky (08:30):

Mm-hmm.

Dr. Kelli Saucerman-Howard (08:32):

... to help translate. Just hearing someone's voice, can you imagine how isolating that must have felt-

Carol Pehotsky (08:38):

Right.

Dr. Kelli Saucerman-Howard (08:39):

... to be a patient and not have the ability to reach out and hold your loved one's hand?

Carol Pehotsky (08:46):

I can't, yeah.

Dr. Kelli Saucerman-Howard (08:46):

So, I think I'm most proud, though it was our most difficult time during the pandemic-

Carol Pehotsky (08:53):

Mm-hmm.

Dr. Kelli Saucerman-Howard (08:53):

... I'm really most proud of how we really became creative-

Carol Pehotsky (08:58):

Mm-hmm.

Dr. Kelli Saucerman-Howard (08:58):

... to continue the process of healing with patients and families.

Carol Pehotsky (09:02):

Sure. And just because a family member is on the other side of a tablet doesn't mean we're still caring for them-

Dr. Kelli Saucerman-Howard (09:06):

Right.

Carol Pehotsky (09:07):

... in a different way.

Dr. Kelli Saucerman-Howard (09:07):

Right.

Carol Pehotsky (09:08):

Yeah. So, in other episodes, we've talked with other guests about how challenging it can be when patients or visitors are finding themself in, in a state of escalated emotion, right, for a variety of reasons. So, in light of some, uh, sometimes there are those situations. What can I, as a nurse, do to, to really balance that? You know, I'm trying to deescalate this situation, and, and to this person, but I also want to make sure that they have, that they feel heard and cared for and, and s- and have a good patient experience, whatever that means to them. How do I balance that?

Dr. Kelli Saucerman-Howard (09:41):

So, g- great question. And I think you really pulled back a layer of this onion. It's complex.

Carol Pehotsky (09:49):

Mm-hmm.

Dr. Kelli Saucerman-Howard (09:49):

So, what is going on with that patient or family member? It may not be what they're showing on the surface.

Carol Pehotsky (09:57):

Oh, sure. Yeah.

Dr. Kelli Saucerman-Howard (09:57):

So, are they angry about a diagnosis?

Carol Pehotsky (10:02):

Mm-hmm.

Dr. Kelli Saucerman-Howard (10:02):

Are... Do they feel vulnerable and afraid because they still don't really know what's going on? So how can we really have that conversation and that transparency?

Carol Pehotsky (10:03):

Mm-hmm.

Dr. Kelli Saucerman-Howard (10:15):

And it goes back to really authentically listening-

Carol Pehotsky (10:20):

Hm, sure.

Dr. Kelli Saucerman-Howard (10:20):

... and hearing what someone's saying-

Carol Pehotsky (10:23):

What's driving this, yeah.

Dr. Kelli Saucerman-Howard (10:24):

... because if you really listen, you can start to peel back that layer and go, "Oh, this is what they're saying. But I think-

Carol Pehotsky (10:25):

Mm-hmm.

Dr. Kelli Saucerman-Howard (10:32):

... there's a lot more there." And I think just, uh, really meeting someone where they are.

Carol Pehotsky (10:32):

Mm-hmm.

Dr. Kelli Saucerman-Howard (10:39):

They might have different viewpoints, or they might have different life experiences, but how do you really empathize with them-

Carol Pehotsky (10:39):

Mm-hmm.

Dr. Kelli Saucerman-Howard (10:48):

... for where they are in this situation? Again, and honestly, we do have to set some boundaries.

Carol Pehotsky (10:55):

Right.

Dr. Kelli Saucerman-Howard (10:55):

Yelling or-

Carol Pehotsky (10:56):

(laughs) Yeah.

Dr. Kelli Saucerman-Howard (10:57):

... getting verbally escalated or getting in someone's personal space is not okay.

Carol Pehotsky (10:57):

Hm.

Dr. Kelli Saucerman-Howard (11:04):

But saying, "I appreciate, and I hear your-

Carol Pehotsky (11:08):

Mm-hmm, mm-hmm.

Dr. Kelli Saucerman-Howard (11:08):

... passion, your concern," helping them to identify some of those words and feelings. And then always using other avenues. We have-

Carol Pehotsky (11:09):

Right (laughs).

Dr. Kelli Saucerman-Howard (11:19):

... great avenues with our pastoral care-

Carol Pehotsky (11:19):

Mm-hmm.

Dr. Kelli Saucerman-Howard (11:22):

... and, um-

Carol Pehotsky (11:23):

Ombudsman or other people to come help, yeah.

Dr. Kelli Saucerman-Howard (11:24):

... Ombudsman, anyone who can come-

Carol Pehotsky (11:24):

Mm-hmm.

Dr. Kelli Saucerman-Howard (11:27):

... in and also help to deescalate a situation.

Carol Pehotsky (11:30):

Sure. And probably, those of us who've been in the business a while probably also plenty will say, I know I do, examples of whether... Sometimes it was the, the loved one who was escalating, and the patient afterwards is apologizing for them, or vice versa, the, the patient is, is, you know, having some challenges, and the family are pulling you aside and saying, "This isn't normally how they are." So really-

Dr. Kelli Saucerman-Howard (11:31):

Right.

Carol Pehotsky (11:49):

... thinking about you never want them to feel like they have to apologize, but, you know, w- what is the source of that, and then how do you do some healing-

Dr. Kelli Saucerman-Howard (11:49):

Mm-hmm.

Carol Pehotsky (11:58):

... with either party to make sure you can forge forward together.

Dr. Kelli Saucerman-Howard (12:01):

Right.

Carol Pehotsky (12:01):

Yeah. So, we have all sorts of nurses in our listening audience. We have some listeners who are still in nursing school and some who are looking forward to a little bit of retirement. Let's, let's focus for a moment on our listeners who are still in school or, you know, recording in the month of May. There's hopefully a lot of listeners who have very excitedly finished their school and are getting ready to sit for their NCLEX. So thinking about when I was in that situation many a moon ago (laughs), I remember worrying about, you know, how am I going to transition into being a nurse on my own post-orientation residency, et cetera, to be able to do all the assessments and pick up on the signs and symptoms, and do all of these things, and then also try to deliver a good patient experience? I remember being really worried about that. So, what sort of advice would you have for a listener who might be in that same situation, who's trying to figure out that being a nurse isn't just passing medications, of course, but how do I balance all of that in the, in the bigger picture?

Dr. Kelli Saucerman-Howard (12:59):

Sure. I think one of the things, the best piece of advice I can give to our newer colleagues-

Carol Pehotsky (13:06):

Mm-hmm.

Dr. Kelli Saucerman-Howard (13:06):

... is not to sound cliché, but-

Carol Pehotsky (13:07):

(laughs)

Dr. Kelli Saucerman-Howard (13:10):

... hourly rounding and bedside shift report-

Carol Pehotsky (13:12):

Hm.

Dr. Kelli Saucerman-Howard (13:12):

... and let me tell you the why-

Carol Pehotsky (13:14):

Sure.

Dr. Kelli Saucerman-Howard (13:14):

... behind that.

Carol Pehotsky (13:14):

Okay.

Dr. Kelli Saucerman-Howard (13:15):

So as a newer nurse, I can remember, you know, a lot of times the person you're receiving a hand-off from may have been someone who's been in nursing for a while.

Carol Pehotsky (13:27):

Sure.

Dr. Kelli Saucerman-Howard (13:27):

And if that's the case, now you're doing an exam and a quick look at IVs and tubes and wounds, et cetera, with someone else who has-

Carol Pehotsky (13:39):

Hm.

Dr. Kelli Saucerman-Howard (13:39):

... maybe had some experience.

Carol Pehotsky (13:41):

Some experience catching those, yeah.

Dr. Kelli Saucerman-Howard (13:42):

Even if they're another new nurse like yourself, you can still have that dialogue of, "Did it look like this-

Carol Pehotsky (13:48):

Sure.

Dr. Kelli Saucerman-Howard (13:48):

... earlier-"

Carol Pehotsky (13:49):

Mm-hmm.

Dr. Kelli Saucerman-Howard (13:49):

... that kind of thing. So, there are so much benefit to bedside shift-

Carol Pehotsky (13:50):

Mm-hmm.

Dr. Kelli Saucerman-Howard (13:54):

... report just from that nurse-to-nurse interaction. And now, let's bring the picture of the patient in there-

Carol Pehotsky (14:01):

Right, who's right there, too.

Dr. Kelli Saucerman-Howard (14:02):

... who's right there.

Carol Pehotsky (14:03):

(laughs) Yup, yup.

Dr. Kelli Saucerman-Howard (14:03):

So now the patient can ask questions.

Carol Pehotsky (14:03):

Mm-hmm.

Dr. Kelli Saucerman-Howard (14:06):

And now, they can get some of their answers-

Carol Pehotsky (14:10):

Mm-hmm.

Dr. Kelli Saucerman-Howard (14:10):

... they can talk about the plan of care right there. And that makes that really important connection-

Carol Pehotsky (14:17):

Mm-hmm.

Dr. Kelli Saucerman-Howard (14:17):

... with the patient and/or perhaps there's family there, as well.

Carol Pehotsky (14:21):

Sure, yeah.

Dr. Kelli Saucerman-Howard (14:21):

So, and then hourly rounding.

Carol Pehotsky (14:24):

Okay.

Dr. Kelli Saucerman-Howard (14:24):

Hourly rounding is one of those things that as you get into the routine to do that-

Carol Pehotsky (14:24):

Mm-hmm.

Dr. Kelli Saucerman-Howard (14:29):

... it's more than just going in by a patient's room and saying, "Hey, are you doing, okay?"

Carol Pehotsky (14:29):

Mm-hmm.

Dr. Kelli Saucerman-Howard (14:36):

It's being able to go in, and a lot of nurses feel like it's going to take them longer to do that.

Carol Pehotsky (14:43):

Sure.

Dr. Kelli Saucerman-Howard (14:43):

But in reality-

Carol Pehotsky (14:44):

Lot, lot to balance in a busy shift, yeah.

Dr. Kelli Saucerman-Howard (14:46):

... it, it really, uh... The research really shows it-

Carol Pehotsky (14:50):

Mm-hmm.

Dr. Kelli Saucerman-Howard (14:50):

... reduced the number of call lights because you're in there, and you're saying, "What proactively-

Carol Pehotsky (14:55):

Yes.

Dr. Kelli Saucerman-Howard (14:55):

... can I do for you?"

Carol Pehotsky (14:55):

Yes.

Dr. Kelli Saucerman-Howard (14:57):

And "Can we go ahead and use the restroom." Those kinds of things.

Carol Pehotsky (14:57):

Mm-hmm.

Dr. Kelli Saucerman-Howard (15:01):

But then you get to communicate with your patient, and you get to hear more about what's happening with them-

Carol Pehotsky (15:07):

Right.

Dr. Kelli Saucerman-Howard (15:07):

... create a little bit more of a bond, and then do some education at the same time. So, I think incorporate those skills-

Carol Pehotsky (15:15):

Hm, mm-hmm.

Dr. Kelli Saucerman-Howard (15:16):

... early on. The sooner you c- incorporate them into your practice, the easier that is-

Carol Pehotsky (15:21):

Mm-hmm.

Dr. Kelli Saucerman-Howard (15:22):

... as you transition to independent practice.

Carol Pehotsky (15:26):

Yeah. Well, and it's all about organizing, too. You know, I'm... It's time to do hourly rounds, and Ms. Pehotsky needs this medication. And then it becomes... I'm, I'm getting all these things accomplished together-

Dr. Kelli Saucerman-Howard (15:35):

Mm-hmm.

Carol Pehotsky (15:36):

... so, I have a little more ease getting to know Ms. Pehotsky, perhaps.

Dr. Kelli Saucerman-Howard (15:38):

Exactly.

Carol Pehotsky (15:39):

Yeah. You also, when you talked about the bedside report, I couldn't help but think about, you know, they talk about managing up, right? So being able in the hand-off to say, "Ms. Pehotsky, it was, has been so great taking care of you. I'm so excited to introduce you to Kelli. She's going to take great care of you, as well."

Dr. Kelli Saucerman-Howard (15:39):

Right?

Carol Pehotsky (15:52):

And that way, sets up that runway for the next nurse to really thrive.

Dr. Kelli Saucerman-Howard (15:57):

Mm-hmm. Yes. And gives them a chance, then, to really meet and-

Carol Pehotsky (15:57):

Yes.

Dr. Kelli Saucerman-Howard (16:01):

... and have that connection from the get-go.

Carol Pehotsky (16:04):

Yeah, absolutely. So, we've all had our challenging shifts. (laughs) And, and so, you know, whether you work eight, 10, 12, et cetera, within that time span, there can be a lot of challenges that present themselves, especially to those of us who are newer in our careers. H-... What's the best way to maintain empathy on an especially challenging shift, and how to prioritize compassion as part of that?

Dr. Kelli Saucerman-Howard (16:28):

Sure. You know, it's tough, and there are a lot of really busy shifts and challenging patients from complex etiology-

Carol Pehotsky (16:40):

Mm-hmm.

Dr. Kelli Saucerman-Howard (16:40):

... to interpersonal and dealing with the things they have to deal with when they're in the hospital. And, and I think it's really important that nurses take care of themselves-

Carol Pehotsky (16:51):

Mm-hmm.

Dr. Kelli Saucerman-Howard (16:51):

... because you have to take care of yourself-

Carol Pehotsky (16:53):

Right (laughs).

Dr. Kelli Saucerman-Howard (16:53):

... in order to be able to help take care of others. And I think we can do that a couple of ways, ensuring that you're taking your breaks and taking-

Carol Pehotsky (16:53):

Sure, yeah.

Dr. Kelli Saucerman-Howard (17:04):

... some time away.

Carol Pehotsky (17:05):

Mm-hmm.

Dr. Kelli Saucerman-Howard (17:05):

And I know it's hard to balance that because we think we're too busy to do that, but it's really important because-

Carol Pehotsky (17:05):

Yes.

Dr. Kelli Saucerman-Howard (17:12):

... that's time that you can recenter and refocus-

Carol Pehotsky (17:16):

Yeah, refresh your brain. Yeah, mm-hmm.

Dr. Kelli Saucerman-Howard (17:16):

... however you do that, whatever works for you individually. And then I know there's a lot of lavender rooms, or relaxation rooms-

Carol Pehotsky (17:16):

Mm-hmm.

Dr. Kelli Saucerman-Howard (17:24):

... that are really great ways to decompress. You might be able to use that prior to your shift or immediately after-

Carol Pehotsky (17:33):

Sure, you get in a really good space-

Dr. Kelli Saucerman-Howard (17:34):

... your shift, that-

Carol Pehotsky (17:34):

... walking in, yeah. Mm-hmm.

Dr. Kelli Saucerman-Howard (17:36):

Right. Just to center yourself because it is.

Carol Pehotsky (17:36):

Yeah.

Dr. Kelli Saucerman-Howard (17:40):

And it is tough to have compassion, but really taking care of that or asking a colleague, "Hey, I've got-

Carol Pehotsky (17:47):

Right.

Dr. Kelli Saucerman-Howard (17:47):

... a really challenging patient. Is there any way I can take a few minutes?

Carol Pehotsky (17:52):

Mm-hmm.

Dr. Kelli Saucerman-Howard (17:52):

Can you answer a call light for a while?"

Carol Pehotsky (17:55):

Sure.

Dr. Kelli Saucerman-Howard (17:55):

Um, just to really tap into someone else and maybe get ideas from them on how-

Carol Pehotsky (18:01):

Yes.

Dr. Kelli Saucerman-Howard (18:01):

... you can handle things, as well.

Carol Pehotsky (18:03):

Yes. And sometimes, that's all it takes is, "You know, I'm, I'm, I'm worried about this patient, I'm worried about this situation." Y- you know, we fool ourselves into thinking we need to do all this by ourselves. But if you just bring another team member, it's a fresh set of eyes. Sometimes, it also helps the patient realize, like, "Oh, they're both seeing something maybe I'm not," and, and it changes sometimes the tone of the interaction.

Dr. Kelli Saucerman-Howard (18:23):

Right.

Carol Pehotsky (18:23):

You know, we, we think we have to do it all, but we don't. (laughs) And so-

Dr. Kelli Saucerman-Howard (18:26):

That's why it's a team.

Carol Pehotsky (18:27):

That's right. So, we've talked about being newer as a nurse. Let, let's think of our more tenured nurse leaders. One challenging shift, it's easy to bounce back from. Unfortunately, sometimes with the tincture of time, uh, we would never want to come off as being jaded, but sometime (laughs) it, it can be easy to fall into that trap. And, and even if we feel that way, it's even worse if our patients pick up on it.

Dr. Kelli Saucerman-Howard (18:49):

Right.

Carol Pehotsky (18:49):

Nobody wants to be taken care of by a nurse where you say, "Well, yeah. Carol's a, a great clinical nurse, but..." Like, no. (laughs) Nobody wants that. So how can we stay energized and recharged for our patients to make sure that our s- experience is informing our practice and not making us jaded.

Dr. Kelli Saucerman-Howard (19:03):

Sure. I think really reconnecting with your why.

Carol Pehotsky (19:07):

Hm, mm-hmm.

Dr. Kelli Saucerman-Howard (19:07):

Um, why did you become a nurse? What's important to you? If you've had experiences with the healthcare system...

Carol Pehotsky (19:16):

Sure.

Dr. Kelli Saucerman-Howard (19:16):

All of us have either had experience or we've had loved ones-

Carol Pehotsky (19:16):

Yeah.

Dr. Kelli Saucerman-Howard (19:20):

... who have had experiences with it. What did you see that makes you the most proud to be a nurse?

Carol Pehotsky (19:20):

Yeah.

Dr. Kelli Saucerman-Howard (19:27):

And reconnect with that-

Carol Pehotsky (19:28):

Mm-hmm.

Dr. Kelli Saucerman-Howard (19:30):

... and then take those opportunities with those patients that really fill your bucket-

Carol Pehotsky (19:36):

Hm, sure.

Dr. Kelli Saucerman-Howard (19:37):

... that you really connect with, and use those thoughts and that experience to really find that joy and that-

Carol Pehotsky (19:38):

Yeah.

Dr. Kelli Saucerman-Howard (19:45):

... joy in what you're doing, because it is tough work, but it is actually the most rewarding work we have.

Carol Pehotsky (19:53):

Oh, sure.

Dr. Kelli Saucerman-Howard (19:53):

So, if you reconnect with your why-

Carol Pehotsky (19:54):

Mm-hmm.

Dr. Kelli Saucerman-Howard (19:56):

... and really come back to that purpose, then it helps to recenter, as well.

Carol Pehotsky (20:01):

So, it really goes back to your comment about taking care of ourselves as nurses. It isn't just after a challenging shift. It's, it's with the passage of time, making sure we're still in touch-

Dr. Kelli Saucerman-Howard (20:09):

Yes.

Carol Pehotsky (20:09):

... with ourselves.

Dr. Kelli Saucerman-Howard (20:10):

Yes.

Carol Pehotsky (20:10):

I like it. So patient experience is not exactly the same as customer satisfaction (laughs). Sometimes we do have to provide patients with difficult news, or maybe we're, we're trying to push them to challenge them to adopt different behaviors so the, the whole, the customer is always right doesn't necessarily apply in these situations. So how can we balance all of this, especially if maybe the patients are coming through sort of with that feeling that says, "Y- I, I don't want to accept the things you're trying to challenge me on"?

Dr. Kelli Saucerman-Howard (20:39):

When I talk to our new nurses, it's unfortunately, we have to get past the I can make people happy-

Carol Pehotsky (20:39):

(laughs) Yeah.

Dr. Kelli Saucerman-Howard (20:48):

... or they can be satisfied-

Carol Pehotsky (20:50):

Hm, mm-hmm.

Dr. Kelli Saucerman-Howard (20:50):

... because again, we don't know what makes others happy or satisfied.

Carol Pehotsky (20:56):

Sure.

Dr. Kelli Saucerman-Howard (20:56):

We don't even always know what contributes to their experience. So, we have to ask, and we have-

Carol Pehotsky (20:56):

Yeah.

Dr. Kelli Saucerman-Howard (21:04):

... to say, "I know you didn't expect to be here.

Carol Pehotsky (21:08):

Right, right.

Dr. Kelli Saucerman-Howard (21:09):

This isn't... When you woke up this morning-

Carol Pehotsky (21:09):

Mm-hmm.

Dr. Kelli Saucerman-Howard (21:11):

... you didn't expect to be in our emergency room and now admitted to our hospital, but what can we do to help-

Carol Pehotsky (21:11):

Hm.

Dr. Kelli Saucerman-Howard (21:19):

... support you while you're here in partnership because this is-

Carol Pehotsky (21:23):

Sure.

Dr. Kelli Saucerman-Howard (21:24):

... a way we have to-

Carol Pehotsky (21:24):

Yes.

Dr. Kelli Saucerman-Howard (21:25):

... communicate?" And sometimes, that's allowing somebody to see them or stay a little longer-

Carol Pehotsky (21:31):

Oh, yeah.

Dr. Kelli Saucerman-Howard (21:32):

... or maybe, uh, think about our patients on post-partum. One of the biggest things-

Carol Pehotsky (21:32):

Hm.

Dr. Kelli Saucerman-Howard (21:36):

... they ask for was bagels.

Carol Pehotsky (21:39):

(laughs)

Dr. Kelli Saucerman-Howard (21:39):

Uh, right?

Carol Pehotsky (21:40):

Yeah.

Dr. Kelli Saucerman-Howard (21:41):

And, uh, and you think, "Okay," but that contributes to that experience. They haven't eaten.

Carol Pehotsky (21:47):

Right (laughs).

Dr. Kelli Saucerman-Howard (21:47):

Y- you know, those kinds of things. So-

Carol Pehotsky (21:49):

They've lost an awful lot of control.

Dr. Kelli Saucerman-Howard (21:50):

Right.

Carol Pehotsky (21:50):

One little bagel brings you back some control, yeah.

Dr. Kelli Saucerman-Howard (21:53):

And, and you think for that moment-

Carol Pehotsky (21:56):

Mm-hmm.

Dr. Kelli Saucerman-Howard (21:56):

... "We made their experience better by something pretty simple that we-

Carol Pehotsky (21:56):

Right.

Dr. Kelli Saucerman-Howard (22:01):

... could do." It's not always that simple.

Carol Pehotsky (22:03):

Right.

Dr. Kelli Saucerman-Howard (22:04):

... because unfortunately, we do have to provide some news that's not always-

Carol Pehotsky (22:09):

Mm-hmm.

Dr. Kelli Saucerman-Howard (22:09):

... great for patients or families to hear. But within that, can we allow them privacy? Can we get-

Carol Pehotsky (22:16):

Hm, sure.

Dr. Kelli Saucerman-Howard (22:16):

... um, our chaplain to visit with them? Can we help with social work or care management-

Carol Pehotsky (22:22):

Right.

Dr. Kelli Saucerman-Howard (22:22):

... to help ease a burden when they leave?

Carol Pehotsky (22:25):

Mm-hmm.

Dr. Kelli Saucerman-Howard (22:25):

So really, that's what we're trying to do is that overall experience versus satisfaction and happiness-

Carol Pehotsky (22:32):

Sure.

Dr. Kelli Saucerman-Howard (22:32):

... because those are things that are very individual.

Carol Pehotsky (22:36):

Yes. Well, and you think about it. It goes back to your comments about how important the family is. If our patient needs to consider quitting smoking or adapting a new medication, really bringing that family, and treating the unit, and educating the family unit [inaudible 00:22:49], make sure people understand the why and hope they can help support that person through a very challenging change.

Dr. Kelli Saucerman-Howard (22:54):

Yes.

Carol Pehotsky (22:55):

Wow. Well, I can talk to you for hours about this (laughs). We probably need to start wrapping it up, though. So, one more question related to patient experience. You obviously are an amazing leader, and so from a leadership perspective, how can leaders best support nurses in providing an excellent patient experience?

Dr. Kelli Saucerman-Howard (23:12):

Rounding.

Carol Pehotsky (23:13):

Okay.

Dr. Kelli Saucerman-Howard (23:13):

100% being out on the nursing units, rounding with your teams, hearing what's working, how you can support them-

Carol Pehotsky (23:22):

Hm, mm-hmm.

Dr. Kelli Saucerman-Howard (23:22):

... partnering with our EVS colleagues and food and nutrition-

Carol Pehotsky (23:26):

Mm-hmm.

Dr. Kelli Saucerman-Howard (23:26):

... and our essential services to really help support-

Carol Pehotsky (23:31):

Sure.

Dr. Kelli Saucerman-Howard (23:31):

... because every patient is our patient, and that's the whole team.

Carol Pehotsky (23:36):

Hm.

Dr. Kelli Saucerman-Howard (23:36):

It's not-

Carol Pehotsky (23:37):

Just that nurse or-

Dr. Kelli Saucerman-Howard (23:37):

... just nurse-

Carol Pehotsky (23:40):

... just that aid. It's, it's all of us.

Dr. Kelli Saucerman-Howard (23:40):

Um, right.

Carol Pehotsky (23:40):

Yeah, absolutely.

Dr. Kelli Saucerman-Howard (23:40):

It's all of us-

Carol Pehotsky (23:40):

Mm-hmm.

Dr. Kelli Saucerman-Howard (23:41):

... as a team.

Carol Pehotsky (23:42):

Mm-hmm. Excellent. All right. Well, folks, you heard some really thoughtful words of wisdom. Now, we're going to flip to our speed round. So, this is where our audience gets to learn a little more about you as the amazing human being you are. So, a couple of questions for you. We'll start with what's the best advice you've ever received?

Dr. Kelli Saucerman-Howard (24:00):

From a professional perspective, I would say I've always been told to have several mentors-

Carol Pehotsky (24:08):

Okay.

Dr. Kelli Saucerman-Howard (24:08):

... and mentors that provide different things-

Carol Pehotsky (24:11):

Sure, yeah.

Dr. Kelli Saucerman-Howard (24:11):

... to you, different experiences, they're not all nurses-

Carol Pehotsky (24:15):

(laughs) Yeah.

Dr. Kelli Saucerman-Howard (24:15):

... they're not all in hospitals-

Carol Pehotsky (24:17):

Mm-hmm.

Dr. Kelli Saucerman-Howard (24:18):

... they're in a variety of fields. So, I would say that's my biggest one. And I think personally-

Carol Pehotsky (24:23):

Mm-hmm.

Dr. Kelli Saucerman-Howard (24:23):

... it's really to live every day to its fullest-

Carol Pehotsky (24:27):

Hm.

Dr. Kelli Saucerman-Howard (24:27):

... because you never know what tomorrow brings.

Carol Pehotsky (24:28):

Oh, that's true.

Dr. Kelli Saucerman-Howard (24:28):

Not to sound cliché, but-

Carol Pehotsky (24:28):

No.

Dr. Kelli Saucerman-Howard (24:30):

... just live it and make yourself happy. So.

Carol Pehotsky (24:35):

Love it. And, uh, since we are in the season of newly graduated nurses, what's something you wish you knew as a brand-new nurse?

Dr. Kelli Saucerman-Howard (24:42):

I think if I could impart any wisdom would be absolutely get involved in-

Carol Pehotsky (24:48):

Hm.

Dr. Kelli Saucerman-Howard (24:49):

... professional organizations early on. It is so vital for your professional networking-

Carol Pehotsky (24:55):

Mm-hmm.

Dr. Kelli Saucerman-Howard (24:55):

... but it gives you a lot of educational opportunities, and you can really get involved to move the profession of nursing forward.

Carol Pehotsky (25:04):

I love it. Thank you. Thank you so much for joining us today.

Dr. Kelli Saucerman-Howard (25:07):

It was a pleasure. Thank you for having me.

Carol Pehotsky (25:13):

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.

(25:47):

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.