Speaking Up in the Perioperative Setting

Podcast Transcript

Carol Pehotsky (00:05):

I was taken aback this summer when, in rounding with some nurses and talking about the oh, so important topic of speaking up, one of the nurses said to me, "Whether I speak up a second time depends on how I was treated the first time." Um, it's pretty sobering, right? When we think about how much our patients count on us to speak up, we also need to make sure that we're doing it in such a way that we're heard and that we'll do it again because our patients are counting on it. I joined today by Dena Salamon to talk more about speaking up.

Carol Pehotsky (00:39):

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. If you've been listening since the beginning, you know that we had Craig Tobias on early in our journey here to talk about speaking up. And a great conversation that took every form from you know, questioning an order, checking in with a team or on plan of care, all the way into much more specific patient type settings. 

Carol Pehotsky (01:20):

But it's one of those topics we as nurses have to keep talking about and it can take so many shapes and forms. You know, here we are in 2024 and across the country nurses were once again for the 21st year in a row rated by the public as the most ethical profession. So, our patients are counting on us to speak up. They give us this gift of time and they expect that we are going to be ethical, we are going to stop the line and we're going to have their best interests at heart. As many of you know, if you've been listening long, you know that my specialty is perioperative nursing. 

Carol Pehotsky (01:51):

And so, certainly speaking up comes from a very personal place, somebody who has received surgical care as well as somebody who has participated in that care. And in a setting where patients cannot speak up for themselves many times. So, it's so important that we do this in all sorts of setting and that's why it's near and dear to my heart as well. And today I have a guest on with us who it's also very near and dear to her heart. So, my pleasure to welcome Dena Salamon here with me today. She is the perioperative nursing director for the Cleveland Clinic main campus, main pavilion operating rooms. Dena, welcome. So glad to have you here today. 

Dena Salamon (02:22):

Thank you, Carol. My pleasure. 

Carol Pehotsky (02:24):

Yeah. So, you have a really fascinating career and how the journey that brought you here today, and probably lots of speaking up examples along that way. So, I'm, I'm hoping you'll start us off by giving us a little bit about your career so far. 

Dena Salamon (02:36):

Sure. I started out as a surgical technologist and I started here at Cleveland Clinic. I am not from Cleveland-

Carol Pehotsky (02:44):

That's right.

Dena Salamon (02:45):

I'm from the Youngstown area. 

Carol Pehotsky (02:46):

Yeah. 

Dena Salamon (02:46):

So, it was a leap for me to come here. I was very young, I was 20-

Carol Pehotsky (02:50):

She was only 10. 

Dena Salamon (02:51):

I was 20 years old. So, it was a leap for me to come here. And I applied at Cleveland Clinic in general surgery. 

Carol Pehotsky (02:52):

All right. 

Dena Salamon (02:58):

We do a lot of our training on general surgery. And when they called me back, they wanted me to really observe in cardiac surgery. 

Carol Pehotsky (03:05):

Oh, all right. 

Dena Salamon (03:05):

I said, "Um, okay, but I've never really never seen a heart." We never had that experience when I did my surgical tech training.

Carol Pehotsky (03:05):

Sure.

Dena Salamon (03:12):

I was open to it because I really wanted to come to Cleveland Clinic. So, I did and I observed and I interviewed, and I got the job. So, I was all gung-ho to get in there and look at, you know, all these hearts and learn about all these hearts in cardiac surgery. So, I started here at Cleveland Clinic in August of 1996. 

Carol Pehotsky (03:30):

All right. 

Dena Salamon (03:31):

In cardiac surgery and I learned so much. I was trained by some of the best cardiac surgery nurses that I have ever worked with in surgery. They were amazing, they really taught me so much. I worked with some great cardiac surgeons at the time and I just learned so much from them. And they really inspired me to go to nursing school. 

Carol Pehotsky (03:54):

Okay. 

Dena Salamon (03:55):

I was about a year and a half into my surgical tech career-

Carol Pehotsky (03:55):

Oh, okay. 

Dena Salamon (03:59):

Here in the cardiac ORs and my nurse manager, as well as the nurses that I worked with in the cardiac OR really, really pushed me and taught me to go to nursing school. 

Carol Pehotsky (04:09):

Fantastic. 

Dena Salamon (04:10):

So, I looked around at different programs and I ended up at Ursuline College. Here in Cleveland in Pepper Pike because I eventually got over commuting from Youngstown, all the way to- 

Carol Pehotsky (04:11):

You were, oh my gosh. Wow.

Dena Salamon (04:22):

All the way to Cleveland. 

Carol Pehotsky (04:25):

For those of you who are not from Ohio and that is a hole.

Dena Salamon (04:26):

But I did it but they were able to give me three days a week, which was nice and it was kind of unheard of-

Carol Pehotsky (04:26):

True.

Dena Salamon (04:32):

You know being such a new caregiver. So, they, they were able to accommodate me and I think they liked me. (laughs) So, it was nice, but I eventually moved up here and I settled in the Lakewood area and I applied at Ursuline College and I got into the nursing program. And if it wasn't for the cardiac department, the nurses and my nurse manager with all of their support, I probably wouldn't have been able to do it.

Carol Pehotsky (04:32):

Wow.

Dena Salamon (04:56):

They are so supportive. The family that I created and, you know, got to know and love, they really gave me so much support- 

Carol Pehotsky (05:05):

Sure.

Dena Salamon (05:06):

To go back to school. So, I went to Ursuline college and it took me four years to get through, but I earned a bachelor's degree-

Carol Pehotsky (05:06):

Awesome, yeah.

Dena Salamon (05:12):

While doing that. So, I did both, which I'm glad I did it that way. A lot of people do, you know, associate's degree with the RN and then go back through to bachelors and I didn't know any better. I probably would have been the right thing to do for me then but I just dove right in and I got through it. It wasn't easy, but I did it because I was working full time as well in cardiac surgery.

Carol Pehotsky (05:33):

Oh, gosh. Wow.

Dena Salamon (05:33):

Again, with the support of all the family that I've made here at Cleveland Clinic. And then I became an RN in surgery and I stayed with cardiac surgery for quite some time and I migrated to PEDS congenital heart surgery. So, that was always a place that I wanted to go.

Carol Pehotsky (05:49):

Sure.

Dena Salamon (05:49):

And at the time, when I worked in cardiac, you had to be an RN to work there. 

Carol Pehotsky (05:50):

Oh, okay.

Dena Salamon (05:54):

They didn't have surgical techs, and they only had two rooms and it was an all-RN staff. So, I was so proud. 

Carol Pehotsky (06:01):

Yeah. 

Dena Salamon (06:01):

And I got chosen to, to do that to kind of work. So, I, I stayed there for a couple of years. And after the surgeon that I worked with there retired, and went back to his country that he lived in, I went and did liver transplant. I left the OR, I wanted to do something a little bit different because I was in the OR- 

Carol Pehotsky (06:20):

Sure, it's all you knew. Yeah.

Dena Salamon (06:20):

All I knew because I went from a surgical tech to an RN and I stayed in those walls. So, I wanted to do something a little bit different. So, I went to be a transplant coordinator, which consisted of taking care of patients before they were listed and while they were listed for liver transplant. And I learned so much over there, it was- 

Carol Pehotsky (06:41):

It's a whole different type of nursing. 

Dena Salamon (06:41):

Oh, it's a whole different type of-

Carol Pehotsky (06:41):

That's a whole other episode, I'm sure. 

Dena Salamon (06:43):

Yeah. So, I, I learned so much over there still, you know, I knew the surgical piece so that really helped me understand what these patients were going to go through. 

Carol Pehotsky (06:53):

Sure. 

Dena Salamon (06:54):

And really educate them on a lot of things when they were coming through to get pre testing to be listed for liver transplant. I really enjoyed my time over there. And at that point, I really wanted to get into leadership and I knew that's kind of the route that I wanted to go. So, I'd made some moves and I ended up in plastic surgery. And from there, it escalated to assistant nurse manager in one of our ambulatory surgery centers in Strongsville and I really enjoyed my time there. I learned a lot, I worked in pre op, I worked in, um-

Carol Pehotsky (06:54):

That's right, yeah. 

Dena Salamon (07:28):

You know, post op, which, which I did in plastic surgery because it was A60. We had your main campus, the pleasure of doing pre post and OR all in the same day maybe on the same patients. So, the continuity of care was great. 

Carol Pehotsky (07:40):

Really solid. Yes. 

Dena Salamon (07:41):

Um, so I, I learned a lot there. But really in the leadership piece and Strongsville pre post, you know, frontline caregiving, as well as the OR with the, the different sub specialties that they offered there, and the leadership piece that really came together for me. And then from there, I came back to the main campus, which is my place. And I took on the role of the general surgery nurse manager. And that was a very big challenge for me. They were in a spot where they needed some help and I was in question that I was going to be that person to help them (laughs) because I wasn't a real seasoned manager. 

Dena Salamon (08:19):

And I, I, my leadership skill was very green. 

Carol Pehotsky (08:22):

Sure. 

Dena Salamon (08:23):

You know, just coming from an A&M and in an ambulatory care setting, I had great mentorship from my manager that I had there at the ambulatory center. But it was just such a short time. 

Carol Pehotsky (08:34):

Yeah. 

Dena Salamon (08:34):

That I felt like I didn't- 

Carol Pehotsky (08:35):

In a scope of a career. Yeah.

Dena Salamon (08:36):

Yes, I felt like I didn't have enough time. But I, I, I was assured that I did (laughs).

Carol Pehotsky (08:36):

Mm-hmm

Dena Salamon (08:41):

And I was assured that I would have the support that I needed. And it did work out, I did have the support that I needed and we made great progress in general surgery. And it ended up the, you know, colorectal joined and we made a DTSI, which was Digestive Disease Surgical Institute, the names have changed many times before and after and now.

Carol Pehotsky (09:01):

But family is the same. 

Dena Salamon (09:02):

But, we're, well, you know, we continue to stay as one and I managed that group for 10 years. It was a great time in my management and my leadership career and we made a lot of progress. And that the surgical Institute area was great, made a lot of great friends, the colleagues there were great. We, we really made a difference, I believe over there, you know, with the liver transplant piece, which I had the, the-

Carol Pehotsky (09:02):

(laughs) Yup.

Dena Salamon (09:26):

Pre and the, and the post that really came into play for me because now I was really doing it in that service. And I really had full circle of the care that the patients needed. And I was able to pass on to the surgical nurses that didn't have that-

Carol Pehotsky (09:27):

Sure.

Dena Salamon (09:41):

Piece what they needed to- 

Carol Pehotsky (09:42):

Deliver [inaudible 00:09:43] care. Yeah. 

Dena Salamon (09:43):

Bring that care full circle and it really opened up a new light for everybody. 

Carol Pehotsky (09:47):

Sure. 

Dena Salamon (09:47):

I was really proud that I was able to bring that to those nurses. And you know, it keeps growing from there. You know, liver transplant when I took over general surgery, we were building the program and we would get excited when, you know, we were at, I don't, I can't even, I don't even remember how many liver transplants that they did when we were so excited. And now it's like, we can't even keep up, we have offer after offer and those rooms are going 24/7 and it's very rare. And if you find that room that's not, not being used, it's very rare-

Carol Pehotsky (10:18):

Sure. 

Dena Salamon (10:18):

That there's not a liver transplant in there. So, the program has grown leaps and bounds since, you know, I've, I've been the manager there. But from there, I grew into the position in the role as the director of the main OR. So now, from learning, you know, general surgery and colorectal surgery, now, I'm learning all the sub specialties and the specialties that the main campus the main OR has to offer, which is a lot of fun. You know, I get to learn neuro and spine and all the cool things that they do. And ortho, you know, it's, it's crazy because, you know, coming from the ambulatory center, you know, that's true in itself-

Carol Pehotsky (10:57):

Ortho's a whole different animal.

Dena Salamon (10:57):

I mean, you're doing knee scopes, and you, you get a variety of sports injuries with pediatrics. And, you know, I have kids and my daughter was in gymnastics, and I'm like, "Okay, so this is where I'm gonna go with, if something happens." 

Carol Pehotsky (11:07):

Sure. 

Dena Salamon (11:08):

And you're seeing these kids come in with these sports injuries, and you're doing those things in the ambulatory setting. And then now I'm here on main campus, learning the ortho piece, and it's just a whole another ballgame. You know, these patients that they're caring for with some of the things that they come in with you're-

Carol Pehotsky (11:24):

Some of those oncology cases where it's-

Dena Salamon (11:26):

like, "Oh, my goodness- 

Carol Pehotsky (11:26):

... three in four service lines coming and help for sure. Yeah. 

Dena Salamon (11:28):

It's crazy, but you know, learning that is really cool. And then plastics, when you think of plastic surgery, it's not plastic surgery, it's something like never seen before.

Carol Pehotsky (11:28):

Like changing. Yes.

Dena Salamon (11:39):

It's crazy what they do, and they're so successful at it. So, it's neat to learn, you know, head and neck and, you know, some of the, the tumors that they take out and some of the things that they do to, you know, make people's lives better. It's just unreal. So, I get to learn all of this stuff now and it's great. I have a great group of managers that I work with, and I, I just couldn't be in a better place. 

Carol Pehotsky (12:04):

That's right. So, you, you've, even in your introduction given us a glimpse into what it's been like for you probably with no shortage of opportunities to speak up. You know, for those of you aren't familiar for, with our world. A surgical technologist is somebody who is trained to specifically provide that at the elbow, support for patients when they're undergoing surgery. They're handing up instruments, they're maintaining sterility, they're doing a million different things. So, that's where you started and here you are today. So, I'm sure that speaking up has looked a little bit different for you throughout your career. 

Carol Pehotsky  (12:35):

So, let's talk a little bit about at the entry of your career or anyone's career, whether the surgical technologists whether a, a nurse who's new to the OR, or any procedural space because that's sort of our home. What was that like for you? What, do you have any examples or people you learn from and techniques that you stole from, uh, in the form of imitation is the highest form of flattery. 

Dena Salamon (12:56):

So, for anybody in the operating room, the operating room can be a very intimidating environment. It doesn't matter what role you're in, it just can be very intimidating. And it doesn't matter what role you're in from a surgical technologists to whether you're a surgical assistant if you're a Triple S or your SPD, it doesn't matter what role you're in, surgeon, anesthesia, everybody has the same right to speak up. The roles are dropped, everybody has the same right to speak up. If you see something, say something. 

Dena Salamon (13:27):

What I see new caregivers, they don't want to be wrong. 

Carol Pehotsky (13:30):

Right. 

Dena Salamon (13:30):

They don't know what they don't know, they're learning. A lot of the new caregivers that we have in the Or never been in an OR before. 

Carol Pehotsky (13:39):

Sure. 

Dena Salamon (13:39):

So, even nurses, we don't have that training. When I was in nursing school, we never stepped foot in OR, we didn't have that training. Now, nursing schools you're seeing it more and more that they're having that perioperative experience. We did not have that perioperative experience. In some nursing schools don't have that perioperative experience still. So, these nurses coming out of nursing school may have not even been in an OR. But they're interested, you know, they've seen, they've seen TV shows (laughs), you know, so they may have shadowed or they know somebody. 

Dena Salamon (14:09):

They know, you know, their mom might be a CRNA or their dad might be a surgeon or they've, they've been around so they're interested. So yeah, we get people who've never really been in the operating room so they don't know what they don't know. So, it's, they don't want to be wrong, nobody wants to be wrong. So, getting new caregivers to stop the line can be a challenge and they're timid. It's intimidating when you have a team of surgeons and it's not just one surgeon, there's multiple surgeons. It's very rare that you just have one surgeon in the room. 

Dena Salamon (14:43):

Cleveland Clinic's a teaching hospital, so you have a resident, you might have two residents, you have a fellow, you might have a clinical associate, you might be in a combo case, and there might be three surgeons. It's just you know, just a matter of what kind of case you're in and you don't want to be the weakest link in the room. 

Carol Pehotsky (14:43):

Sure. 

Dena Salamon (15:01):

And you don't want to be the new kid who doesn't know what they're doing. So, it's, it's a challenge to get new caregivers to really feel comfortable to step up and stop the line if they feel that something's wrong. So, education, getting them educated, it's hard to speak up, if you don't know. So, you know, getting them in, getting them to the point where they're comfortable in doing the case. 

Carol Pehotsky (15:23):

So, they have some knowledge base-

Dena Salamon (15:24):

And they know what is right and what is wrong. 

Carol Pehotsky (15:27):

Right. 

Dena Salamon (15:28):

That takes time. I mean- 

Carol Pehotsky (15:28):

Yeah.

Dena Salamon (15:29):

You know, just think how long your training is, as, as a nurse, or how long your training is as a surgical tech. And now you're coming into the operating room, surgical techs, not so much because they have that, that training. But a nurse, they don't so, you, you know, you're learning how to be a nurse and then you're learning how to do surgery and that's going to take some time. So, to really understand what's not right- 

Carol Pehotsky (15:51):

Sure. 

Dena Salamon (15:52):

Even takes longer. So, to get them there can be a challenge. 

Carol Pehotsky (15:55):

Yeah. And it's so, so important to help those who are new to our space be matched up with a preceptor, with a mentor, whatever that terminology is at, at the variety of, of organizations. But really somebody who, who already does it well. 

Dena Salamon (16:10):

Yes. 

Carol Pehotsky (16:10):

So, so, you're somebody who's been doing this for a few minutes. So, what techniques did you use to speak up when you were in clinical care? 

Dena Salamon (16:18):

So, in clinical care, and I love to be in clinical care, it's like, it's like my Zen.

Carol Pehotsky (16:22):

I say it like, like you aren't there, but you still are. 

Dena Salamon (16:24):

It's like my, it's my favorite place to be. It's relaxing. (laughs) Repetition like, the more you're in there, the, the familiar your face is. And the, and the more you're in there, the more practice you get, the more you, you see things, the more you're able to understand and know what's going on. And the more practice you get, the more you know, so they begin to trust you, the surgeons, um, lean on you. They understand that you might know your table, um, because that's, that's your space. You know, the surgeons whether he or whether she is, you know, operating they, they rely on you to keep your space. 

Dena Salamon (17:01):

To know what's on your space, to keep it clean, to make sure that you know what's going on over here, while they're operating over there. They start to form a, a bond and a trust in you.

Carol Pehotsky (17:01):

Sure.

Dena Salamon (17:12):

Um, and they value your opinion. So, it's just a familiar face, it's getting in there, it's asking questions. I mean, at the end of the day, we're in a teaching hospital. Yeah, you might get an angry surgeon here or there but we all get angry once in a while. 

Carol Pehotsky (17:25):

Right (laughs).

Dena Salamon (17:25):

Especially sometimes when the, you know, these patients are really sick. 

Carol Pehotsky (17:28):

It's high stakes environment. Yeah.

Dena Salamon (17:30):

I mean it's a very high stakes environment, but the, they love to teach, you know. We're in a place that is, it's, it's a very educational environment. So, you learn when and where to ask the questions. 

Carol Pehotsky (17:30):

Right. 

Dena Salamon (17:42):

So, you kind of gauge and you kind of learn the room. But at the end of the day, they love to talk and they love to teach. So, you're learning, every day is a learning experience and I don't think there's one day that I come in here that I don't learn something. 

Carol Pehotsky (17:53):

Absolutely. 

Dena Salamon (17:54):

I mean, it's constantly evolving and constantly, there's so many moving parts that you're learning constantly. So, it's just asking the questions and really gauging where you're at. And it comes like, you, you, you know, we're all medical professionals, we're all medically trained- 

Carol Pehotsky (18:09):

Right. 

Dena Salamon (18:10):

And you get it, you pick it up, it, and it's, it comes natural. Like I always tell the new caregivers, "You're either gonna love it or you're gonna hate it."

Carol Pehotsky (18:16):

(laughs) That's right. I think your, your point is well taken about timing. One of the caregivers who used to work here at education would talk about it's like hopping on a moving train. You know, you have to gauge pace yourself to hop on the train, they're not, every, everybody's not gonna stop what they're doing and say, "Oh, hi, everyone said hi to Carol. Hi, Carol." (laughs) But you know, it's, it's reading that room. And that's for those of you who are listening who have some more experience, whether it's in the or not. 

Carol Pehotsky (18:40):

We do a lot of things for those nurses and other nursing professionals we help train and that's so important that we don't know say talk about is, is enculturating them to the team but also to the pacing of things. You know, when is it detrimental to ask a question because, you know, they're in such a delicate form of surgery. And, and how do we as nurses anticipate that? So, if we do need to stop the line, we're doing it before we get to that critical juncture where now they're really trying to focus on that piece and a question that can be detrimental. 

Carol Pehotsky (19:12):

Still, still meant to be the right question but that timing is everything. I'm never surprised, you know, when we try to celebrate somebody who stopped the line, right? We speak about and huddles, we'd send caregiver celebrations, which is our way of recognizing people and we turn to the nurse and the tech and say, "How do you know what to do?" And they say, "Well, I was just doing my job," (laughs) because it becomes like you said second nature. 

Dena Salamon (19:32):

Yes. 

Carol Pehotsky (19:33):

Yeah. 

Dena Salamon (19:33):

It sure does. 

Carol Pehotsky (19:34):

So, we've talked a lot about that fear of being wrong. And I think the other thing that is unique to our setting anyway, is that you know you're in a room with the same team, sometimes for eight or 10 hours and maybe sometimes every Monday it's the same team. So, how do you help caregivers sort of work through, yes, but today's what matters and does not get hung up on what might be if I say something. 

Dena Salamon (19:57):

Right. So, you know, when you're always with the same team, you got to make sure that you're doing the right thing all the time. Because I can say, "You know what, I have 10 sponges," and they're like, "I trust you." You know, "I know that you're gonna be correct"-

Carol Pehotsky (20:12):

No, I need to show you (laughs)-

Dena Salamon (20:12):

No, I need to-

Carol Pehotsky (20:12):

All 10. Yup.

Dena Salamon (20:12):

Show you that I have 10. So, you want to make sure, and you really want to stay on your toes, and you want to make sure that everybody's doing the right thing. That's a part of speaking up. It's not that you don't trust anybody, it's not that you don't trust the person that's circulating for you or that you don't trust the person that scrubbing or you don't even trust the surgeon. Um, it's that you're just checking and double checking and checking again. Because at the end of the day, it's the patient that's on the table-

Carol Pehotsky (20:40):

That's right.

Dena Salamon (20:40):

And it's the patient that we're the eyes and ears for and we have to keep them as, as safe as we possibly can. You know, I always tell the patients when I'm bringing them into the operating room and I'm their circulator, I'm their family now. You know-

Carol Pehotsky (20:40):

Yeah.

Dena Salamon (20:54):

They have separated themselves from their family, I'm their keeper. I'm their eyes, I'm their ears, I'm their family, and they trust me like I'm their family. And I have to do everything to make them as safe as possible. So, yes, check, check and recheck. I trust you, but guess what? 

Carol Pehotsky (21:11):

Verify, that's right.

Dena Salamon (21:12):

(laughs) Yes, we're gonna verify, perfect I like that. 

Carol Pehotsky (21:14):

And I think that's, that's great advice for those of you listening who aren't in the OR have zero desire to be in the OR. But we all have situations no matter what kind of nurse we are, where is that where patients have lost their autonomy, they've lost their ability to advocate for themselves. And sometimes we asked caregivers to get into some tough situations. But if they were that patient, if that patient was the person they hold most dear in this world, what would they do instead? 

Dena Salamon (21:41):

Correct, exactly. 

Carol Pehotsky (21:42):

Yeah. So, we have some tools out there as an organization, we have adopted ARK, ask a question, make a request, voiced concern or chain of command. And those of you who have ever done team steps, I do kind of like that we used to say you could CUS in the OR, C was for concern, U was for uncomfortable and S was for stop the line. But whatever tools you use in your organization, what's your, what's your thought on that and how that can help those folks who are, who are newer to speaking up?

Dena Salamon (22:10):

I think it's a nice guide, uh, to follow. It gives you, you know, a direction. For the new caregivers, you know, the management team, the, the assistant nurse managers, their preceptors, their mentors, we always make it known that if they feel that something is off, and they, they are afraid to speak up, call. 

Carol Pehotsky (22:33):

Absolutely. 

Dena Salamon (22:33):

I will do it for you, they will do it for you, there's somebody that will do it for you, and then we'll talk it over. 

Carol Pehotsky (22:39):

Sure. 

Dena Salamon (22:39):

Why, why were you hesitant in speaking up? 

Carol Pehotsky (22:42):

So, debrief afterwards. Yeah.

Dena Salamon (22:43):

We'll debrief after and we'll get their confidence there, but those tools are, are great. Uh, it's a starting point-

Carol Pehotsky (22:50):

Sure. 

Dena Salamon (22:50):

At least to get the conversation moving. 

Carol Pehotsky (22:53):

And that, and then you're not having to think creatively about, "Uh-oh, I need to stop the line, what am I going to say?" 

Dena Salamon (22:58):

Correct. And at the end of the, the, the surgeons aren't bad guys or gals.

Carol Pehotsky (23:03):

No (laughs).

Dena Salamon (23:03):

I mean, they're not. 

Carol Pehotsky (23:04):

They have different focus than nurse.

Dena Salamon (23:06):

Yes. And, and, and then if, if you say, "I have a question." You know, the way, it's all in the approach, or the delivery, or however you want to say it. "I have a question, you know, is this something that should be? Or is this how we do this? Or I'm not"-

Carol Pehotsky (23:23):

I'm not sure you're still sterile (laughs). 

Dena Salamon (23:24):

Right. You can, you could phrase it in a way that, you know, they would have to answer and you would get your, your question. And it might be that you are right, or it might be like, "Okay, he's or she's explaining it to the point where I miss saw something or I, it wasn't." And it's a learning experience, every, every day is a learning experience and you move on, you're new. 

Carol Pehotsky (23:45):

Right. 

Dena Salamon (23:45):

Like so. 

Carol Pehotsky (23:46):

And for those of us who are further along in our career, then a point is worth making that sometimes somebody might speak up to us. You know, I'm a very senior OR nurse, there might be a physician resident who comes in and, and they feel the need to speak up to me. So, what advice would you give to people in terms of being able to be listening up and humble enough to take some of that feedback? 

Dena Salamon (24:09):

I think as a senior nurse you just know. I mean, if somebody's gonna say something you've been there, um, you've been the one saying it. I think it's easier, uh, I think you know the process. Sometimes you write the process.

Carol Pehotsky (24:22):

(laughs)

Dena Salamon (24:22):

Um, but I, I think it's a little bit easier to, to take because you, you know why they're doing it. You know, the consequence, if you don't, I mean, even if you think like you brought up, you, you're not sterile anymore. Even if you, you swear up and down that you are, if somebody even thinks you're not, you're not. So, just, you got to change it. It's same with counting, I think we need to count if, uh, even if you don't need to count it's not, you know, a documented on the policy or the procedure that we don't have to do this count. It's not something that we need to do. 

Dena Salamon (25:00):

If somebody wants to count- 

Carol Pehotsky (25:02):

You count. 

Dena Salamon (25:02):

You count. 

Carol Pehotsky (25:02):

Yup.

Dena Salamon (25:03):

It's just something that you do. Where you were saying if, if a resident or, uh, a surgeon says something to me, uh, that's what it is. 

Carol Pehotsky (25:04):

That's what it is. 

Dena Salamon (25:12):

Um, that's what it is.

Carol Pehotsky (25:13):

Sort this out later after the surgery.

Dena Salamon (25:14):

Right. 

Carol Pehotsky (25:15):

But right now, yup.

Dena Salamon (25:16):

That's what it is. And then you, you just follow suit and, and do what needs to be done at that point. Like you said, you said, perfect, we'll sort it out later. 

Carol Pehotsky (25:24):

We talked about this in nursing school, we talked about this as nurses really taking yourself out of the equation, really thinking about ultimately, what's the best thing for the patient. So, just I could talk to you for hours about this (laughs). I, I want to just spend a little bit of time talking about as nurses, some of us go from being clinical bedside to a formal leadership. So, what does speaking up look like when I've moved from the, the highly time pressured, you need to stop right now scenario. To, I'm in a meeting, things aren't headed in the right direction for patient care, how do I as a new nurse leader speak up? 

Dena Salamon (25:59):

So, I had the opportunity to work with a lot of new nurse leaders in the past couple of years. When I took the director position, I had the opportunity to hire a lot of the managers that I- 

Carol Pehotsky (25:59):

You built your team.

Dena Salamon (26:11):

I work with now. So yeah, I, I did build the team and it's fantastic team. And it's, it, it can be a challenge as well. I mean, you go from a new nurse, and you're learning how to speak up, and then you're a seasoned nurse, and now you're a new leader, and you're learning those leadership skills. And you know, you're just kind of settling into what type of leader you want to be. And then speaking up as a leader, like, you know, are people going to respect me? Are people going to listen to what I have to say?

Carol Pehotsky (26:38):

I'm back to being novice in the space. Yeah.

Dena Salamon (26:39):

I'm novice, exactly, I'm novice in this space, I'm, I'm still earning the trust and respect, you know, I, I need to approach this in a way that I'm going to earn that from not only my direct report-

Carol Pehotsky (26:53):

Sure.

Dena Salamon (26:54):

But to, but the, the everybody else, you know. The, the su, sur, surgeons and the anesthesia, and everybody that kind of comes together in the operating room. Um, you want to make it so that you have that reputable presence in the operating room. Um, you want to be that strong piece, uh, that people respect. So, it's, it's, it can be very challenging because you don't want to do it wrong again.

Carol Pehotsky (27:14):

Right.

Dena Salamon (27:15):

Like when you were, when you're a baby nurse, you don't want to do it wrong. You want to make sure that you're doing it right and you wanna, you wanna earn that trust and respect by everybody. So, it can be challenging. So, you know, just coming and making sure that you're doing the right thing, like how would you approach it? 

Carol Pehotsky (27:15):

Sure. 

Dena Salamon (27:28):

I, I think I've come to you before (laughs). How would you do this? Or, you know, coming to a, and you know, anybody, bouncing things off of somebody else. You know, we always like to use that, you know, "Can you, can you read this email before I [inaudible 00:27:39]?" (laughs) You know, those kinds of things as a leader just to make sure that we're speaking up in the right manner, and we're saying the right words, so people understand what we're trying to say. 

Carol Pehotsky (27:48):

And those same tools apply. I, I vividly remember having a somewhat heated conversation with another leader that everybody wanted to do the right thing, but we were on different sides of the fence. And, and I ultimately, that's when we were using CUS and so I told them, I had a concern, and we kept going and I told them, I was uncomfortable. And I said, "I think we need to stop." And that's when the other person said, "You just use CUS on me." I said, "Did it work?" I said, "Well, it did now." 

Carol Pehotsky (28:14):

So, so it's going back to some of those key things and you have a little more time perhaps leader than in that absolute heat of the moment clinical setting when something's the wrong side might be done for example. Like I said, I could talk to you all day about this, but we do have to start wrapping it up. So, we want to flip over to our speed round questions where our audience gets to learn a little bit more about you beyond your expertise in speaking up. So, if you were not a nurse, what would you be?

Dena Salamon (28:40):

I think I would be a sports photographer. 

Carol Pehotsky (28:44):

Oh, a sports photographer? 

Dena Salamon (28:45):

Yes.

Carol Pehotsky (28:45):

Tell me more. 

Dena Salamon (28:46):

I love action shots. 

Carol Pehotsky (28:47):

Okay.

Dena Salamon (28:47):

I think getting those, those shots at that moment when nobody else, like you don't see him like with the naked eye and it's just those-

Carol Pehotsky (28:54):

Okay.

Dena Salamon (28:54):

Action pieces, I think that would be fun. 

Carol Pehotsky (28:58):

All right. And maybe this is highly related to my next question, what brings you joy? 

Dena Salamon (29:02):

I love family, I have four children from all ranks. I have a 24-year-old and I have an 11-year-old. So, they're great on every level and I love seeing them happy, I love seeing them succeed, it makes me really happy. 

Carol Pehotsky (29:16):

And you've probably gotten some action shots of them in their- 

Dena Salamon (29:18):

Yes. 

Carol Pehotsky (29:18):

Activities (laughs).

Dena Salamon (29:19):

Yes, yes. That's great. 

Carol Pehotsky (29:21):

All right. Well, thank you so much for joining me today, Dena. 

Dena Salamon (29:23):

Thank you, Carol.

Carol Pehotsky (29:28):

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.

Carol Pehotsky (30:02):

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.