Mentoring and Positive Growing with Laurel Ash
Meet Laurel Ash
Beth and Laurel have a conversation about Laurel’s start in hospice and home care, working as a nurse practitioner, her transition to academia, her mentorship program, and more. Laurel currently goes out doing healthcare with seniors and is loving what she’s doing. She loves working in this capacity, and they talk about the return to a system where healthcare workers go out into the field to work instead of at a facility.
The transition to practice and mentoring is critical for Laurel as it’s an opportunity to help retain MPs and PAs. It’s also an opportunity to work on a reduction in bullying in the field. “As a leader, for me to develop a culture of belonging – where people feel they belong, that they are valued, that they are respected – can really set the stage for giving each person that safety so that they can perform at their highest level.” Being non-judgmental is key as a mentor, and everyone needs those people to help them in the field.
Mentoring is critical.
Part of mentoring may be doing more training to learn how to communicate better. It’s also important to get away from the blame-and-shame system that still happens. The field may not be perfect, but it’s important to build a place for everyone to be that’s safe and working according to your values.
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Links
- Connect with Laurel on LinkedIn
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Intro/Outro:
Welcome to Don't Eat Your Young, a nursing podcast with your host, Beth Quass. Before we get started, we have a few quick notes. Don't Eat Your Young is a listener supported podcast. To learn more about becoming a member and the perks available to you for becoming a patron yourself, visit patreon.com/donteatyouryoung. You can learn more about the show, share your story to join Beth as a guest, or connect with our wonderful community in our Facebook group. You can find all those links and more at donateyouryoung.com. And now, on with the show.
Beth Quaas:
Welcome to Don't Eat Your Young, a nursing podcast. I'm your host Beth Quass. We are so fortunate today to have Laurel Ash on the show. She is a family nurse practitioner, and also the chair of the graduate nursing program. She co-developed a mentoring program for nurse practitioners and PAs in a large institution, and was also part of developing a wellness program at the college in which she works, and that is just a sum of the things that Laurel has done in her long career in nursing. I look forward to having you learn from her. Welcome Laurel to the show. Hi, Laurel. Thank you so much for being on the show today. How are you?
Laurel Ash:
I am good. I'm so honored to be part of this incredible podcast. Thank you so much. Great work.
Beth Quaas:
I thank you for coming on and being willing to be a guest. Tell us a little bit about yourself and your nursing career.
Laurel Ash:
I have a long career with lots of different positions in big companies, nurse-run clinics, and it's been really a fun and exciting career. Definitely some bumps along the way. Hard times, good times, just like everyone else's careers. Started out in hospice and home care. Actually, I started in the hospital. Didn't fit there at all. It was extremely higher patriarchal. I was trained at the U of M and that didn't fit my training at all, or my understanding of what nurses could do, so ended up leaving there, needed some more independence. Ended up in home care and hospice, and then realized that I wanted to increase that independence and became a nurse practitioner kind of at not the beginning of the movement, but pretty close. Was the first nurse practitioner in my county, so that was really exciting.
Did a rural practice for several years, and then went to academia because I wanted to spread the good word about what an NP could do and give nurses that sense of, "You can do this. This is well within your scope." Did that for 13 years, then went back to rural practice. In the meantime, I had started a nurse-run clinic at the Student Health Service. We were very independent, and actually was part of the process of getting independent practice here in Minnesota. Thank you so much CRNAs. Yay! You guys really helped us along. The fact that we went with all ... Woohoo! It was an all APRN or nothing kind of plan, and that was the way we got it through. Anyway, so then we were able to really spread our wings, start our own practices and all that. I also did a cardiovascular-run clinic, cardiovascular prevention within a college, which was really fun with another nurse practitioner, then went back to full-time practice.
We had more nurse practitioners and APRNs within the large system that I was in, but they were getting thrown to the wolves. In other words, you got hired on Monday and on Tuesday, you were doing the full practice and then they would hit this moment like, "I can't do this," and so we were losing people. Two other nurse practitioners within the system and I, developed three others, sorry, developed a program to help transition nurse practitioners, at that point, it was just nurse practitioners, and PAs into practice with a one-year long mentorship program. That is one of my most proud moments of getting that started, because that was a real way to advocate for new practitioners within the world of large, corporate healthcare. So did that, and then kind of felt the call to go back to academia and back to academic practice, did some leadership there.
And now, I am doing teaching, which I absolutely love, and I have to tell you that I have, in my heart, for 20 years have been really concerned about helping the helper. Worked with other disciplines within the college setting that I was in to teach healthcare professionals about the importance of self care, which sounds like no big deal right now, but 20 years ago, it wasn't really a thing, which is amazing to me. Okay, so now my practice is with a company that I go out and do healthcare for seniors, doing a holistic assessment and a plan, and hooking them up to different resources, sending a long evaluation back to their primary care provider, but I get to spend a whole hour with people and evaluate their home settings or loneliness, all of the social determinants of health, so it's been really fun to get started with that.
Beth Quaas:
I am amazed by that, and I think there are going to be so many nurses that feel that calling as well. Going to the patient, not expecting them to navigate number one, how to get to the healthcare facility, but then also how to navigate once they get inside the doors, so I think what you're doing is extremely important. Do you have to be a nurse practitioner in order to do that job?
Laurel Ash:
In this setting, I think they have OTs, PTs. I'm not sure. It's a national corporation ... It's really interesting, the whole economic model and everything for it. I don't know all the different healthcare providers that they have, but I know they have quite a few, and they're expanding. This is going to be the future, I think.
Beth Quaas:
Absolutely. That's why I'm wondering if RNs, I know they are patient navigators, but I would love to see RNs going out as well and helping doing some of those assessments as well. There's a huge role for them.
Laurel Ash:
Absolutely. That's well within their scope of practice.
Beth Quaas:
Beyond just public health, but going out, assessing. You, as an NP, can prescribe and help those people right at the spot that they're living in, which is where we should be caring for those individuals when we can.
Laurel Ash:
It's really an honor, too, to just meet them in those settings because I mean, I started out as a home care nurse so I do get that. It feels really good to be that intimate with someone in their home setting, and you see it all. It's humbling at times.
Beth Quaas:
I agree that this is the future of healthcare, and it's going to go back to the years and years and years ago when physicians used to go out and see patients in their homes. And now, we're expanding that and we're bringing many people in to see them. I have to say, I'm fortunate enough to know Laurel long before we were on this podcast, and I have to say to you, thank you because you are the one that brought me into education, and I thank you for that and mentoring me there.
Laurel Ash:
Oh, and it was a bumpy ride too.
Beth Quaas:
I tell you, going into academia from being a clinician is a huge feat. They're totally different, but I have to say thank you for that. And then I want to talk a little bit about the transition to practice because that is huge. We're seeing it everywhere. Nurses, nurse's aides, NPs, PAs CRNAs, they need mentoring to keep them in those roles. Did you see any outcomes from the program that you started?
Laurel Ash:
We were data driven because we knew that's how we had to make our program even get funding in the beginning, so we had very good data about retention. I was only there for three years. I wish we would've had more data about how nurses, nurse practitioners, and PAs were feeling, but we did a lot in the beginning just on retention because it's very expensive to onboard a new person into healthcare. Very strong data about retention of the new NPS and PAs.
Beth Quaas:
And I know that this podcast kind of started by talking about how we were treating each other and bullying. Do you find that part of what you were working on with the mentoring?
Laurel Ash:
Absolutely. Unfortunately, as you know, and as I was reviewing some of your other really great podcasts, bullying and microaggressions are huge in healthcare. Maybe they're in many, many other places too, but it was very eye-opening. I think that one of the biggest pieces of the work for me was seeing that culture was everything. You can put the most expert person in a crappy culture and they're just not going to be able to function very well. You do see that. You see that all the time. So culture as a leader, for me to develop a culture of belonging, where people feel they belong, that they are valued, that they are respected, can really set the stage for giving each person that safety so that they can perform at their highest level. We saw some environments, where we were onboarding new PAs and NPs, where the culture was so negative and bullying and all of that, that we, at one point, just told HR not to put any more new folks in those places because until that changed, it just wasn't going to work.
So the advocacy piece was huge, and I think as you and I have talked about the importance of a mentor, you need somebody to be nonjudgmental about even how well you're doing, but to just be there for you to make you feel safe, comfortable enough to ask questions that we all need to ask when we're onboarding without feeling you're slighted or it's not okay. That just made all the difference for everyone to be able to have that person to mentor them. And that's where I think when we look at nurses who've been around for a while, we can really be there for the next generation of nurses because of course, all of us have gone through a lot of this stuff already, and we just don't want that to happen again. Definitely the culture of the organization, big and the small, for us, we were sending them out into smaller clinics or settings, can be just very, very detrimental or it can be really great. That's what I learned from that process. I think mentoring in nursing is one of the most important pieces to help us move the next generation along.
Beth Quaas:
I completely agree, and I don't think I recognized it as much years ago as I do now. Seeing these nurses come out, as the name implies, don't eat your young, but they're being eaten alive and we need to help them. I applaud you for the work that you did in this mentoring because I think it's going to expand, well it needs to expand, into every portion of healthcare for sure.
Laurel Ash:
Well and at the time, the physicians were really wanting to start the same thing because they felt the same way about onboarding a physician. It's sort of assumed you went to medical school, so you should be able to just get this five minutes after you start. You're right, it's every profession and it's just really ... Well, first of all, it can be very economically good for the corporation to do this because of retention and culture, but it's just respectful. I think we need to increase respect and honor a little bit more in our healthcare facilities.
Beth Quaas:
100%, and we've talked about this before as well. Don't eat your young doesn't just mean the young, new people. Respect, like you mentioned, is a big thing, but I've seen this go the other way too, where younger people kind of bully more experienced nurses, and what do you have to say to that?
Laurel Ash:
It's alive and well. I think anxiety in organizations causes people to behave poorly. I've seen rampant anxiety, especially in the last few years. I'm working with a consultant in my leadership class at the college that I teach at, and she uses family systems theory. It's really amazing how well that works in systems where with increased anxiety, you're going to get more the shame, the blame, the negative, the put downs. You have to work to decrease the anxiety of each place, but what I just saw recently was really sad. I had a student who went to their first clinical experience, and the student was older, at the end of their career, but still had a lot to offer. The preceptor made some comments right away, like, "You aren't my student, why are you here?" And also, he overheard some discussions about him and he had to leave that setting. He's talking about coming back, but we may lose him, and what a waste of talent.
This person has been in many, many settings. They're very, very, very kindhearted and ethical, and this is what happens. These kinds of events can cause so much pain and anxiety that the person can no longer tolerate that position and they have to leave. That's the only way that they can decrease that, so it's definitely out there. I'm hoping that this situation will be a learning one for everyone involved. We're still working on that, but ageism is out there, along with all kinds of other isms, and I think we need to learn more about our own biases, and then be open to understanding ways that we can mitigate that in our own world.
I mean, we all do microaggressions, but we should have the intention of not harming anybody, right? We should have the intention of, "Maybe I said something to someone that was taken wrong or was not well said." I want that person to come back to me and say, "Wow, that really made me feel like X, Y, Z," so that I can say, "Wow, I never intended that. I am really, really sorry." We need to apologize to each other more and normalize that within settings.
Beth Quaas:
Communication.
Laurel Ash:
It can be a tremendous waste of talent.
Beth Quaas:
Communication is where we need to start, and don't be afraid to communicate with someone. They're hard. Communicating is hard, sometimes.
Laurel Ash:
Very hard.
Beth Quaas:
And maybe, we need to do more training on that in nursing school or in our organizations. I think organizations should offer, instead of the annual training that we spend hours doing every year, let's do something around what really matters, and maybe communication could be a big piece of that.
Laurel Ash:
It's so true. It is so true that we need more work with that. I mean, it's everything to be a good team member and a good team leader, communication, and is just huge. I saw it when I was reviewing some podcasts. I see medical schools are doing simulations on not doing microaggressions, and there's probably some nursing schools too, but that's the kind of thing we need to just embed right in our curriculum.
Beth Quaas:
I agree.
Laurel Ash:
Just as important as doing a budget. That's not a super hard thing to learn. I mean, I shouldn't say that because I'm not super number-oriented, but the people skills, those are what can really make a difference in how things flow.
Beth Quaas:
And those people skills, our patients know when they're being taken care of by nurses that are comfortable, and then they also know when they're being taken care of by people that are already, like you said, anxious and not feeling comfortable in what they're doing.
Laurel Ash:
Yeah. I was a patient this last year, and also I brought my mom through several different healthcare places, and the difference was amazing. When the staff was relaxed and, I'll say it, almost happy, looked almost happy to be there, she got this amazing care. It totally affects patient care. Not only just that kind of quality, but sentinel events. We know it affects sentinel events. If you don't feel comfortable saying to someone maybe above you who's questioning their care, stuff happens. I sat on a review board and stuff happens when communication breaks down or when people don't feel safe. It's more than just a nice thing. It's very serious.
Beth Quaas:
Right, and I would say nurses are sometimes on edge because when we talk about sentinel events and root cause analysis, and when the nurse walks in the room, usually the first question that they're asked is what could you have done to prevent this? And there's already blame and shame and guilt on that nurse, and that's another thing we have to change.
Laurel Ash:
Oh. To Err Is Human came out when? How long ago was that?
Beth Quaas:
1999?
Laurel Ash:
That report, it's been 20 years and we're still doing the blame thing. Yeah. I mean, we don't want to make mistakes, but they happen. They definitely do, so I'm glad that you brought that up because that's really, really important. Also, I serve as a consultant to the Board of Nursing, so I end up seeing nurses who get in trouble with the board and the first thing that I do is ask them to tell me their story. It's almost always a systems issue or a lack of assertiveness of the sense of feeling like they could safely challenge what was going on. It's amazing to me. Seriously, I almost never see someone who really dropped the ball. It's more about the system and the lack of being able to be safe enough to question it, or they didn't get the right onboarding. So yeah, it's really amazing to see the impact of safety. I think just plain, old safety, feeling safe in your environment. It's okay to question things.
Beth Quaas:
Does the Board of Nursing ... Do they send a report back to the facility, or is there a bridge between the Board of Nursing and the facilities that employ nurses? Are there any conversations happening?
Laurel Ash:
I don't know. I shouldn't even speculate on that.
Beth Quaas:
The huge case that we've all heard of is, of course, RaDonda, and what did that system do? Did they change anything? Is anyone making them change anything? I'm not putting blame on one place or another, and when we talk about systems, who is overseeing when nurses have issues, or anyone, to make sure that those facilities are doing what they should be doing?
Laurel Ash:
That's a really, really good question, and I don't know the answer, but you would hope that the accrediting bodies would do that because it's so important.
Beth Quaas:
It absolutely is, and we need to support our nurses.
Laurel Ash:
Yeah. Unfortunately, my role is just advocating for the nurse. Yep. We need to support our nurses. I was pleased that the ANA did have, last year, Healthy Nurse, Healthy Nation as what they were promoting, so there's a recognition, but as you know, it takes a long time to get these things really embedded into the right places. The work you're doing is great! Yay!
Beth Quaas:
Thank you, getting the word out. And I know that Laurel and I, and a few others, are working to help improve nursing, and it's one step at a time and we're just in the foundational stages, but we truly are committed to making nursing a better place. We don't want people to leave. We want more people to come in. It's a great profession, and I'm hoping that we are going to make some great strides, and there are a lot of people working to improve the nursing profession.
Laurel Ash:
And it's a place that many different types of brains and many different types of people can add and flourish and make it a better place. So the more, different people we bring in, the better.
Beth Quaas:
Absolutely.
Laurel Ash:
I'm just so happy to be part of what you guys are doing.
Beth Quaas:
In your career, you have done so much for nursing already. And like I said, I am fortunate enough to know the things that you didn't even mention on this podcast today, so I encourage people to go find you. I know that The Essentials that you wrote for doctorate programs, you are a co-author in one of those chapters, which is so important. Now that I am in doctoral education, I can see the applications of everything that you've done up to this point, which is amazing.
Laurel Ash:
Well, and I'm so happy that you're back in academia. That's awesome! They're so lucky to have you.
Beth Quaas:
Well, I appreciate that. After years of experience, there's a lot to keep teaching people.
Laurel Ash:
Yep. We have to unpack our past and help people see their futures.
Beth Quaas:
What is something that you would like to leave nurses with today?
Laurel Ash:
I guess I'm so proud to be part of this profession, even though it's not perfect. I think so many of us come into it because we feel called to do something really significant in our lives, and I want you to hold onto that and find the place that you feel safe, comfortable, and valued, and make it happen. I mean, if you're somewhere where that's not working, if you can't change the environment, find a new one. Sometimes, that's the only way you can flourish is by leaving and starting over, but just remember why you came and keep those values connected to what you're doing and live intentionally. Our profession will be the better for it. And absolutely, if you ever want to connect with me, I'd be happy to do that. I'm on LinkedIn. That would probably be the best way to do it. Happy to give you some support.
Beth Quaas:
You can reach Laurel, all of her links will be in our show notes, and so I do encourage you. She's an amazing human. I would say you are probably one of the top nurses I know that practice truly holistic health. And even when I taught with you years ago, you incorporated that in a lot of your classes.
Laurel Ash:
Aww, thank you so much. I really, really take that as a huge honor coming from you, so thank you so much.
Beth Quaas:
Absolutely. I would love to bring you back another time and really dig into more of the mentoring that we've talked about today because I think you have a lot to teach people, and I would love to spend an entire episode just on that.
Laurel Ash:
That would be awesome! I would love that.
Beth Quaas:
Great. I appreciate you coming on, Laurel, and please reach out to her if you have any questions about what you've heard today, and I thank you so much for coming on.
Laurel Ash:
Thanks for having me. This is an awesome journey! I'm glad I get to be back with you again in my journey.
Beth Quaas:
It is very special. Thank you so much.
Laurel Ash:
Thank you!
Intro/Outro:
Don't Eat Your Young was produced in partnership with True Story FM. Engineering by Andy Nelson. Music by The Light Hearts. Find the show, show notes, and transcripts at donateyouryoung.com. If your podcast app allows ratings and reviews, please consider doing that for our show, but the best thing you could do to support the show is to share it with a friend or colleague. Thank you for listening.
