Dual-Role Nursing Research
Dive deeper into Missy’s research on dual-role nursing here!
Transcript
Chapters
00:00 Introduction to Missy Dorsey and Her Journey
05:30 Exploring Dual Role Nursing
09:48 Successes and Challenges of Dual Role Nursing
13:10 Advice for RNs Interested in Dual Roles
16:15 Future Initiatives for Nurse Wellbeing
Ellie Kirkpatrick (00:01)
Hi everyone and welcome back to the non-traditional nurse. I’m so excited for today’s interview with special guest, Missy Dorsey. Welcome, Missy.
Missy Dorsey (00:09)
Thanks, thanks for having me.
Ellie Kirkpatrick (00:11)
Missy is a nurse leader who has made significant contributions to improving nursing retention and satisfaction through innovative work on dual role nursing. Her efforts have not only addressed critical issues like burnout, but have also helped nurses find fulfillment by blending roles and expanding their skill sets. Missy also has published research on this impactful initiative and will be linking her work in the video description for anyone interested in diving deeper into this.
So today we’re going to talk a little bit about Missy’s career journey, her dual role nursing initiative, and her insights into navigating and thriving in non-traditional nursing roles. So Missy, thanks again for joining us. To start out, could you share a bit about your background, how you got started in nursing, and what led you to pursue leadership roles?
Missy Dorsey (00:56)
Yeah, thanks, Ellie. I have been a nurse now for 15 a half years. And I think what got me in—you’re asked this a lot when you’re a nurse is like, why did you get into nursing?—And everyone’s like, because I love to care about people. And that definitely is part of it. But I think just the profession of nursing and the growth opportunities, you really can do anything when you get that degree and the license. It definitely doesn’t hold you to just being at the bedside. There’s so much more. So, I think that growth opportunity is one of the reasons I got into it. But then I do like the caring aspect of it. So, I’ll be that cliche to say that plus both of my grandmas were in the medical field and you know, it’s kind of a nice role model.
Ellie Kirkpatrick (01:44)
Awesome. And what made you want to be a nurse leader in particular?
Missy Dorsey (01:48)
You know, I always was drawn to leadership roles. So, when I played, sports in high school or college, I always like went into that captain role and I just loved being able to empower people to do their best work. I felt like I took control sometimes, maybe not always the best, but, I felt like that was just kind of where my passion was. So, as I got into nursing and I was working at the bedside, I had people that would tap me on the shoulder to do different positions and charge nurse supervisor and then nurse manager is kind of where it started for me. I was asked to do that and it was so funny because when I was asked it was like a like a “heck no” and it was like I’m absolutely not going to do that. It just seemed like a little bit out of my league.
And it’s like, OK, fine. I will go home and I’ll think about it. And the more that I thought about it, I was like, why wouldn’t I do this? This seems like everything that I would want to do. And obviously, when you’re on the outside of leadership, it looks like not great. It looks not fun. It looks like you’re just telling people what to do, and you’re getting people in trouble, and you’re having to be on meetings. But there’s just so much more to it. So, I decided to apply for the position.
As I continue to grow in my leadership, it affirms me almost every day that I made the right decision to get into leadership. I love it. There’s so much good about it. And yes, you have to do some of those difficult things, but it really is about empowering people to do their best work. So it’s been a good decision.
Ellie Kirkpatrick (03:26)
Do you feel like there was any like very pivotal moments that kind of led you from bedside nursing to becoming a leader and now a director?
Missy Dorsey (03:37)
Yeah, I think, you know, I mentioned my peer kind of like tapping me on the shoulder. I was a bedside nurse in the cardiothoracic ICU. I worked night shift and the manager of that unit had pulled me in her office. And to be honest, I didn’t even think she knew who I was because I worked a night shift, but I was, you know, a charge nurse. And she had said, I think that you would do really good at [being a nurse leader]. And I think obviously that was huge to me because I would not have taken the chance to apply for a position unless she would have said, “Hey, I think that you could do a really good job at this.” I think that is something that I’ve taken with me as a leader is that there are a lot of people that don’t know the potential that they have. And just to say like, “Hey, I see something in you.” Whether they’re interested in taking that or not, I think it’s really important just to say the words to people. So that was a huge pivotal thing.
And I think as I grew as a leader, the most difficult times with people, so the times that maybe a conversation went really bad, and we both walked away feeling frustrated. Those were actually pivotal times to me to keep me going in the role, because I recognize I can make mistakes and I can go and say, “Listen, I’m sorry that that’s the way that it went.” And we can come back together and actually grow stronger relationships.
That’s kind of what kind of keeps me going and even in the director role it does.
Ellie Kirkpatrick (05:07)
That’s wonderful and I’m sure you’ve made such a difference just giving that positive feedback to people and letting them see what their potential is. And now can we dive a little bit into dual role nursing, what it is and what inspired you and your team to implement this initiative?
Missy Dorsey (05:25)
Yeah, so I can’t even remember how many years ago now this was, but what I noticed. So I was the nurse manager in the cardiothoracic ICU. And as you know, Ellie, because you’ve worked there, it can be a difficult environment to work in for multiple reasons. It’s stressful. You have the sickest of the sick patients there. We also sometimes do things to patients that hindsight we wouldn’t want to do again. So potentially giving somebody a transplant and then their prognosis isn’t very good after that. And that moral distress is really difficult on the nurse at the bedside. It’s also a stepping stone for people to come in and to go do other things because we have people like yourself that want to continue to grow and to continue to do things.
It was kind of a question of how to fix a problem. So how do we fix turnover? How do we keep retention at the bedside, but also keep people happy and healthy with their wellbeing at the bedside. And it kind of started with someone coming up to me and saying, “Hey, what do you think about me doing some hours in CTICU, but then also doing some hours in the ED?” And it was, you know, at first as a leader, kind of like, it seems a little messy, you know, it seems like a lot of admin work.
It can be very easy as a leader to kind of brush that request off, but I’m thankful I didn’t. I’m thankful I listened and asked some more questions about it. And we really started slow. We did the ED nurse and that was kind of our first department that we focused on was the ED because we kind of had a relationship with the ED nurse leaders. We got them on board. So, then we had a few more nurses that started to do that.
And what we saw was that they were balancing out their week with a couple shifts in CTICU and a shift in the ED. So, they would work 24 hours in the CT ICU and then they would work 12 in the ED. And both are intense environments, but they are different intense environments. And it gave people that ability to continue to grow in what they were doing. So we just continued to promote this as a wellbeing initiative. Something to increase clinical skillset. It also, once we started to do it and we had more dual role nurses, it was kind of a strategic staffing plan. Because if CTICU was not staffed appropriately or we had call-ins or whatever, we could call Labor and Delivery. And if they were slow that day, the nurse that typically worked, you know, in the ICU and L&D would be able to get pulled to our space. So that was interesting and that was kind of an after effect that we realized as we went live. But it really showed that it helped mix up a full-time person’s employment and just give them a different aspect of life. It’s not the same constant difficult. And we get wins in CTICU, we absolutely do, but it can be just a difficult environment. And so can the ED or L &D, I mean, even the PACU sometimes.
So doing those different things really kind of spiced up their week, if you will. And they had a skillset of no one else. I mean, literally one of the dual role nurse who worked in L&D and in CTICU, delivered a baby in CTICU. I mean, it’s kind of ironic that it was like the nurse next door was the L&D nurse. So just kind of that unique aspect of having the clinical skillset that other people don’t have. It’s very marketable.
Ellie Kirkpatrick (09:11)
Absolutely, that’s amazing. And this is obviously near and dear to my heart because it was something that I was a part of as a dual role nurse and it really did help with personal burnout and just having that job fulfillment at the bedside. So, I know you touched on this a bit, but can you just summarize some of the biggest successes as well some of the biggest challenges in implementing this type of program?
Missy Dorsey (09:42)
Yeah, I think we saw within our cohort, we saw a decrease in that turnover. It was difficult to measure in the fact of the grand scope of the CTICU because we had kind of a controlled group of people that were going through it. But they liked it and they stayed. And I think it allowed them to, like I said earlier, build the skill set that was very marketable.
For instance, a flight nurse; we had people that worked in CT and worked in the ED and that is a nice recipe to become a flight nurse. And also, and we look at CRNA. So obviously the goal is for these people to stay, but we also recognize that people are going to continue to want to go on with their schooling and stuff. If we can keep them happy and satisfied and healthy while they’re within our space, then that is just as important. I think we learned a lot as a system. You think about the ED and the ICU and how different they are and how the relationships can be a little tense. You have an ED nurse that drops off a patient and you’re the ICU nurse and you’re like, where’s the report at? Literally they know nothing. And then if you’re an ED nurse, they’re like, they’re asking me you know, when the last time this patient pooped. They’re like, I don’t know, they just came in the ED. So, it’s all about sharing that perspective. And I think we did that amongst many different departments. I think at one point we were at 27 different departments, kind of interrelated to this dual role, which was awesome. And then as a leader, it just helped me connect with other leaders and kind of bridge the gap between departments because sometimes we can be so siloed in what we do.
I would say that the challenge is definitely when you are the nurse who’s doing this, you’re now responsible for double staff meetings, double in services, double, you know, whatever those online modules you’re doing. And that’s kind of an expectation that’s set up front because, the ED might have something that’s different than what the ICU is doing, but you do need to do them both. So, we tried to do our best to have communication between the nurse leaders about this just to make sure we were treating the employee with respect and not just expecting them to be doing everything. But there were call requirements for some of our dual roles when they did the ECMO coordinator position. And we sometimes in nursing had extra staff, you know, extra shifts. So, we wanted to make sure that we weren’t expecting them to be working seven days a week just to fulfill their obligations. Those were some of the nuances. And I think definitely, from an administrative perspective, it does take a little bit more time from a leader because you’re going to have a time card that looks a little bit different. You’re going to need to communicate between the units with leaders and admins and the employee is going to need to be aware. That’s a challenge, but I also think it’s a huge benefit because like I said before, you’re breaking down those walls and those barriers and you’re having conversation. And the more that you do that, the easier it gets.
So just something that we were aware of and needed to kind of work around.
Ellie Kirkpatrick (13:05)
Absolutely, and I know a big part of the research that you had published talks about setting expectations up front so that theren are no surprises with that. I think that’s obviously so important. And I’m not sure that this is available at most hospitals, but what advice would you give to RNs who might be interested in pursuing a dual role but might not have this option at their current workplace?
Missy Dorsey (13:28)
I think just talk to your leader. And that’s what I’ve even said to people within my organization that are like, how do I get to do this? It’s not anything fancy, you know, as long as your HR platform can break up an FTE into different slices. I would be shocked if you had a system that couldn’t do that. It’s really getting the leadership on board to say, I’d like to try to work this space and another space. I do think, and I talk about this in the article, the orientation piece can be a challenge. And I think that is the biggest thing that most leaders, when they hear it, they’re like, wait, you’re going to go away from my unit for how long to go orient in another unit? It’s worth it. I truly believe that. I think the investment in the person is so worth that time that they’re going to step away. And there’s times that from a staffing model, you have to say, not right now. If it’s flu season and you’re seeing a lot of flu cases, or if it was during the pandemic, you’re like, not right now, but maybe in April. And we’ve done that in the past where you’re not promising them a date, but you’re saying, we’ll reevaluate. And then you’re being held accountable to that. I would say talk to a leader, have a plan of what you think that would look like. What would you think your orientation would look like? If you’ve already worked in the space that you’re looking at working in, would you need a full orientation? If you have somebody you can talk to in education, talk about what they would think that it would look like. Because I think the more information you have when you present it to your leader, he better prepared you’re going to be able to speak to the benefit of it.
And there are leaders that might think this is very self-focused for the employee, but there are just so many wins to the organization. Like I mentioned, the staffing. There are times where departments are canceling people because they don’t have enough patients. And then there’s another department that is in dire need of staff. And we have been able to kind of shift those needs around and that saves money for the organization. And then also prevents that frustration from people getting canceled or having to work short in a different department. So have the conversation, be ready to speak to what you think it’s going to look like, and then just hope for the best.
Ellie Kirkpatrick (15:54)
Absolutely. And just to finish off, what is next for you as a nurse leader? Do you have any additional initiatives or goals aimed at enhancing nurse satisfaction or looking at improving patient care?
Missy Dorsey (16:09)
Yeah, I feel like we’re doing so many things that are focused on not just the nurse satisfaction, but it’s more focused now on the wellbeing of the nurse. We recognize that through the pandemic, after the pandemic, before the pandemic, we weren’t taking care of ourselves the way that we needed to take care of ourselves. So, there’s a lot of wellbeing initiatives that I’m involved with, but then also just as an organization, we’re promoting because it’s so key.
One thing that we are introducing at our organization is nurse coaching. And Ellie, I know we’ve talked about that before, but I do believe that having nurse life coaches for nurses at the bedside is really going to help people kind of get out of their own way and realize that they’re part of their self-care package. Sometimes staff just kind of want it, you know, dropped in front of them. “This isn’t what I wanted. How come you didn’t know I wanted something different?”
But it kind of puts the ownership on them with all of these resources that are around them to figure out what’s best for them and then to just kind of live a healthy, happy career, whatever that is. It includes coaching and mentoring, but then also growth, opportunity, and development. So, I think there’s so much we can do in the world of nursing. And I think it’s just going to continue to ramp up, which is exciting because I think we need it.
Ellie Kirkpatrick (17:33)
Yeah, absolutely. And everybody’s needs and everybody’s self-care looks so different. So that’s a really great angle at that. Well, Missy, thank you so much for sharing your journey and insights with us today. Your work is truly inspiring and there’s really so much value for nurses looking to really find fulfillment in their work, whether that be at the bedside or in leadership. For those watching, don’t forget to check out the link to Missy’s research in the description and be sure to subscribe for more interviews and resources to guide your unique nursing career. Thank you and see you next time!
