Episode 13 - Developing, RN
March 31, 2025
About This Episode
Northwestern Medicine nursing leaders Karena Brown, MSN, RN, CMSRN, and Katie Doyle, MS, RN, delve into the challenges and rewards of nursing careers and their paths in leadership, emphasizing the importance of having nurses in decision-making roles.
“The best nurses have perspective on everybody's roles and responsibilities, everybody's background. They really seek to understand how the other person that they're involved [with] ticks and ties because that helps them better have grace with themselves, with other people, which keeps you in the profession longer.”
Karena Brown, MSN, RN, CMSRN
Director, Northwestern Medicine Academy
“I also think being curious is really important. I learned as a bedside nurse at Northwestern Medicine that I was afraid to ask questions for my first year because I thought I should have all the answers. And I realized the more I asked questions, the more respect I got, the more I learned, the better care I gave. And so, practice with curiosity. You will be a better nurse if you practice with curiosity.”
Katie Doyle, MS, RN
Vice President, Operations, Northwestern Medicine Regional Medical Group
Show Notes
Episode Guests
Karena Brown, MSN, RN, CMSRN
Director, Northwestern Medicine Academy
Katie Doyle, MS, RN
Vice President, Operations, Northwestern Medicine Regional Medical Group
Northwestern Medicine nursing leaders Karena Brown, MSN, RN, CMSRN, and Katie Doyle, MS, RN, delve into the challenges and rewards of nursing careers and their paths in leadership, emphasizing the importance of having nurses in decision-making roles.
“The best nurses have perspective on everybody's roles and responsibilities, everybody's background. They really seek to understand how the other person that they're involved [with] ticks and ties because that helps them better have grace with themselves, with other people, which keeps you in the profession longer.”
Karena Brown, MSN, RN, CMSRN
Director, Northwestern Medicine Academy
“I also think being curious is really important. I learned as a bedside nurse at Northwestern Medicine that I was afraid to ask questions for my first year because I thought I should have all the answers. And I realized the more I asked questions, the more respect I got, the more I learned, the better care I gave. And so, practice with curiosity. You will be a better nurse if you practice with curiosity.”
Katie Doyle, MS, RN
Vice President, Operations, Northwestern Medicine Regional Medical Group
Show Notes
- Brown and Doyle both started their careers as bedside nurses and credit these hands-on experiences for their ability to take on leadership roles with important skills like empathy and communication.
- They say having nurses in leadership roles means that there is someone at the decision-making table in health care who understands patients' experiences and advocates for patient-centered care.
- There are many challenges in health care today, both Brown and Doyle tress the need for greater transparency in costs, processes and patient navigation, and they believe better communication can help relieve some obstacles created by these concerns.
- Brown suggests a more diverse workforce that reflects the patient population will improve patient care and enhance trust in the healthcare system.
- Burnout is a major concern for nurses and healthcare professionals, both guests agree that hobbies outside of the work-related activities and a strong network of colleagues is critical for maintaining a healthy work-life balance.
- They encourage new nurses to be curious and lead with inquiry, recognizing that experience is about quality rather than time.
- They both agree that nursing is a deeply rewarding and impactful career, both see the profession as a privilege, and they are motivated to keep nurses and patients centered in their leadership roles.
Episode Guests
Karena Brown, MSN, RN, CMSRN
Director, Northwestern Medicine Academy
Katie Doyle, MS, RN
Vice President, Operations, Northwestern Medicine Regional Medical Group
transcript
00:00:00] Alyssa Saklak: I'm Alyssa Saklak
[00:00:06] Laurin Henderson: and I'm Laurin Henderson
[00:00:08] Alyssa Saklak: On Better RN, we get real about nursing,
[00:00:11] Laurin Henderson: the good and the gritty.
[00:00:12] Alyssa Saklak: We talk to real healthcare experts
[00:00:15] Laurin Henderson: with the goal of becoming better
[00:00:17] Alyssa Saklak: for our patients, our colleagues,
[00:00:18] Laurin Henderson: our family, our friends,
[00:00:20] Alyssa Saklak: our partners and ourselves.
[00:00:28] Laurin Henderson: Today, we're going to talk to two really incredible nurses, Karena Brown and Katie Doyle, who are both in leadership in different capacities at Northwestern Medicine. Karena Brown is the director of Administration in the Northwestern Medicine Academy, and Katie Doyle is the vice president of Operations for Northwestern Medicine Regional Medical Group. And I'm really excited for today's conversation because it is not, sort of, what I thought it would be. We, in our intro, talk about nursing as the good and the gritty. And I think we really get into the gritty today, which is it's not something that we do quite often.
[00:01:00] Alyssa Saklak: I'm asking some tough questions because I need answers, and I need to know what I can do to keep moving forward. Our hope is to really dive into that a little bit more with some of these gritty questions.
[00:01:12] Laurin Henderson: Karena and Katie both talk a lot about how they are nurses first and then are in leadership, which really resonates with me. I know it resonates with you too. Sometimes when I'm interviewing new nurses, like, for positions here, I like to tell them where I started and that I have always been in the medicine service line because I think it matters. It's important. I am a nurse first. And then second to that. I'm the manager of this unit. So, I love that they both share that with us.
[00:01:39] Alyssa Saklak: I hope the listeners can take away a little bit of advice and wisdom that hopefully both the leaders can share with us today and add into our own lives.
[00:01:47] Laurin Henderson: Nursing really is a choose-your-own-adventure. And Karena and Katie, we'll talk about that a little bit today, but there are so many different ways to grow in your career and they're not all easy, pursuing advanced degrees, getting into operations, moving into leadership, staying at the bedside, whatever that choice is for you is the right choice.
[00:02:06] Laurin Henderson: Let's get into it.
[00:02:12] Laurin Henderson: Welcome, Karena and Katie. Well, I'm really excited to speak with both of you today. Tell us a little bit about who you are and how you got to where you are now.
[00:02:21] Katie Doyle: So, it's a pleasure to be here. My name is Katie Doyle. My role is vice president of Operations for the health network in our ambulatory space. I have been at Northwestern for 19 years and started as a bedside nurse in Labor and Delivery, which is and was my favorite job. I always introduce myself as a nurse first and an administrator second. I feel very fortunate that my time at Northwestern Medicine has really given me not only challenges and support and mentorship, but just an opportunity for my career to go in a place I never expected it to. I would have been fully happy in scrubs the rest of my career. I love nursing. But I'm thankful to be in a role that is at the table to influence how we give health care. My portfolio is primary care operations, and I support our endocrinology teams but I believe that my experience and training as a nurse really helps me do my job as a leader. So, it's a pleasure to be here and meet all of you.
[00:03:18] Laurin Henderson: Great. Thanks so much, Katie. Karena, tell us a little bit about you.
[00:03:21] Karena Brown: I'm a Karena Brown. I'm one of the directors of administration in our Northwestern Medicine Academy. I have been at Northwestern for — hard to believe it — nine years. Started out as a bedside nurse at Northwestern Medicine with you guys.
[00:03:35] Alyssa Saklak: It's a nice reunion to have everyone back together.
[00:03:38] Karena Brown: It is, it's a full circle moment. Yeah, we, uh, have a lot of history together. And so, I think that you all have helped shaped a lot of my nursing career, but I'm like Katie. I could totally put my scrubs back on and do it again tomorrow. I am a nurse first. I love being a nurse. and my path has always led me through leadership. I've just kind of said yes to opportunities and did not think that I would be a director in our Northwestern Medicine Academy, but here I am, overseeing clinical education for nursing for the system, some accreditation, as well as library services, clinical schools and training programs, which is something that's really exciting. And then CME, which is our medical education for our physicians. I cover a lot of different areas, and it's really fun because I get to flex my brain like I did as a nurse, I'm switching gears a lot during the day, which is what I loved as a medicine nurse. Medicine is my favorite discipline of nursing to be in. And I wouldn't trade any of my nursing experiences for the world. So, super excited to be here and to chat with you guys.
[00:04:35] Laurin Henderson: Thanks Karena. So, you both are incredibly busy, have huge portfolios that you're overseeing, but I love that you both mentioned how you're a nurse first. Why as leaders, why do you think that it's so important for nurses to have a seat at these tables in all areas of health care?
[00:04:53] Katie Doyle: Well.
[00:04:53] Katie Doyle: I think nursing background does a couple things. By having the experience of practicing as a nurse, I hopefully am able to empathize and understand the processes that exist when there's patient care happening. Even though my experience was inpatient, even in the ambulatory space, I can appreciate what a busy day looks and feels like because I've lived that busy day. I can appreciate the emotional tension of conversation can feel to a clinician and their team when someone gets bad news. Even in the ambulatory space, I think that appreciation helps me to support the teams better and understand what they're going through. The other thing that I did not appreciate as much as I thought I would is that by the experience of practicing as a nurse, I am confident in speaking the clinical language and that helps translate improvement work and support to our physician workforce as well. What nurses have that some of our MBA colleagues don't always get is that experience of working a patient case together with a physician and that can exist in many different platforms or strategies. We can be doing an improvement project on how to improve triage for patients and by having the ability and experience of having hard conversations with physicians, it helps to be able to understand what's needed to get to yes and getting to yes is really our goal as leaders.
[00:06:09] Alyssa Saklak: And Katie, you said a lot about the ambulatory care setting. For those who are listening that may not know what that setting looks like, how would you describe that versus like inpatient in a hospital where you were a labor and delivery nurse and now kind of working in a different healthcare setting. What would that look like for those listening who haven't heard of that?
[00:06:26] Katie Doyle: The ambulatory space is essentially whenever most of our nurses are going to their primary care physician or perhaps your OB-GYN or specialist, we, depending on the discipline, can see, each physician can see about maybe 20 to 40 patients in a clinic per day. And in that visit, not only are they assessing and diagnosing, but there is a team behind that physician that's helping to answer and manage messages that come through. We all leverage MyChart to our physician team in the ambulatory space. And we also do triage for patients that have concerning needs. That triage is really important because what we hope to do is decant from an inpatient perspective, what's coming to the ED. And so, what I love about the ambulatory space is that we provide care to patients and hopefully help them in prevention and chronic disease so that they don't need the acute environment. And then after the acute environment helps our patients and gets them better, the ambulatory environment follows through on that plan of care to keep them out of the hospital.
[00:07:22] Alyssa Saklak: Karena, what about you? You know, it's so funny that both of you kind of mentioned something very similar, like I loved the scrubs, and I loved working at the bedside, and I would have never guessed to be where you are today. What inspired you to go in that direction? Similar to Katie's story?
[00:07:37] Karena Brown: Yeah. I think I've always loved being an inpatient nurse at the bedside, taking care of patients and doing that hands-on work. And that's something that I think has shaped my decision-making process and how I move about my life to be quite honest. But I always had a knack for leadership. I always joke and say, when you charge train, you get a hold of that pager, and you're like, “Oh baby, this is so great. I get to call the shots now.” But it's a lot more than that. And so, I think learning how to be in charge and pulling your scope from just the four to five patients that you care for to now you've got, depending on your unit, 30 patients, six to seven nurses, three to four PCTs, a secretary, and you're, kind of have a hand in making sure everybody gets what they need and is able to escalate care. And again, you're constantly switching gears. And I really liked that. I thought it was really fun and enjoyable, and it made me think about how to solve larger problems for the staff to make their life easier, which ultimately makes the patient's life easier and their outcomes better. And then management came next, which I really didn't see. I took an opportunity to cover a manager who was on maternity leave. And it really showed me how I have a passion to help the employee side of things a little more in the high-level patient concerns and issues. And you learn a lot about staffing and budgeting and supplies just kind of going day by day and just tackling things one at a time. And I think that really showed me that it's important for nurses to have a seat at every table because we're going to touch it, use it, have an impact in it, implement it. It's going to affect our day, which is going to affect patient days. And I think we've all been there where we've been in situations in the hospital and outside where a decision is made or something's happening, and you're like, who made this decision? Like they must not know what I do and how it affects me and my team. And I think that gave me a passion to kind of be the change. You know, we talk about how we want to be a part of the decision-making process, well that means that there are nurses that have to kind of work their way up the ranks and get into rooms and get seats at the table to really help be a part of making those decisions. And I think Northwestern Medicine does a really good job of putting nurses in positions of leadership to help inform projects and initiatives and changes that are happening because they ultimately know that a nurse is going to have something to do with in any ways. And I think that's been part of the reason why I kind of felt like I needed to keep going and take on more leadership opportunities because somebody's got to do it. There's got to be a nurse that's out there doing it. And I'm happy to be that person. And it's taught me a lot about myself and my life. And, there are people who came before me, who spoke up about me in rooms that I wasn't even in, and I get to do that for others now who I think are change makers and really strong nurses and do really good work.
[00:10:06] Katie Doyle: I also think if I can add to that, Karena, is the nursing framework is about assessment, education and empowerment. If the medical physician framework is about a differential diagnosis, finding the answers. And then what I think is so powerful about nursing is just by within that framework, our whole job is to understand what's going on and then empower the people around us, right, to do their work and teach them on that work. And so, from a leadership perspective, nursing, I think, sets up all of us in a way that other clinical models don't. Without that desire for empowerment, I think the best situation is when our patients have self-determination and they start making their changes on their own and they understand their disease. And nurses care about that part. Nurses don't think a patient should listen to us. We think a patient should understand us. And they should understand us because we educate them and help them make a decision for their life. And so just within the framework, I believe nurses are really strong leaders. And when we're at the table, you'll notice when you're at an interdisciplinary table, the nurses are the first ones that bring it back to the patient. And the nurses are the first ones to advocate for the patient and what the patient wants in their care. Not what's right from a differential diagnosis, but what they want. And that is powerful.
[00:11:18] Laurin Henderson: I agree. I think that's huge. And as we think about the landscape or the culture of health care, it's so rapidly evolving, even in this, post-COVID world that we're trying to navigate still, even five years later. And we think about it. New nurses coming into the profession. And I think about how different nursing is now than it was eight years ago when I started. And I wonder how successful I would have been, because I think problems exist today that didn't used to exist, or maybe that weren't at the forefront of my mind. So, I'm curious if you, either of you, had a magic wand that could instantly solve one major problem in health care. What would you choose? What would you try to tackle with your magic powers here?
[00:12:00] Katie Doyle: If I could have a magic wand, we would be completely transparent to patients about what health care is and how to navigate it. Healthcare costs would be transparent, expectations would be transparent, the reality of what we can actually deliver would be transparent. If patients understood the cost of health care, they might do more prevention, right? If patients understood how crucial it is to understand how to navigate amongst specialists and who is in charge of your care, they might choose different ways to engage. For example, a patient that is a Type 2 diabetic and sees our Endocrinology team, and now has a really great A1C, they don't need to see endocrinology anymore. They can go back to primary care and open access for our sick patients. We tend to clog up a lot of parts of the healthcare system. And patients go to the ED because they think that's the answer. It's not always the answer. And so I would love to see us focus on our patient's behavior and transparency and how we do care. I think that would really be a game-changer.
[00:12:55] Laurin Henderson: Yeah, I love that answer, Katie. And it really reminds me of season one of Better RN, when we really focused on overall well-being with nurses at the focus. But the same thing translates to the general population too. How do we make the emergency department not primary care for people. People which I think we see a lot of, especially in downtown Chicago.
[00:13:16] Katie Doyle: Yeah. I think expanding upon that. I think if I had a magic wand, I think creating a way for patients of every single background, to Katie's point, to have a clear transparency of what life looks like for them in a prevention standpoint, in an illness standpoint. And I think that has a dotted line to a diverse workforce. And so, I think having a way to magically be able to effectively communicate with us, the things that are important. So, we can ultimately do what is right for the patient and most importantly, what the patient wants. I think, to Katie's point, that's all we really want as nurses. Is this what the patient wants? Is this the right thing by the patient, for the patient and making sure that happens. And I think that's where a lot of the struggles I tend to see. And that was really morally distressing for me as a nurse. I know that I'm doing everything that I can for my patients that I know understand me and I understand them, but what am I missing in the patients that don't, you feel like you're doing a little bit of a disservice. So I think that's what I would love to see. I think it starts with a diverse workforce. And we just don't talk about it enough to your point, Karina. It's so important for us to, as leaders, always be pushing for our workforce in all roles to look and understand like our patients. And I think we just are trying to touch the surface of it, but it is uncomfortable to talk about it, but it's the right thing to talk about. And the more we have leaders like you three, honestly, the better we will be down the road .
[00:14:37] Laurin Henderson: Yeah. Karena, I completely agree with what you're saying. I'm thinking back to my time at the bedside, you know, we have a great Interpreter Services Department here at Northwestern Medicine with a lot of in-person interpreters available, I think that is such a big part of what we do, especially in downtown Chicago. And I agree it does. It starts with a workforce that's representative of the population that we serve.
[00:14:59] Alyssa Saklak: I want to pivot a little bit. I know we've taken a deep dive on some of these really big healthcare challenges that I think, as leaders, really drive our passion and our drive to develop more, learn more, grow more. I'm going to ask Katie and Karena a challenging question: have there been times in your career where you doubted your development? Or felt burnt out from the profession in totality of health care and the massive problems that feels like impossible to solve? Even here, we talk about it and I feel inspired and I'm like, I'm ready to take on the world, but I know that that's not always the truth. And so, I'm curious from, the lens and the journeys that both of you have taken, can you tell, and resonate maybe with some of the listeners of when that has happened to you in your career and how did you get through it or, what were those things that influenced you to keep pushing forward and keep developing when you kind of have those moments?
[00:15:52] Karena Brown: I think we can all relate to, “Oh my gosh, what did I sign up for?” Is this, you know, was I really meant to do this? You know, I am a firm believer that health care is a calling, but nursing specifically you really have to want to be in this profession because there is a lot of, the grime and the not-great, and it's not glamorous. And you really have to be able to manage that. And how do you show back up the next day for your team? How do you show back up for your patients and how do you show back up for yourself? So, I think burnout is a really big thing that happens. I do feel like a lot of the ways that I've combated the burnout is I've really had to self-reflect on where am I allocating my time and where separately am I allocating my thoughts and my energy? Because I think a lot of times when I would have reached moments of burnout, it was self-inflicted. I was the one that was picking up all these extra shifts, not because, you know, there was a need, but I was the one that was like, “Oh, I'll stay for another four hours or I'll come in again tomorrow.” Then I realized that I cannot do anymore because I was so burned out, and I really had to take a step back and think about what am I willing to do that is going to have an impact and a win for everyone and not just like a win for one area and not for myself. I think one of the great ways that I was able to solve to a lot of burnout is: I got a hobby. I got a hobby, and I think that is, I recommend that for anybody in any profession, especially health care, is to have a non-healthcare-related hobby that gets you out of your house, excited about something, whether it's crocheting or going to a workout class, and it refills your cup in a way that allows you to then return to your work environment and be ready to tackle it again. And know that every problem is not your problem to solve. You got to pick and choose your battles. And we have to pivot and focus on something that we can actually have an impact in. You just have to have the ability to let it go and it's really hard. But doubling down on the hobbies, I think that they're a really helpful thing to have, and it helps you come back into the workplace with a renewed energy and you are able to be an effective part of the team.
[00:17:49] Katie Doyle: Yeah, and, Karena, it is important to have a hobby. That's such a great point because we can so easily allow health care to be our life and it is all-consuming. People's stories are all-consuming. Our teammates' stories can be all-consuming. So, I love the idea of a hobby
[00:18:05] Katie Doyle: I will say as I reflect on my 19 years at Northwestern Medicine, each part of my career path probably had different ways for me to work through burnout. When I was a bedside nurse, like, we all can remember a couple cases where I almost thought, “This is it. I'm not going to be a nurse. This is too much stress. I am hurting. I don't know if I can do this job.” And it was the nurses that I worked with that not only helped support me through a really hard traumatic patient experience, but also reminded me of the humanity of nursing and the fact that they've been through similar things. And we have to work with each other and help each other out when these really hard situations happen. And then as I went into leadership, which has been the majority of my career, manager and director and now vice president at Northwestern Medicine, it's always been about, when I get burnt out, I have to pull back and I write down all the stuff that's on my to-do list because I'm feeling overwhelmed so I have to see it. And then I remember what's in my circle of control. So I think colleagues are super important, hobbies are important. When you're feeling burnt out, have the awareness to reflect on what you can do today. What can you accomplish that will then bring you back to your why and re-energize you for the rest of your work?
[00:19:15] Alyssa Saklak: And I love the point, too, of like how health care can be all-consuming, So I appreciate you sharing those things.
[00:19:22] Laurin Henderson: It can sometimes feel in health care like we're building the plane as it's going down the runway, and it's so important to know when I'm done building for today and now it's time to hand off to someone else. This is really such a 24/7 operation, and I do think that it's so vital to have good people surrounding you and, like, Karena, you mentioned earlier in our conversation, good people that are going to mention your name in a room when you're not there.
[00:19:46] Katie Doyle: Yeah, it requires trust. You have to trust that your colleagues are in it for the same reason. And then you go to those that you trust to debrief about what can be different, what can you control and, to be honest, some days are just hard and you're not going to get some wins every day. And that's okay.
[00:20:02] Laurin Henderson: It's not all sunshine and rainbows. I love the way that this conversation has gone because so often, yes, we want to paint health care in this great light and nursing is such a noble profession. And we are so lucky to be responsible for caring for people in their most vulnerable times. But it is really hard. And I think it's, sometimes there's a little bit of a stigma that we shouldn't say that, or that you shouldn't really talk about that because it makes it seem undesirable, but that's the reality of it. We're doing really challenging, important, hard work, and it's not always great.
[00:20:36] Katie Doyle: Yep, and I always say the right work to do is the hard work and that makes it the fun work. It's really a privilege when people let us into their lives to take care of them, regardless of the situation. It's a true privilege.
[00:20:48] Karena Brown: Our goal is to really impact the patient experience, and it is really funny because the reality is that when people do let us into these vulnerable moments of their lives, especially in the hospital. There is nothing glorious about it. It is not pretty. It is very raw. It is very real. It is very emotionally charged. It gets messy. And the nurses are there to be the people, to help kind of hold that space and help move people through the process. In addition to the other care member teams. But sometimes I feel like we have this juxtaposition of we're like, it's not all rainbows that I thought it would be. And I'm like, it shouldn't be, if we're going into this very vulnerable patient situation that is really hard and heavy and messy. Why do we think that we're going to go in and make it sparkle and shine? We're going to move them through the process appropriately, which is hard to do, but that's where the good work is. And that's okay to know, like, I'm headed into the situation. And it's going to give us. A good learned experience to have a better impact on the next patient. And so you go in no matter what. And I think that's to me what nursing is, is nursing is a, no matter what, you learn how to protect yourself and you'd learn how to care for the patients.
[00:21:51] Laurin Henderson: Yeah. And then as leaders, I think it really falls on us. And there's a huge spotlight on this now, thank God, more than there used to be, that the bedside nurses are caring for the patients, but who's caring for the bedside nurses? We have to make sure that we are doing just as much of the hard work to care for them as they are doing at the bedside, and that is what is going to keep healthcare care moving forward. Otherwise, we're going to stall out, and no one's going to want to do this job, which would be such a disaster, right?
[00:22:22] Karena Brown: Yeah, as leaders, it's our job to protect the people at the bedside, the nurses it's a huge part of our job and I think Northwestern Medicine does a good job of taking that seriously and really trying to intervene and do right by the nurses they deserve to have a quality of life just like the patients do.
[00:22:36] Karena Brown: I agree.
[00:22:36] Laurin Henderson: As we close, what would be a quick sort of one-liner piece of advice that you would give to a new nurse who maybe is having a rough time, is second guessing if this is the right thing for them? Katie, what would you say to that new nurse listening?
[00:22:51] Katie Doyle: I would say, give yourself grace and remember why. None of us know all the answers. Nobody ever will, to be honest.
[00:22:58] Laurin Henderson: It's perfect.
[00:23:00] Karena Brown: I think I would say, and this is something that I've learned in my time here is that time and experience are not directly correlated. And I think a lot of people think that, and you would rather have an intense quality experience for a short amount of time than a long time of a lackluster experience where you're just going through the motions. And so as long as you know that, then put your head down and do the good work and things will come your way. And to have perspective — there's so many things, but I think perspective is really important. The best nurses have perspective on everybody's roles and responsibilities, everybody's background. They really seek to understand how the other person that they're involved in ticks and ties because that helps them better to Katie's point, have grace with themselves, with other people, which keeps you in the profession longer than nurses that come in and want to just be high performing nonstop, no matter what, they are the ones that often struggle because they realize that the world is not set up for you to only ever be successful. It would be so nice if it was though.
[00:23:56] Katie Doyle: I also think being curious is really important. I learned as a bedside nurse at Northwestern Medicine that I was afraid to ask questions for my first year because I thought I should have all the answers. And I realized the more I asked questions, the more respect I got, the more I learned, the better care I gave. And so, lead, practice with curiosity. You will be a better nurse if you practice with curiosity.
[00:24:18] Laurin Henderson: I love that. That's so great. Thank you both so much. I feel inspired. Alyssa?
[00:24:23] Alyssa Saklak: Yes. I think this is what we needed. Absolutely.
[00:24:26] Katie Doyle: Well, thank you for this experience. I will say,
[00:24:29] Katie Doyle: It's a real privilege to give back and talk about how nursing continues to impact my career. So, thank you for letting me share.
[00:24:36] Laurin Henderson: Thank you, Katie.
[00:24:37] Karena Brown: This has been so much fun, and I'm so glad that we got to chat and talk about one of my favorite things to do, be a nurse.
[00:24:42] Laurin Henderson: Well, Katie and Karena, this was such a lovely conversation. Thank you both so much for doing the good work and for taking the time out of your busy schedules to talk with Alyssa and I today, I couldn't be more grateful.
[00:24:55] Katie Doyle: Thank you.
[00:24:55] Karena Brown: Yeah. Thanks.
[00:25:01] Laurin Masnari: Thank you for listening. Please follow us wherever you get your podcasts and rate and review the show.
[00:25:06] Alyssa Saklak: We'd love to hear your comments and any topics you might want us to explore.
[00:00:06] Laurin Henderson: and I'm Laurin Henderson
[00:00:08] Alyssa Saklak: On Better RN, we get real about nursing,
[00:00:11] Laurin Henderson: the good and the gritty.
[00:00:12] Alyssa Saklak: We talk to real healthcare experts
[00:00:15] Laurin Henderson: with the goal of becoming better
[00:00:17] Alyssa Saklak: for our patients, our colleagues,
[00:00:18] Laurin Henderson: our family, our friends,
[00:00:20] Alyssa Saklak: our partners and ourselves.
[00:00:28] Laurin Henderson: Today, we're going to talk to two really incredible nurses, Karena Brown and Katie Doyle, who are both in leadership in different capacities at Northwestern Medicine. Karena Brown is the director of Administration in the Northwestern Medicine Academy, and Katie Doyle is the vice president of Operations for Northwestern Medicine Regional Medical Group. And I'm really excited for today's conversation because it is not, sort of, what I thought it would be. We, in our intro, talk about nursing as the good and the gritty. And I think we really get into the gritty today, which is it's not something that we do quite often.
[00:01:00] Alyssa Saklak: I'm asking some tough questions because I need answers, and I need to know what I can do to keep moving forward. Our hope is to really dive into that a little bit more with some of these gritty questions.
[00:01:12] Laurin Henderson: Karena and Katie both talk a lot about how they are nurses first and then are in leadership, which really resonates with me. I know it resonates with you too. Sometimes when I'm interviewing new nurses, like, for positions here, I like to tell them where I started and that I have always been in the medicine service line because I think it matters. It's important. I am a nurse first. And then second to that. I'm the manager of this unit. So, I love that they both share that with us.
[00:01:39] Alyssa Saklak: I hope the listeners can take away a little bit of advice and wisdom that hopefully both the leaders can share with us today and add into our own lives.
[00:01:47] Laurin Henderson: Nursing really is a choose-your-own-adventure. And Karena and Katie, we'll talk about that a little bit today, but there are so many different ways to grow in your career and they're not all easy, pursuing advanced degrees, getting into operations, moving into leadership, staying at the bedside, whatever that choice is for you is the right choice.
[00:02:06] Laurin Henderson: Let's get into it.
[00:02:12] Laurin Henderson: Welcome, Karena and Katie. Well, I'm really excited to speak with both of you today. Tell us a little bit about who you are and how you got to where you are now.
[00:02:21] Katie Doyle: So, it's a pleasure to be here. My name is Katie Doyle. My role is vice president of Operations for the health network in our ambulatory space. I have been at Northwestern for 19 years and started as a bedside nurse in Labor and Delivery, which is and was my favorite job. I always introduce myself as a nurse first and an administrator second. I feel very fortunate that my time at Northwestern Medicine has really given me not only challenges and support and mentorship, but just an opportunity for my career to go in a place I never expected it to. I would have been fully happy in scrubs the rest of my career. I love nursing. But I'm thankful to be in a role that is at the table to influence how we give health care. My portfolio is primary care operations, and I support our endocrinology teams but I believe that my experience and training as a nurse really helps me do my job as a leader. So, it's a pleasure to be here and meet all of you.
[00:03:18] Laurin Henderson: Great. Thanks so much, Katie. Karena, tell us a little bit about you.
[00:03:21] Karena Brown: I'm a Karena Brown. I'm one of the directors of administration in our Northwestern Medicine Academy. I have been at Northwestern for — hard to believe it — nine years. Started out as a bedside nurse at Northwestern Medicine with you guys.
[00:03:35] Alyssa Saklak: It's a nice reunion to have everyone back together.
[00:03:38] Karena Brown: It is, it's a full circle moment. Yeah, we, uh, have a lot of history together. And so, I think that you all have helped shaped a lot of my nursing career, but I'm like Katie. I could totally put my scrubs back on and do it again tomorrow. I am a nurse first. I love being a nurse. and my path has always led me through leadership. I've just kind of said yes to opportunities and did not think that I would be a director in our Northwestern Medicine Academy, but here I am, overseeing clinical education for nursing for the system, some accreditation, as well as library services, clinical schools and training programs, which is something that's really exciting. And then CME, which is our medical education for our physicians. I cover a lot of different areas, and it's really fun because I get to flex my brain like I did as a nurse, I'm switching gears a lot during the day, which is what I loved as a medicine nurse. Medicine is my favorite discipline of nursing to be in. And I wouldn't trade any of my nursing experiences for the world. So, super excited to be here and to chat with you guys.
[00:04:35] Laurin Henderson: Thanks Karena. So, you both are incredibly busy, have huge portfolios that you're overseeing, but I love that you both mentioned how you're a nurse first. Why as leaders, why do you think that it's so important for nurses to have a seat at these tables in all areas of health care?
[00:04:53] Katie Doyle: Well.
[00:04:53] Katie Doyle: I think nursing background does a couple things. By having the experience of practicing as a nurse, I hopefully am able to empathize and understand the processes that exist when there's patient care happening. Even though my experience was inpatient, even in the ambulatory space, I can appreciate what a busy day looks and feels like because I've lived that busy day. I can appreciate the emotional tension of conversation can feel to a clinician and their team when someone gets bad news. Even in the ambulatory space, I think that appreciation helps me to support the teams better and understand what they're going through. The other thing that I did not appreciate as much as I thought I would is that by the experience of practicing as a nurse, I am confident in speaking the clinical language and that helps translate improvement work and support to our physician workforce as well. What nurses have that some of our MBA colleagues don't always get is that experience of working a patient case together with a physician and that can exist in many different platforms or strategies. We can be doing an improvement project on how to improve triage for patients and by having the ability and experience of having hard conversations with physicians, it helps to be able to understand what's needed to get to yes and getting to yes is really our goal as leaders.
[00:06:09] Alyssa Saklak: And Katie, you said a lot about the ambulatory care setting. For those who are listening that may not know what that setting looks like, how would you describe that versus like inpatient in a hospital where you were a labor and delivery nurse and now kind of working in a different healthcare setting. What would that look like for those listening who haven't heard of that?
[00:06:26] Katie Doyle: The ambulatory space is essentially whenever most of our nurses are going to their primary care physician or perhaps your OB-GYN or specialist, we, depending on the discipline, can see, each physician can see about maybe 20 to 40 patients in a clinic per day. And in that visit, not only are they assessing and diagnosing, but there is a team behind that physician that's helping to answer and manage messages that come through. We all leverage MyChart to our physician team in the ambulatory space. And we also do triage for patients that have concerning needs. That triage is really important because what we hope to do is decant from an inpatient perspective, what's coming to the ED. And so, what I love about the ambulatory space is that we provide care to patients and hopefully help them in prevention and chronic disease so that they don't need the acute environment. And then after the acute environment helps our patients and gets them better, the ambulatory environment follows through on that plan of care to keep them out of the hospital.
[00:07:22] Alyssa Saklak: Karena, what about you? You know, it's so funny that both of you kind of mentioned something very similar, like I loved the scrubs, and I loved working at the bedside, and I would have never guessed to be where you are today. What inspired you to go in that direction? Similar to Katie's story?
[00:07:37] Karena Brown: Yeah. I think I've always loved being an inpatient nurse at the bedside, taking care of patients and doing that hands-on work. And that's something that I think has shaped my decision-making process and how I move about my life to be quite honest. But I always had a knack for leadership. I always joke and say, when you charge train, you get a hold of that pager, and you're like, “Oh baby, this is so great. I get to call the shots now.” But it's a lot more than that. And so, I think learning how to be in charge and pulling your scope from just the four to five patients that you care for to now you've got, depending on your unit, 30 patients, six to seven nurses, three to four PCTs, a secretary, and you're, kind of have a hand in making sure everybody gets what they need and is able to escalate care. And again, you're constantly switching gears. And I really liked that. I thought it was really fun and enjoyable, and it made me think about how to solve larger problems for the staff to make their life easier, which ultimately makes the patient's life easier and their outcomes better. And then management came next, which I really didn't see. I took an opportunity to cover a manager who was on maternity leave. And it really showed me how I have a passion to help the employee side of things a little more in the high-level patient concerns and issues. And you learn a lot about staffing and budgeting and supplies just kind of going day by day and just tackling things one at a time. And I think that really showed me that it's important for nurses to have a seat at every table because we're going to touch it, use it, have an impact in it, implement it. It's going to affect our day, which is going to affect patient days. And I think we've all been there where we've been in situations in the hospital and outside where a decision is made or something's happening, and you're like, who made this decision? Like they must not know what I do and how it affects me and my team. And I think that gave me a passion to kind of be the change. You know, we talk about how we want to be a part of the decision-making process, well that means that there are nurses that have to kind of work their way up the ranks and get into rooms and get seats at the table to really help be a part of making those decisions. And I think Northwestern Medicine does a really good job of putting nurses in positions of leadership to help inform projects and initiatives and changes that are happening because they ultimately know that a nurse is going to have something to do with in any ways. And I think that's been part of the reason why I kind of felt like I needed to keep going and take on more leadership opportunities because somebody's got to do it. There's got to be a nurse that's out there doing it. And I'm happy to be that person. And it's taught me a lot about myself and my life. And, there are people who came before me, who spoke up about me in rooms that I wasn't even in, and I get to do that for others now who I think are change makers and really strong nurses and do really good work.
[00:10:06] Katie Doyle: I also think if I can add to that, Karena, is the nursing framework is about assessment, education and empowerment. If the medical physician framework is about a differential diagnosis, finding the answers. And then what I think is so powerful about nursing is just by within that framework, our whole job is to understand what's going on and then empower the people around us, right, to do their work and teach them on that work. And so, from a leadership perspective, nursing, I think, sets up all of us in a way that other clinical models don't. Without that desire for empowerment, I think the best situation is when our patients have self-determination and they start making their changes on their own and they understand their disease. And nurses care about that part. Nurses don't think a patient should listen to us. We think a patient should understand us. And they should understand us because we educate them and help them make a decision for their life. And so just within the framework, I believe nurses are really strong leaders. And when we're at the table, you'll notice when you're at an interdisciplinary table, the nurses are the first ones that bring it back to the patient. And the nurses are the first ones to advocate for the patient and what the patient wants in their care. Not what's right from a differential diagnosis, but what they want. And that is powerful.
[00:11:18] Laurin Henderson: I agree. I think that's huge. And as we think about the landscape or the culture of health care, it's so rapidly evolving, even in this, post-COVID world that we're trying to navigate still, even five years later. And we think about it. New nurses coming into the profession. And I think about how different nursing is now than it was eight years ago when I started. And I wonder how successful I would have been, because I think problems exist today that didn't used to exist, or maybe that weren't at the forefront of my mind. So, I'm curious if you, either of you, had a magic wand that could instantly solve one major problem in health care. What would you choose? What would you try to tackle with your magic powers here?
[00:12:00] Katie Doyle: If I could have a magic wand, we would be completely transparent to patients about what health care is and how to navigate it. Healthcare costs would be transparent, expectations would be transparent, the reality of what we can actually deliver would be transparent. If patients understood the cost of health care, they might do more prevention, right? If patients understood how crucial it is to understand how to navigate amongst specialists and who is in charge of your care, they might choose different ways to engage. For example, a patient that is a Type 2 diabetic and sees our Endocrinology team, and now has a really great A1C, they don't need to see endocrinology anymore. They can go back to primary care and open access for our sick patients. We tend to clog up a lot of parts of the healthcare system. And patients go to the ED because they think that's the answer. It's not always the answer. And so I would love to see us focus on our patient's behavior and transparency and how we do care. I think that would really be a game-changer.
[00:12:55] Laurin Henderson: Yeah, I love that answer, Katie. And it really reminds me of season one of Better RN, when we really focused on overall well-being with nurses at the focus. But the same thing translates to the general population too. How do we make the emergency department not primary care for people. People which I think we see a lot of, especially in downtown Chicago.
[00:13:16] Katie Doyle: Yeah. I think expanding upon that. I think if I had a magic wand, I think creating a way for patients of every single background, to Katie's point, to have a clear transparency of what life looks like for them in a prevention standpoint, in an illness standpoint. And I think that has a dotted line to a diverse workforce. And so, I think having a way to magically be able to effectively communicate with us, the things that are important. So, we can ultimately do what is right for the patient and most importantly, what the patient wants. I think, to Katie's point, that's all we really want as nurses. Is this what the patient wants? Is this the right thing by the patient, for the patient and making sure that happens. And I think that's where a lot of the struggles I tend to see. And that was really morally distressing for me as a nurse. I know that I'm doing everything that I can for my patients that I know understand me and I understand them, but what am I missing in the patients that don't, you feel like you're doing a little bit of a disservice. So I think that's what I would love to see. I think it starts with a diverse workforce. And we just don't talk about it enough to your point, Karina. It's so important for us to, as leaders, always be pushing for our workforce in all roles to look and understand like our patients. And I think we just are trying to touch the surface of it, but it is uncomfortable to talk about it, but it's the right thing to talk about. And the more we have leaders like you three, honestly, the better we will be down the road .
[00:14:37] Laurin Henderson: Yeah. Karena, I completely agree with what you're saying. I'm thinking back to my time at the bedside, you know, we have a great Interpreter Services Department here at Northwestern Medicine with a lot of in-person interpreters available, I think that is such a big part of what we do, especially in downtown Chicago. And I agree it does. It starts with a workforce that's representative of the population that we serve.
[00:14:59] Alyssa Saklak: I want to pivot a little bit. I know we've taken a deep dive on some of these really big healthcare challenges that I think, as leaders, really drive our passion and our drive to develop more, learn more, grow more. I'm going to ask Katie and Karena a challenging question: have there been times in your career where you doubted your development? Or felt burnt out from the profession in totality of health care and the massive problems that feels like impossible to solve? Even here, we talk about it and I feel inspired and I'm like, I'm ready to take on the world, but I know that that's not always the truth. And so, I'm curious from, the lens and the journeys that both of you have taken, can you tell, and resonate maybe with some of the listeners of when that has happened to you in your career and how did you get through it or, what were those things that influenced you to keep pushing forward and keep developing when you kind of have those moments?
[00:15:52] Karena Brown: I think we can all relate to, “Oh my gosh, what did I sign up for?” Is this, you know, was I really meant to do this? You know, I am a firm believer that health care is a calling, but nursing specifically you really have to want to be in this profession because there is a lot of, the grime and the not-great, and it's not glamorous. And you really have to be able to manage that. And how do you show back up the next day for your team? How do you show back up for your patients and how do you show back up for yourself? So, I think burnout is a really big thing that happens. I do feel like a lot of the ways that I've combated the burnout is I've really had to self-reflect on where am I allocating my time and where separately am I allocating my thoughts and my energy? Because I think a lot of times when I would have reached moments of burnout, it was self-inflicted. I was the one that was picking up all these extra shifts, not because, you know, there was a need, but I was the one that was like, “Oh, I'll stay for another four hours or I'll come in again tomorrow.” Then I realized that I cannot do anymore because I was so burned out, and I really had to take a step back and think about what am I willing to do that is going to have an impact and a win for everyone and not just like a win for one area and not for myself. I think one of the great ways that I was able to solve to a lot of burnout is: I got a hobby. I got a hobby, and I think that is, I recommend that for anybody in any profession, especially health care, is to have a non-healthcare-related hobby that gets you out of your house, excited about something, whether it's crocheting or going to a workout class, and it refills your cup in a way that allows you to then return to your work environment and be ready to tackle it again. And know that every problem is not your problem to solve. You got to pick and choose your battles. And we have to pivot and focus on something that we can actually have an impact in. You just have to have the ability to let it go and it's really hard. But doubling down on the hobbies, I think that they're a really helpful thing to have, and it helps you come back into the workplace with a renewed energy and you are able to be an effective part of the team.
[00:17:49] Katie Doyle: Yeah, and, Karena, it is important to have a hobby. That's such a great point because we can so easily allow health care to be our life and it is all-consuming. People's stories are all-consuming. Our teammates' stories can be all-consuming. So, I love the idea of a hobby
[00:18:05] Katie Doyle: I will say as I reflect on my 19 years at Northwestern Medicine, each part of my career path probably had different ways for me to work through burnout. When I was a bedside nurse, like, we all can remember a couple cases where I almost thought, “This is it. I'm not going to be a nurse. This is too much stress. I am hurting. I don't know if I can do this job.” And it was the nurses that I worked with that not only helped support me through a really hard traumatic patient experience, but also reminded me of the humanity of nursing and the fact that they've been through similar things. And we have to work with each other and help each other out when these really hard situations happen. And then as I went into leadership, which has been the majority of my career, manager and director and now vice president at Northwestern Medicine, it's always been about, when I get burnt out, I have to pull back and I write down all the stuff that's on my to-do list because I'm feeling overwhelmed so I have to see it. And then I remember what's in my circle of control. So I think colleagues are super important, hobbies are important. When you're feeling burnt out, have the awareness to reflect on what you can do today. What can you accomplish that will then bring you back to your why and re-energize you for the rest of your work?
[00:19:15] Alyssa Saklak: And I love the point, too, of like how health care can be all-consuming, So I appreciate you sharing those things.
[00:19:22] Laurin Henderson: It can sometimes feel in health care like we're building the plane as it's going down the runway, and it's so important to know when I'm done building for today and now it's time to hand off to someone else. This is really such a 24/7 operation, and I do think that it's so vital to have good people surrounding you and, like, Karena, you mentioned earlier in our conversation, good people that are going to mention your name in a room when you're not there.
[00:19:46] Katie Doyle: Yeah, it requires trust. You have to trust that your colleagues are in it for the same reason. And then you go to those that you trust to debrief about what can be different, what can you control and, to be honest, some days are just hard and you're not going to get some wins every day. And that's okay.
[00:20:02] Laurin Henderson: It's not all sunshine and rainbows. I love the way that this conversation has gone because so often, yes, we want to paint health care in this great light and nursing is such a noble profession. And we are so lucky to be responsible for caring for people in their most vulnerable times. But it is really hard. And I think it's, sometimes there's a little bit of a stigma that we shouldn't say that, or that you shouldn't really talk about that because it makes it seem undesirable, but that's the reality of it. We're doing really challenging, important, hard work, and it's not always great.
[00:20:36] Katie Doyle: Yep, and I always say the right work to do is the hard work and that makes it the fun work. It's really a privilege when people let us into their lives to take care of them, regardless of the situation. It's a true privilege.
[00:20:48] Karena Brown: Our goal is to really impact the patient experience, and it is really funny because the reality is that when people do let us into these vulnerable moments of their lives, especially in the hospital. There is nothing glorious about it. It is not pretty. It is very raw. It is very real. It is very emotionally charged. It gets messy. And the nurses are there to be the people, to help kind of hold that space and help move people through the process. In addition to the other care member teams. But sometimes I feel like we have this juxtaposition of we're like, it's not all rainbows that I thought it would be. And I'm like, it shouldn't be, if we're going into this very vulnerable patient situation that is really hard and heavy and messy. Why do we think that we're going to go in and make it sparkle and shine? We're going to move them through the process appropriately, which is hard to do, but that's where the good work is. And that's okay to know, like, I'm headed into the situation. And it's going to give us. A good learned experience to have a better impact on the next patient. And so you go in no matter what. And I think that's to me what nursing is, is nursing is a, no matter what, you learn how to protect yourself and you'd learn how to care for the patients.
[00:21:51] Laurin Henderson: Yeah. And then as leaders, I think it really falls on us. And there's a huge spotlight on this now, thank God, more than there used to be, that the bedside nurses are caring for the patients, but who's caring for the bedside nurses? We have to make sure that we are doing just as much of the hard work to care for them as they are doing at the bedside, and that is what is going to keep healthcare care moving forward. Otherwise, we're going to stall out, and no one's going to want to do this job, which would be such a disaster, right?
[00:22:22] Karena Brown: Yeah, as leaders, it's our job to protect the people at the bedside, the nurses it's a huge part of our job and I think Northwestern Medicine does a good job of taking that seriously and really trying to intervene and do right by the nurses they deserve to have a quality of life just like the patients do.
[00:22:36] Karena Brown: I agree.
[00:22:36] Laurin Henderson: As we close, what would be a quick sort of one-liner piece of advice that you would give to a new nurse who maybe is having a rough time, is second guessing if this is the right thing for them? Katie, what would you say to that new nurse listening?
[00:22:51] Katie Doyle: I would say, give yourself grace and remember why. None of us know all the answers. Nobody ever will, to be honest.
[00:22:58] Laurin Henderson: It's perfect.
[00:23:00] Karena Brown: I think I would say, and this is something that I've learned in my time here is that time and experience are not directly correlated. And I think a lot of people think that, and you would rather have an intense quality experience for a short amount of time than a long time of a lackluster experience where you're just going through the motions. And so as long as you know that, then put your head down and do the good work and things will come your way. And to have perspective — there's so many things, but I think perspective is really important. The best nurses have perspective on everybody's roles and responsibilities, everybody's background. They really seek to understand how the other person that they're involved in ticks and ties because that helps them better to Katie's point, have grace with themselves, with other people, which keeps you in the profession longer than nurses that come in and want to just be high performing nonstop, no matter what, they are the ones that often struggle because they realize that the world is not set up for you to only ever be successful. It would be so nice if it was though.
[00:23:56] Katie Doyle: I also think being curious is really important. I learned as a bedside nurse at Northwestern Medicine that I was afraid to ask questions for my first year because I thought I should have all the answers. And I realized the more I asked questions, the more respect I got, the more I learned, the better care I gave. And so, lead, practice with curiosity. You will be a better nurse if you practice with curiosity.
[00:24:18] Laurin Henderson: I love that. That's so great. Thank you both so much. I feel inspired. Alyssa?
[00:24:23] Alyssa Saklak: Yes. I think this is what we needed. Absolutely.
[00:24:26] Katie Doyle: Well, thank you for this experience. I will say,
[00:24:29] Katie Doyle: It's a real privilege to give back and talk about how nursing continues to impact my career. So, thank you for letting me share.
[00:24:36] Laurin Henderson: Thank you, Katie.
[00:24:37] Karena Brown: This has been so much fun, and I'm so glad that we got to chat and talk about one of my favorite things to do, be a nurse.
[00:24:42] Laurin Henderson: Well, Katie and Karena, this was such a lovely conversation. Thank you both so much for doing the good work and for taking the time out of your busy schedules to talk with Alyssa and I today, I couldn't be more grateful.
[00:24:55] Katie Doyle: Thank you.
[00:24:55] Karena Brown: Yeah. Thanks.
[00:25:01] Laurin Masnari: Thank you for listening. Please follow us wherever you get your podcasts and rate and review the show.
[00:25:06] Alyssa Saklak: We'd love to hear your comments and any topics you might want us to explore.