S012 Liam Caswell High Performance Nursing

Hi everyone, my name's Dex Randall and this is The Burnout to Leadership podcast, where I teach professional men to recover from burnout and get back to passion and reward at work. Hello my friends, Dex here and today I'm very pleased to have Liam Caswell join us to talk about high performance nursing. And Liam's a former nurse unit manager and he's now turned to career coaching for nurses. And his mission is to create a psychologically safe work environment for nurses who can then thrive within their careers. And part of the reason I invited Liam on today is because that's an aim I'm very much aligned with. I really believe our healthcare workers in general do an incredible job under often very stressful, demanding and sometimes unsupportive conditions. So I hope you'll join with me on that one. Because I think really burnout in healthcare has reached dangerous epidemic proportions, as I'm sure many of you would know. And qualified people, nurses, doctors, dentists, general practitioners, so many other specialisations in healthcare particularly are experiencing very high stress. They've been under the hammer a lot in recent years, then they had COVID to tackle. It's just been a big challenge. And I do work a lot with physicians myself and nurses in my own coaching practice. And it's my experience that they can thrive within challenging systems. So I'm really, really keen to hear Liam brings a big depth of experience. He's been around in nursing for quite a long time on the front line and he works with a lot of students and graduates too. So I'm very keen to hear what he's got to say about that. By the way, Liam is a fellow Sydneysider and it's not often I get to speak with an Aussie on the podcast. I'm particularly happy about that one. And welcome Liam to The Burnout to Leadership podcast. How are you enjoying the summer so far? Thank you so much. I'm thrilled to be here. I'm enjoying the warm weather for sure. I'm an adopted Aussie originally from Scotland. So... But yeah, I'm so excited to be here and we're literally down the road from each other. That's right. I'm giving you the... Don't worry I'm giving you the Aussie badge, even though I can hear it from your accent. Thanks. You're probably not born here. I wasn't born here either. No? Uh huh. But yeah, we live pretty close to one another. So it's kind of funky. All right. So I got a few questions I want to ask and I think it would be good to start first of all, tell us a little bit about yourself and your own kind of early nursing experience. Yeah, for sure. So I've been a nurse for about 12 years. I studied and trained in Edinburgh in the UK and very quickly finished my degree and got down to just outside London Reading and I started my career and I went into the full experience of healthcare. I've worked in a very busy medical unit and from there built my career through acute care. So moved from acute medical nursing into intensive care nursing and then migrated across to Australia and just continued to build on that. And I built my career very quickly. Within less than 10 years, I was up to nurse unit manager, managing a team of 50 people, large budgets, dealing with all of the challenges that healthcare present pre pandemic. And then from there, I had a little couple of bites of burnout and experienced a lot of challenges on that path. I was about 28 years old by the time that I was leading this team and I kind of hit a bit of a brick wall where I no longer really kind of felt the passion and the love for nursing anymore. And at that point I was looking for a coach, I was looking for answers outside of me and I found one. It was like a general career coach in Canberra at the time. And that's where this journey for me transitioning from healthcare into coaching kind of all started. Oh, cool. So you were working in Canberra, were you? Yeah, I've worked across the UK, Canberra, Sydney and Fiji as a clinician. Wow, Fiji must have been interesting. It was quite the experience for sure. Yeah, it was a great opportunity to see how really, like, we are so privileged and lucky, in Australia and in the UK with the resources that we have and also showed me that true happiness and gratitude and all of that is just so integral. The Fijian people were so beautiful and they had very little but they were so, so grateful for what they did have. And that's something I took away and took back to my clinical practice was just immense gratitude for the access that we have to everything. It's incredible in comparison. Yeah, isn't it amazing? Sometimes I stop and pause and think about that too. Actually, I was interviewing last week, another guest, Andrew Lustig, who is a naturopathic doctor, who went from running a media company in New York to running a humanitarian aid in crises all over the world, including sending medical aid to Ukraine. And that was quite an epic conversation and sometimes the reality, the sheer reality check of going somewhere different is quite a blast in the face. Yeah, absolutely. And just the community connection, we went out to rural communities and we would be in the community halls, like running clinics and doing minor procedures with absolutely nothing. A little scary, but at the same time, just so grateful. And that's something that I really took away is that all that happiness, that gratitude, we're often as clinicians, we spend a lot of time looking for it externally. And that was a real reminder to me at the point where I burnt out actually quite significantly, it was like a realignment. You have all of this internally, you just go and find it. A good point really, because we feel so disconnected in burnout and some of that is about Western culture and the culture of individualism and how we're supposed to be individual performers. That's actually not how humans work. So I think it would be very interesting to learn how many people in Fiji get burned out. Yeah, that would be fascinating actually. Yeah. I couldn't help but notice how the clinicians, despite what they had access to, absolutely just loved the work that they were doing. I walked through the hospital and it was falling down around us. Like the hospital was not in a good state and there was people in the corridors and the clinicians just loved their work. They loved it despite all of that. It's a good reminder to me that, it is what happens in your mind that ultimately determines how you perceive an experience. And that was the first kind of indication for me that there was something not quite right in my experience of healthcare. Because I had led... Up until that point, I believed that healthcare was the issue. And I believed that the industry was the challenge. And I found that to be quite different when I went to Fiji and could see that there was some clear challenges, but yet they were all still really happy and grateful and driven and motivated and passionate about what they were doing. And what did you think the difference was between their situation and your situation then? Oh, at the time I couldn't put my finger on it because I didn't have the insight, I didn't have the awareness. But now looking back, I can just see, community connection and their mindset about the work that they're doing. Like the immense deep gratitude, the thoughts that they're having about their careers, I think is what would get them through those days. They were really deeply connected to why they did what they did. And they were really clear on that. I've worked with nurses that had like populations of like 5,000 people that they were looking after and they just loved their job. I can't imagine here in Australia saying to one nurse, "Hey, you've got 5,000 patients look after them." It would be... It would not go down well here. So interesting. I mean, to me, that deep connection of community is immensely supporting of us, in our human resilience and state of well being. It's irreplaceable, I would say. So it's interesting that that's the foundation on which they were able to love and feel grateful for their work, even under what we would think of as perhaps more primitive conditions than in the Western world. I think it's very important though, that people who have grown up in Western society don't become self critical if they can't be in love with their jobs because it is to some extent cultivated at a societal level. And I don't want people to blame themselves for being unable to be as grateful and engaged as those Fijians. I think they enjoy a much more integrated, actively integrated sense of community, that for sure is helping them stay buoyant and become grateful. But yeah, so interesting hearing that. So you've had a lot of years in your own nursing career and you've had surprise, surprise, exceptional success, which most people who end up in burnout have had. Where did you kind of start to get this inkling about mentoring other nurses, looking out for other nurses? I think that it's on reflection, something that I've been doing the whole way through my career. I feel like I've always wanted to help other people and kind of nurse the nurse, so to speak. And as I moved up through my career, I started seeing gaps in support. And I also recognize that every time that I moved up into a new level, that I kind of had to shed a bit of an identity. Like I had to move up and re identify myself as a nurse educator. I wasn't a floor nurse anymore and there was challenges that came with that. And I was also looking for the support. So I wanted to be that person that provided support to students and graduates and nurses with great experience. So each level educator, nurse unit manager, working in the university system, I saw an opportunity to help clinicians. And what I started to recognize is that we're amazing at the job that we do. We're amazing clinicians. We're great healthcare workers. What we're challenged by is the non clinical side of healthcare. We're not taught how to manage our emotions. We're not taught how to manage change and all of the things that come up in healthcare day to day. And that is where the biggest gap is. So high performance nursing was born and I really was trying to explore what is it the nurses really need and want in their careers so that they can choose to love their job again and really find that passion. Because we all come into it for a reason, right? We want to stay, we want to be here, we want to help our patients. But when we're really just focusing on the clinical aspects, it's not sustainable in my experience. Nurses are lovely. I've got to say, I have days when I wish I'd grown up in nursing. And though I see the state of nursing now, the kind of people that have had a lot of years in nursing are amazing humans. Seen a lot of life. Yeah. Yeah. I think we experience a lot of things that, you know, the general public don't anticipate that we would experience. We see the high highs, the low lows. And it's kind of like, it comes back to me, I think it's kind of a little bit crazy for us to just expect that we can manage all of that without support. I think that it is a huge ask. It's so detrimental to our own human well being that we don't see that and we don't value support a little bit more in the industry. It's not... One day you can walk in and there's a birth and the next day there can be a cardiac arrest. Like it's, or that could be within minutes of each other. How do you manage yourself through that as a human first, nurse second? I think is the question that we're yet to answer. I had an experience of that too. I mean, I had my heart attack when I was in hospital for a while and then I got hit by a car and I was in hospital for three months. And that was the biggest experience of vulnerability I think I've ever had. So my observations about the nurses in that time and what total lifesavers were, were pretty interesting to me. It was like being in a whole new world. But it was a whole new world. Anyhow. So you've been on this kind of progression path. I see it from your bio, you've done a bunch of studying about the human psyche, really NLP and stuff like that. And now coaching. When did you bring the coaching in? What happened there for you? The coaching for me came about because I was in a really negative head space around blaming the industry. I ran a lot of stories that, the industry was the problem that, when we have ratios and when we have all of these things and when my manager is better, my life will be better. And I started to question that. I started listening to podcasts, and listened to this podcast, full circle moment. I listened to Life Coach School podcast and started recognizing that I was giving away all my power, right? And I could see it amongst my peers and they were so distraught about this idea that like I've trained so hard, I'm here and we give so much to the industry and to our patients. Like what are we getting back? And I was like, maybe we're asking the wrong question. Like how can we give it to ourselves? How can we bring it back within our power? And that for me was a catalyst for starting coaching and exploring the world of coaching because I started to understand that maybe it's not about the industry changing. Maybe that's never actually going to happen in the way that we perceive it to be. And maybe there's an opportunity here for me to realign and to see what truly is possible for me. And when I made that shift, not comfortable, but fully embraced it, went into it and it's opened up a whole new world. As you talk about when you go past that buoyancy that now I'm like, "Oh my goodness, I feel like my what's possible for me and for my clients, there's no limit," which is so, so exciting. Yeah. And I think people, when people transition from a profession into coaching, they're such a gift to the people who remain in difficulties in burnout in that profession because they understand both sides of the coin by them. 'Cause it sounds like, I think you went through coach school. When was that? This year? Yeah. So I just finished about a month and a half ago. Yeah. Super. We could have run into each other there 'cause I'm an instructor on the same course. Oh no! But we didn't. Anyway, so looking back then, is this on the back of the kind of COVID experience as well? Do you think that's exacerbated things? Was that a factor for you or not? Yeah. I think I worked through COVID, the first part of COVID and yeah, it was really challenging for sure. And I think that now post COVID or still, I mean, COVID is still a thing, right? That we're now in a situation where it's just, we're just added other layers of complexity on top of what was already there. And now more so than ever, people are really feeling like they have no options. Nurses are thinking that they have to leave, they have to go and work at ALDI or do something outside of nursing to be able to enjoy the life again. And for me, like doing this coaching training and connecting with people like yourself is giving me an opportunity to take it all back to them and be like, "Hey, actually you don't have to leave, but you can choose to love your job again. You can work through all of this because we need you here," right? Like we have a huge deficit by 2030 that like tens of millions of nurses is going to be short globally. And we have to do something about that. People aren't even seeing it now as a profession that they want to consider.

4 nursing ratios isn't going to change that. And I think that it has to... It's bigger than that, right? It has to be the internal shifts, the culture shifts, the support, the coaching, the connection, at a nurse level that will help us really change and influence the industry. I think the longer that we wait for the industry to change the more disappointed we're going to be. Yeah, I hear that. So what do you think then, if you're going to encapsulate what you think the biggest challenges are for nurses these days, what would you say? I think it is managing their burnout. I think it's prevention and management of burnout is the main thing. And for me, what I've noticed and what comes up time and time again, and the work that I do with my clients is, is all of the mind drama. Like it's all of the stories, right? That we run about what's possible for us. So we have a lot of self limiting beliefs. We are people pleasers. We go through imposter syndrome, we have anxiety, we have a lot of self doubt. We externally source all of our answers, all of the time we're always needing to go to other people for answers like doctors, physios, OTs. So we get into this habit of looking outside of ourselves for the answers. And I think that one of the biggest shifts for nurses is really about, how can we tap into our real power? How can we really tune into what it is that you want and aligning your career with that? I think a lot of us are told industry narratives and myths like you've got to start in acute medicine and then build your career. And that's not necessarily true. If you're somebody that doesn't like the hustle bustle culture of acute medicine, go and work in community nursing or work in a non clinical role. But we have a lot of thoughts about that. And I think that that's our biggest challenge is how do we map all of that out and deal with all the non clinical stuff. Interesting. So when people come to you and they're kind of a bit crispy around the edges, a little bit fried, what's the thing they say to you first of all? What do they say to you is their biggest problem? It varies, but typically like it's not possible for me. There's not a role that's suitable for me. I don't have enough experience. I don't know how much longer I can do this. There are things that come up. There's no hope. There's a lack of hope in healthcare right now where clinicians genuinely look ahead of themselves like I did. And they're like, I don't want that. That's not what I want. The roles ahead of us are just not perceived to be of value and not sustainable. I had those beliefs as well. I got to NUM, Nurse Unit Manager and then I looked above and I went, I don't want that. I don't want to be dealing with this despite the changes that I could make. So there are a couple of things that people often offer. Yeah. And I was interested, you mentioned a little bit earlier that there was an identity shift for you each time you ascended to the next rung of the ladder. What did that identity shift look like for you? What was it? I think for me it was about letting go of the... Really it's about the thoughts that I had about myself right at each level. And it was about me re identifying myself at each level as I moved up. So there's a perception when you move from floor nursing to like nurse educator that you're no longer responsible for a patient load, right? But you're responsible for a team of 50 people. So how do you make that shift? How do you then transition your mindset to be able to manage that work and also see yourself in a new role? I think a lot of us think that we have to have a certain amount of experience before we can do something. So like we're trying to work out the how before we get there rather than just doing it and then working at the how on the journey and embracing all of that. So every time that I moved, I was confronted by my own thoughts and my own perceptions. And I was worried about not being good enough and all of those things. And there was never any support there to help me through that. There was never any... And it was just kind of shrugged off. It was like, "Well, you're here now you're capable, get on with that type thing." And as you move up and you get to nurse unit manager and you move up to assistant director of nursing, the challenges are much more complex. And you then have days where you might have six to 10 patient complaints and maybe some staff performance issues. And as a nurse from the floor, that's great as a clinician, you're totally ill equipped with managing a team of 50. So of course you have all of the mind drama about that, all the stories, all the feelings, and yeah, it becomes really burdensome without the right support and the tools. So that's something I'm passionate about moving forward is how can I help people transition within their careers so that they understand that imposter syndrome is part of the process. Understand that not feeling confident in yourself is optional as you move forward and that we can work through that together. So yeah, that's kind of what I experienced as I moved up. Interesting. And that was kind of my experience being promoted to leadership from technicians. So almost everybody who comes to me in one way or another has been a very top class technician, if you like. They're on the front line, they're taking the action. They're very task orientated. So this is healthcare, this is IT, this is accounting, this is all kinds of other disciplines. And I think it's very rare for people ascending the ladder to really be taught how to be a leader and what's important when you're a leader, how to think about yourself when you're a leader, how to behave, what skills you need as a leader. I think very few of us received that education. And I work with a lot of executives who've been promoted to executive because they are top performers in their technical aspects of their role and they're completely at sea. And that's, I think, for a lot of people, the self criticism, the imposter syndrome kicks in, right about then and they start seeing themselves as inadequate, which if you've been in a career for 10 or 20 years, inadequacy is not a familiar feeling. We're used to unconscious competence and suddenly we're thrust into conscious incompetence. So it's very hard for a lot of people. I think it's quite regrettable that we don't teach leaders to lead a little bit more. Yeah, I totally agree. That was my experience for sure. And I think looking around me, it was just accepted. That that was the norm. And I'd love to question that moving forward in my coaching, why do we choose to set people up for failure in these roles? And how can we better prepare them so that they can step in?'Cause it's so integral, right? Those positions are so important in team development and culture and in healthcare in particular right now. The last thing we need is instability at the leadership level. We need really strong leaders that are able to manage the mind, do all of the things and lead the team through immense periods of change. Oh on the flip side, when you're coaching people who are going up into management, when you're coaching them into the kind of leadership skills they need in order to mentor and support their staff, in order to support all of the people, the ancillary people around them and patients and everybody else, you're kind of a supercharged force for good. And that's what I love about teaching people leadership is it just amplifies the deep goodness and their willingness to serve and support people that they inherently have. Yeah, I love that. I'll take that. That's you, right? That's the job you do... Yeah, totally. Amongst other things. Amongst helping people make career moves and make more money. Yeah. Well, I'm curious on the money side. So what do you think about nursing pay in Australia? How does that compare internationally? That's a great question. So I'm a bit controversial on this here in Australia, but I think that Australian nurses are paid well. We're paid well. For sure, we could be paid more. I think that there's not a number where we're gonna be happy. We could always ask for more, have more, we deserve more for sure. Coming from the UK, it's a third, a quarter of the salary that I make here in Australia. Wow. And in fact, as I built my career, it was considerably more, almost double the salary here in Australia. So the pay here, I believe is good. I think we could be paid more for sure, but I also understand and know that when we're paid more, it's not necessarily gonna change anything. And if they would, just pick a new number and wanna keep moving towards that. So I do hear it a lot of times where nurses want more money, but interestingly, a lot of people that come to me are not looking for that. They just really wanna make an impact. They just really want to find the work that lights them up. And when I question them and say, "Well, any work can light you up. It's really... Any job that you do could potentially light you up." They can have a look at me a little square eyed and like,"Are you sure?" And we explore that and we really truly get to know what it is they're looking for. And typically it's not money. You know what? I agree with you. Typically for any human in a workplace who's not very satisfied, it's very rarely money if they have enough money to keep their families. Obviously, there are people on the poverty line, I'm not talking about those people now, but people who can afford to keep their families beyond the basic needs, money is never the real issue. Fulfillment, yes. Following the vocation that you came in there for, yes, but money is not usually the number one driving force. I would sit with you on that. So when nurses come to you and they're in difficulties and they need some help, what do you think? Or what have you found supports them the best? It's really interesting 'cause I've been doing this for two years now, just full time for this year. It depends really, because I work with a lot of graduates who are coming into the system, into the industry. And for them, they think that they just come to us for application support, like CV, resume, cover, all of those things. But what they take away from it is being able to manage the mind, being able to manage their imposter syndrome, the self doubt, the fear, the transition at the graduate level. And then as I work with people higher up in their career or further along the path, it comes down to options and possibility and busting through a lot of self limiting beliefs about I need a masters for this. And as a chief, I call myself a chief certificate collector, I know it all not to be true. You don't need these things to be able to progress and develop. You don't need the double master's and you don't need the coaching so... None of that is required. And it's about giving at that higher level, it's about giving people the permission to just do what they wanna do and to embrace the risk of quote unquote "failing" and just trying it. So we create a container where they can come and they can fail, they can succeed and we help them through that process from start to finish. Oh, cool. And yes, I did see from your bio that you're a card carrying certificate collector. You gave it a red hot go aye. Oh, definitely. At least I tried, right? You tried. But it's brought you to a beautiful place. I think it gives us a real breadth of knowledge to understand and delve into a lot of different subjects. I'm a constant learner myself. I find that just understanding human nature is a full time job, really. So what would you say then if a nurse came to you and said they're thinking of leaving the profession, what would you say? Sorry Dex, I lost that. I didn't hear the first part of the question. What would you say to a nurse who came to you saying they were thinking of leaving the profession? I would get really curious about why they're choosing to leave. And I would really want to explore, is it just a story that we're creating in our mind that our subconscious mind is offering us? Or is it something that they genuinely want to pursue and explore? And what does that look like for them? I think a lot of times it is a reactive thing. I know from me, I was like,"I'm leaving. I've had enough." And I was on Dr. Google trying to find all of the roles and all of the things that were gonna make me feel better. But I would be really exploring their thoughts about their work as a nurse and really opening them up to the idea that they could stay or they could find something else within nursing. It doesn't have to be clinical. And this is the biggest challenge that I have with nurses is that they think they have to stay clinical and that the moment that they leave clinical, that they're gonna lose all their skills and they're gonna be less of a nurse. And in fact of the genites, obviously not factually true. And just giving people that permission to explore, sometimes is more than enough. Sometimes they just come and have a call with me. I tell them to explore and to think about what their options are. And that's enough of a catalyst for them to just move forward. Other times we've gotta dive real deep into why did you start your nursing? What's your why? What are your values? What do you want it to look like? Did you know that you can create the life that you want within nursing you don't have to conform to what we've been taught? And you can create from that place. Sounds beautiful. Next time I'm a nurse, I'll come and speak to you. Thanks. All right. It's been great going through some of my burning questions with you today. Was there anything that came up during our conversation today you wanted to make other comments about than sitting there in your mind trying to get out? I did have something earlier, but it's escaped me now. But I just think in general, the biggest challenge as you asked that question, it brought me back to burnout. Like it is burnout. The biggest challenge right now in healthcare is burnout. And I think that even though I provide career coaching, a lot of the stuff that I do is around managing components of burnout and destigmatizing it. I think that it's so important to just... It kind of is an expectation the way that it's set up right now. So it really... I get a little upset when I hear nurses beating themselves up about experiencing it. So it's part of the process and we haven't been trained with the tools to succeed in it. So, so glad that people like yourself are doing this work. You too. I'm glad that everybody who supports people in healthcare is doing so. It's such essential work as far as I can tell. Totally, yeah. So in summary today, I could ask you more questions, but I really wanna ask what you've got up most in your mind right now. What's the current project you're working on and what would you like to share with our listeners today? Yeah, for sure. So I'm always working on lots of things, Taipei personality. But right now I'm really focusing on how can we get in front of more nurses doing that through our podcasts, high performance nursing and through coaching. Coaching isn't really a thing yet in healthcare here in Australia. It's not really integrated into nursing culture. We talk about mentorship a lot. So that's my big goal for next year is really leaning into how can we bring it to the masses in healthcare, get in front of more nurses and midwives to help them thrive within their careers, build a sustainable career that they enjoy, that they're passionate about with all of the tools to succeed. Amazing. And where can people find you? I would really encourage nurses who would like to improve their career or even fall back in love with their career or even leave their career to come and talk to you. Totally. Where can they find you? Yeah, we're at High Performance Nursing across every social media platform and we're at liamcaswell.com is the website. Okay, fantastic. Well, delightful speaking with you today. It's been really an interesting episode and I do hope you get some people come to you and pester you with questions if they're nurses after this. Anyway... Thank you. Thank very much for being here. Thanks Dex, thank you. It's a pleasure. Okay listeners, if you are suffering from burnout yourself, if this has raised questions for you, you are also welcome to come and talk to me. We will discuss your burnout and how to fix that. The link will come after this and it's also in the show notes. If you're in burnout and ready to recover, come and join my Burnout to Leadership Program. You can book in to talk with me at burnout.dexrandall.com. Just tell me what's bugging you and let's make a plan to fix it.