Podcast Interview Jennifer Thietz
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[00:00:00] Jennifer, I'm really curious. Firstly, just wanted to acknowledge the work you're doing and hearing you on the podcast that I listened to really enjoyed the interview that I heard there and some of what you shared about your perspective on, on nursing and nurse leaders as well.
[00:00:16] That's what prompted me to reach out to you and I'd love to hear what the origin story is. With you and your work and how you got into what you're doing.
[00:00:25] Yeah, thank you. I'd love to do that.
[00:00:27] I have been a registered nurse for over 34 years now, and I actually started off in Africa. I grew up in Zimbabwe, and when we were 18, we couldn't do nursing in Zimbabwe, which was the old Rhodesia. So we all went off to South Africa, and I started training when I was 18 in South Africa at Rhodesia Hospital which is where Professor
[00:00:54] And it really enjoyed my training and knew I always wanted to be a nurse. And the minute I finished [00:01:00] as a nurse and midwife, I started working in South Africa and was in acute care. For the 15 years after I trained and then in about 2003 we decided it was time to immigrate. And so we were very lucky.
[00:01:12] We got an international sponsorship, which I believe is happening now, although more difficult for nurses. But at that time in 2003 we were able to have it smooth sailing and we arrived in California and I started working at the bedside in California. And have been working there until at the bedside and leading a team of nurse navigators until April last year.
[00:01:35] And at that point, we have, we moved to Mexico. So I've had a lot of experience nursing, as I said, 34 years as an RN, but over 20 plus at the bedside. And so I feel I have a lot of insight into what is happening in nursing currently and changes that I believe need to take place.
[00:01:55] When you say what is happening in nursing currently, in your opinion, it [00:02:00] is happening in nursing from your perspective.
[00:02:03] I think we are facing the biggest nursing crisis in history. I think that we are in a real jam at the moment, and I believe it's almost like a precipice that we're going to fall off and we're going to, and healthcare as we know it is going to cease to exist.
[00:02:19] And the reason is related to mostly nursing, I believe. We are as nurses 50 percent of the entire workforce in healthcare, and we touch 90 percent of patients. And although everybody is struggling at the moment in healthcare, because we're such a big group, the biggest group of all, I think what happens to nurses and how we are able to provide care is a ripple effect and it goes out to everybody.
[00:02:46] And we are in a crisis and if something doesn't change soon, Trace, I believe that the healthcare as we know it is going to cease to exist.
[00:02:56] So what do you think are some of the things that have [00:03:00] contributed to that crisis? I know, as we look back over the last two years, it's easy to point at COVID 19 , but I think that one of the things that I get is a repeating message from nurses and also clinical leaders is that, hey, this has been going on for a lot longer than the pandemic. The pandemic revealed a lot of things. So what, from your perspective, are some of the reasons why this crisis is happening?
[00:03:25] Compassion fatigue and burnout has been around for a very long time.
[00:03:30] In fact, the first article that was written that described this phenomenon was in 2011. And it was an article that appeared in a journal and what the what the researcher had noted was that nurses in the emergency departments were beginning to burn out. They were starting to feel irritable and. They were having insomnia, they were having GI symptoms, they were just not happy and they were finding that they couldn't perform their jobs like they wanted to. And [00:04:00] this was the beginning, I think, where they noticed that nurses just didn't have everything that they needed at their fingertips.
[00:04:06] To perform their jobs. And part of the reason I think at that point, and it's got much worse is because we are a profession that is extremely task oriented. Everything that we do is around tasks. And when you are tied up with tasks, you tend to be distracted and you are not as present for your patients, for your colleagues, for your physicians, and even for yourself.
[00:04:32] And so I think, with the change in in the Obamacare, the Affordable Care Act, that was also a big change in the way care was provided, and there was much more emphasis on tasks and making sure that patients received patient centered care. And when this was going on, they didn't think about giving nurses more support.
[00:04:53] They just said we are looking at our patient scores. We're getting, we are getting paid according to what those patient [00:05:00] scores are telling us at CMS and therefore you need to do X, Y, and Z, which was more than what they were doing. Previously. And so it just climbed and climbed more and more jobs, more and more hats, and less time to perform them.
[00:05:13] And so it got to the point where they had nurses would come into the unit and they would put their head down and they would have 50 tasks that had to be done by the end of their shift. And they didn't put their head up. Apart from saying a brief hello, maybe eye contact for a couple of seconds. And then it was back to organizing CTs, carrying out orders, etc.
[00:05:33] Going in and doing tasks that were non specific. For example, handing out food trays. Or taking patients to the bathroom because all of this extra auxiliary help had been removed. And so it just got worse and nurses are now really clinically burnt out. And I think it's a global phenomenon.
[00:05:51] I've been speaking with nurses in Canada. I've been speaking with nurses in Australia and New Zealand and of course, South Africa and coming from the States knowing [00:06:00] firsthand what's happening. I think this is a global phenomenon that nurses are not getting the support that they need.
[00:06:11] so that I really listened to you before and heard was that you said something really bold that surprised me. And that was that in your opinion, the way out of this crisis is through nurses and nurse leaders. And I'd love it if you could just elaborate a little bit more on what you meant by that statement. And if you could just share with us your perspective on that.
[00:06:36] Yes, Trace, I'd be happy to. So I do believe that the crisis has fallen on the shoulders of nurses. And I believe that if nurses and nurse leaders are given the opportunity to make changes, which they know they need to make, which they would like to make, but they're tied by their organizations, obviously, to a certain extent, and very tied by [00:07:00] budgets.
[00:07:00] But if nurses were able to nurse the way they wanted to, and nurse leaders were able to give nurses the support that they felt they needed, this healthcare crisis would never have got to this point. And we would not be standing at the precipice waiting for a complete breakdown in healthcare.
[00:07:20] Nurse leaders are they, I take my hat off to them because I think they are in a very unique and challenging position. They are the bridge between nurses who are bedside nurses, majority certainly in the hospitals of bedside nurses. And then you have your charge nurses who relate very closely to bedside nurses because that's where they work.
[00:07:40] That's the arena. And then you get into the nurse leaders who really are the bridge between nurses charge nurses and leadership, they are the in between that understands both sides. So they understand that they have financial goals and they need to meet these.
[00:07:55] And with COVID happening, with budgets being so turned upside [00:08:00] down with the shortage of nurses, et cetera, they have been up against an incredibly difficult. And they have been trying to keep both groups in, stable and in the air, but I don't think they have the support they need to in order to keep both sides happy.
[00:08:17] So I have tremendous respect for those leaders.
[00:08:22] Clinical leaders are in Canada just a linchpin for all of the work that's got to be done on the ground by those frontline staff. And one of the things that we're really doubling down on in Canada is psychological health and safety. And this idea that if we can create a safe space and reprioritize connection with one another and support that we can move in a different direction.
[00:08:51] And one of the things that I've learned in working with people in healthcare is that the old culture is, yeah, let's sacrifice ourselves to take care of [00:09:00] other people. And that never works. And we know that. And yet. There's a sense of anxiety and worry that a lot of clinical leaders have about putting themselves first and just learning how to give themselves what they need.
[00:09:14] So I'd love to hear what your perspective is on psychological health and safety and how that plays into some of the philosophies that you have.
[00:09:23] So psychological safety and wellness is vital to the performance of any job. Let's face it, whether you're a bedside nurse, whether you're a janitor in the hospital we all have our roles, whether you're the CEO or the COO.
[00:09:38] We all have our roles and we need to feel secure in order to provide excellent care. There is no two ways about it. And I think what's been happening is Because we have been so focused on tasks, many of us, including that the nurse leaders they've had to double down and just lose a lot of the [00:10:00] distraction that's been around them, which is, which includes connecting with people.
[00:10:04] And so this breakdown has resulted in. In a silo, in, in loneliness, in working your own job and not having the support that you need to have, not having the time to go and can make those vital connections. And it's happening from the bedside between nurses, nurse colleagues, and patients all the way up to the very top, because everybody I think is busy.
[00:10:27] I think there are very few nurses or, any positions in hospitals and healthcare in general at the moment that where they're just sitting back and being able to provide care the way they want to. I think we're all on a timeline. We have definite tasks. We have specific expectations and we've lost this connection.
[00:10:45] And and so it is vital. And I think that is one of the reasons people are burning out is that they're not, and certainly I experienced burnout, Trace. And I can, give you an example. I have been in oncology care for a lot of my [00:11:00] lifetime and I've loved it. I've loved the whole of the oncology landscape.
[00:11:04] It's an exciting field because there are new the new treatments there, the hope is going up and up as we're finding. immunotherapy, targeted therapy, all of the wonderful modalities that are happening now. But at the same time it takes an exact so toll. And I remember distinctly sitting down with a patient that I had a long term relationship with.
[00:11:26] It had been actually months. And she started telling me something about this treatment and side effects and that she was very concerned about having time with her grandson. And I suddenly realized, , I am not feeling anything. I just had this, it was like I was listening , to a TV.
[00:11:44] . It wasn't like I was listening to a patient. And it was really terrifying. And when I noticed that I realized that I burnt out and that it was time for me to walk away, from the bedside. And so I started focusing more on my team of nurses.
[00:11:59] [00:12:00] And there they, I, knowing what burnout was like, I really made an effort to. To create a safe space where we would sit down together and say, okay, so how are you feeling? I'm feeling X, Y, and Z. And so I would explain, this is what happened to me. And and I think just by being really honest and open and saying this is what I'm experiencing even as a nurse leader because I was leading the team.
[00:12:27] I was still working with more complex patients, but I was leading the team and this is what I'm experiencing. How are you, what are you, your experiences? How's it going with this particular patient? And I knew about the, the patients that were very challenging. What is your take on this? And it was just honesty was just, this is where I am. This is how I'm coping. And there are days where being not okay is okay.
[00:12:50] Wow. So that's really interesting. So in a space like that, when you're a clinical leader and you've got a team of people [00:13:00] and you're in the middle of that sort of clinical chaos that's going on all around you all the time there's a ton of cumulative stress.
[00:13:07] There's. distress at times, moral distress, ethical distress. Am I measuring up to what I feel is important to give this person in front of me? And when I'm not, what do I do about that? And then of course, there's also unaddressed systemic trauma, both Oh, yes. Primary trauma as well as secondary trauma.
[00:13:27] And so in the middle of all of that what sorts of things did you do to create that safe space beyond being honest and being vulnerable, especially as, when you get together in that room and you're talking to one another and you can hear the bells going off down the hall or the different things that are happening.
[00:13:46] So what kinds of things would you do that would help to create that safe space for yourself and also for your team?
[00:13:54] So if there was a situation that had arisen and we were sitting around and we were talking about this [00:14:00] particular situation, I would always come at it as I'm saying, they would say this has happened, Mrs.
[00:14:04] Smith, so and so and and we have a crisis. So I would say, okay. And I would make, I would say, so I'm hearing that. And we would just say, and just so I was, we were on the same page. Yes, this is the problem. And then I would say to them in my experience and having years and years of experience, much more than the new nurses, obviously, in my experience, this is how I would handle it.
[00:14:26] But you are the nurse and you understand the family. You understand the players. You understand the physician. What do you think of this? Do you think this would be the right step or not? And sometimes they would say, I think you're right. And other times they would say, oh, no. No, that isn't the way I would handle it because of X, Y and Z, which I didn't know at the time.
[00:14:46] And so we would open this discussion where we were equals, but I would always let the nurse who was leading the discussion, make the final call. Unless it was something that I really disagreed with. And [00:15:00] then it was always a case of, okay, let's try that. But if you're finding it's not helpful or the patient calls back and is unhappy or a family member or a physician, then we need to, then either I need to become involved as well.
[00:15:13] Or we'll need to do, make another plan B. So it was, I was forever trying to put it back on the nose because I do genuinely believe the nurses, they, and nurses are so smart, super smart. They, they practice the art and science of nursing. They know what is needed. A lot of the time. And sometimes just giving them the, yes, I agree is enough for them to go on.
[00:15:35] But other times it's this discussion with them. And again, just to be honest and, get feedback, are you comfortable telling this physician that, and then there'd be times, no, because he's been rude to me in the past and he won't accept that. Then I would come in and say, okay, I'll have that discussion with them, but it's always based in conversation.
[00:15:53] And it's always based in sharing and that connection.
[00:15:56] So what I hear there is this collaborative [00:16:00] way of leading. I like to call that listening leadership because you're listening, but you're also empowering that person in front of you to be the person that's leading and taking the initiative there.
[00:16:10] So that's really amazing. So when you created a, Based like that, what was the effect? What did you discover? Because one of the things, there's two questions that I am trying to answer on this podcast. The first one is how do you create a safe space in the , middle of clinical chaos? And the second question is what happens when you do so when you did that and you worked like that, what did you notice that happened?
[00:16:37] So first of all, I made it mandatory. So this is very important. I made that I made the meeting a mandatory meeting. Because I think what is happening traces people, nurses and providers are so busy that they would rather put their head down and get through those tasks. And they believe that they don't have that time because I have [00:17:00] so much on my plate.
[00:17:01] I don't have this time. So it was like, it was saying to them, look, this is very important for you as a nurse, for me as the leader and ultimately for your patients. So we do need that time where we are connecting. It's vital to patient care. It's vital to how we work as a team. So I think it's important to not let it be up to the nurses.
[00:17:21] Oh, I think I could do this. We started out as once a month where it was mandatory and then we, and then they actually, what happened, Trace, is amazing is that they, they really started enjoying it. And we would have a couple of minutes in the beginning where we'd say how things, Oh, my sister's coming from Arizona.
[00:17:39] And so there would be a little bit of personal talk as well. So sharing that, and then it would be a case of, okay, what's happening, Cindy, what's happening on your part of the world. What are the problems? What are the issues? And then everybody had to say, somebody else would say, Oh, you know what? I've worked with that provider.
[00:17:55] And I find that if I go through this and this nurse assistant, she [00:18:00] manages to get to him faster than going through this person or through this EMR or whatever it was. So they began sharing with each other. And then it was a case of researching back and just listening to them. They would just be giving advice and helping each other.
[00:18:13] And at the end of that, And that end of that hour, I think it really brought us all together. We enjoyed being together in one room. We would sit together in a room and it was just, it was, everybody looked forward to it because it was a meeting where you'd leave everything behind and we told our patients, we told the providers, it's a managed meeting, we have to be there.
[00:18:32] And it was successful , they realized they saved a lot of time and effort .
[00:18:38] So interesting what you're sharing there, because we have that same complaint and objection come up over and over again.
[00:18:44] So I love what you're saying about making it mandatory. It's almost like you're saying. We're going to prioritize you for you because on some level you keep sacrificing yourself and the argument is always the same. It's what you just said. It's well, I don't [00:19:00] have time. I have to get all these tasks done, but it's incredible because we notice exactly the same thing that you did when you take that time.
[00:19:08] It always creates an expansion of time and energy to be able to do. Yeah. what it is you're here to do practically, but it also, it feeds the human spirit. You actually get that connection with each other and it really helps you to be able to fall back in love with your work again. Which I think that, to your point, a lot of nurses are really struggling with because nobody really got into nursing.
[00:19:31] I don't think. For the money. I think that they probably did it because they wanted to help people and have a meaningful impact. When that's taken away, it just robs people of the reason their passion and why they got into the career that they did. So thank you for sharing that.
[00:19:45] I really appreciate that. So in 2024, you're launching your new book, which is called Nurses Matter, correct?
[00:19:52] Yes, that's right. All right, tell us a little bit about your book and why you wrote it, why you chose that title, because I think that title is [00:20:00] actually telling a lot and what's in the book that we can look forward to in January?
[00:20:05] So this book has been in me for years, Trace, and I started writing it a couple of years, not a couple of years, three or four years ago. And then it just got very busy with work. And so I've had time now being in Mexico, just to me and what is going on in the nursing field. And
[00:20:22] I am deeply Concerned about what is happening to nurses. I come from a family of nurses. My sister's a nurse. My daughter's a labor and delivery nurse. Most of my friends are nurses. So we talk the talk. And we it's incredible trace and I'm imagining it's similar in Canada, but we are, it sounds like when I say something about a situation in a ward, somebody else is somebody else and somebody else is something else, but we all have a common theme.
[00:20:48] And the common theme is. I am not able to do this job the way I want to do it. And people are at the point where, and nurses, you're right, that nurses go into nursing because [00:21:00] it's something that's special to them. It belongs to them. It's something that gives them meaning. And it's, it is an incredible people job.
[00:21:08] It's where you, every day you're meeting with different people. Every situation is different. You are constantly bringing your best self to work. So it's a very challenging and uniquely giving job. And it's a servant's heart and that's what nurses have. I think is this will and this this Just the energy to give more and it breaks my heart to see that nurses are not working as nurses anymore.
[00:21:31] In fact, it gets so bad that nurses are barely many nurses are barely able to make contact with their patients. And so this book for nurses is written by a nurse, an old nurse. That's me having been, having been at the bedside all these years, I understand uniquely coming from South Africa and working at the bedside and in America and seeing the changes over the 34 years that, that it is a very special field.
[00:21:56] And I. I have set out in this book [00:22:00] to look at the different aspects of nursing and to look at burnout, to look at compassion fatigue, to look at communication, to look at ways where we can be empowered and empower each other, to pay it forward to other nurses. And everything in this book is geared to, I hope, help nurses.
[00:22:24] To do their jobs in a more efficient way and have their voices heard.
[00:22:29] What do you think will happen if nurses find their voice and find a way to express what is inside them in, in, in health care?
[00:22:37] Oh, Trace, I'm so excited. I'm so excited you asked me that question because that will be the time that health care turns around. Why do you think it'll turn around? That's a big statement, Jennifer, but I, and I haven't, I have an intuition that you're right about it and I could give my version of that, but I would love to hear what is it that [00:23:00] is motivating that statement?
[00:23:01] That's such a bold statement. It's a, it is a bold statement and I believe it a hundred percent. So if we can allow nurses to work as nurses, in their roles, in their specific roles, and give them the extra auxiliary help to do all the other jobs that they do, which are non specific. We will give back to nurses.
[00:23:27] The joy of working as a nurse, the safety of understanding that your patients are going to be okay the motivation to provide the best. If you are burnt out and you are full of compassion fatigue, and you are so focused on a specific task, you are never going to be able to have that joy.
[00:23:49] That safety, that time to do your job the way you want to do your job. And I do think that nurses are what it's all about if [00:24:00] we can turn nurses around and stop the shortage of nurses. It'll be a ripple effect. Everything else will improve. Our patient safety will improve , nurses themselves will start to look after themselves, have the opportunity to look after themselves.
[00:24:14] They'll be better financial goals that will be met, beta goals that will be met in order for. Organizations to start giving back into their nursing world, into their units, because I think so much of it has been taken away. Just cut, cut, cut. I have a financial goal as a C suite executive.
[00:24:33] I have a financial goal and it's specific to this amount of money. And there's just no connect between that and what's happening on the floor. And so if nurses can just be allowed to work, like they know how to work, everything will turn around. Thank you so much.
[00:24:49] I really appreciated what I've heard you share before about just from a practical operational perspective, how nurses are taking tasks that may not be [00:25:00] the best use of their skill set and to delegate those tasks to somebody else.
[00:25:05] Providing some more employment for others as well as freeing up that time, that capacity and inventory they've got on their shelf now as a nurse to be able to do the work that they really got into healthcare to do in the first place. So what kinds of tasks are you talking about?
[00:25:21] And I think this is related to the hybrid individual team nurse model that you were talking about in your book a little bit. So maybe you could just elaborate a little bit more on the operational implications that you're talking about. .
[00:25:33] So first of all, just to backtrack trace looking at nursing models, doing the research that I've done for this book, I've been amazed that they have, there are four.
[00:25:44] Primary nurse models that have gone from World War Two until the 1980s. Of course, they've been tweaked in some institutions, but they are not current nursing models. They are an old template that [00:26:00] has been used in the past, and it amazes me in medicine, which is so evidence based looking at trends, current trends, data, et cetera, that we haven't changed how we nurse.
[00:26:11] For years. It's just been this one way of doing things. Now I believe that with an approach where you have a registered nurse working with a nurse assistant in a team of five patients. Now, immediately, I know they're going to be raised eyebrows because, of course, the organizations are trying to save money.
[00:26:34] And so nurse ratios are a very big hot topic in America. It's all about nurse ratios. Now we know nurses can only work because we're human and we're fallible. We can only work with a certain number of patients at a time to provide excellent care. A safe care. The, our centers our CMS.
[00:26:55] They have come through and they have recommended a number, [00:27:00] which is a ratio of one nurse to five patients. Now that's a recommendation. They haven't mandated it. But and when I talk about this trace, I just want to clarify that I'm talking about units like med surge. telemetry, oncology the specialty units which work with a ratio of one to five, one to four in times where there's a high acuity rate.
[00:27:20] And so what my nurse model is looking at what CMS has recommended, which is a ratio of one to five. Again, it needs to be worked according to acuity, but say one to five in med surge unit, one registered nurse, one nurse assistant that works only with those five patients. Now it's different in in Canada, I'm sure, but just to give you an example of the the cost of salaries.
[00:27:46] When we're looking at a ward assistant in America, the national average is around 36, 000 per shift a ward secretary which is very similar to a nurse assistant, but they're also around 36, 000 per shift [00:28:00] per annum. And then you look at registered nurses who are earning anything from, the sliding scale in the States is huge from when you look at California and New York down to other States that, that pay, substantially less.
[00:28:12] When you're looking at these ratios. You realize that turning a nurse around, which is happening every day in units daily. There are nurses leaving. We know we're hemorrhaging nurses it costs around 52, 000 nationally to turn a nurse around. So to, to find that nurse, to orient that nurse, bring that nurse in.
[00:28:31] Now you're looking at a busy 25 bedded med surge unit, for example, say we have to add in five nurse assistants. And the ward secretary, which would help with the actual running of the, the nurses stations, if we have the nurse the charge nurse, we're looking at around 220, 000 extra per shift per annum.
[00:28:51] But if you were turning four nurses round only in that year which is, which we're doing much more of, you would already have covered those extra costs.[00:29:00] And having those two nurses in a team, or that nurse assistant and that registered nurse, two nurses, essentially in a team means you have two sets of eyes.
[00:29:09] You have nursing assistants who work as closely with the RN with, as as a team together, but they would do the tasks where we might be taking patients to the bathroom, handing out food trays, doing vital signs, just checking in with patients, et cetera. All of that would really free up the nurse and allow the nurse to do nursing specific tasks without being constantly distracted.
[00:29:33] Because when you're looking at new orders, people coming in every five minutes, every three minutes, every two minutes, your phone's going off. People are calling you, you've got to go and answer this phone, et cetera. This physician's looking for you. If you can have somebody that's taken that off your shoulders, you will have the chance to really look at those orders.
[00:29:52] Be more more focused, less distracted. And this is where it comes to patient safety, satisfaction, and just [00:30:00] better outcomes all around. I think. A patient ratio of one to four or one to five would be a dream come true for a lot of our nurses. I think right now we're looking at patient ratios that are way more out of control than that.
[00:30:14] And that's based on just the shortage of people that we're noticing in Canadian healthcare right across the country. And of course that's a global phenomenon as well. So when your book comes out, we'll get a good outline of what it is. You're talking about in January, I'm curious.
[00:30:31] In the meantime, technology is obviously, changing our lives very quickly when, with the advent of artificial intelligence. I'm curious if you've given any thought to how technology will change nursing going forward. Yes, I have. Technology is changing nursing as we speak. You'd be becoming more and more tech savvy.
[00:30:51] We have all our remote nurses who are doing telehealth. In fact, what's happening now in the States is they vote for nurses who are burnt out. They're actually [00:31:00] saying, okay, you can't do bedside nursing anymore, but there, here's a position where you can do discharges through Teddy house, so that, that is a, I think it's a great tool.
[00:31:09] I think it's important to use it. If we can keep any nurses. And we're in nursing jobs. We're doing, we're helping the problem. And so yes, technology is needed. It's vital. The new, the apps that are coming out that I don't know if you know of a lot of the nursing apps, but they certainly apps in America where patients get, get a little lap, not a laptop, but a little iPad.
[00:31:34] They are working with the nurse from home, they're being monitored. Again, that's fantastic because it's keeping patients out of the hospital. So yes, that it's needed, but it's not going to solve the problem. Technology is not going to be the saving grace. For nurses globally, the saving grace is going to come when we look at the environment that nurses or working in.
[00:31:58] That's going to be the most [00:32:00] important part of this whole healthcare revival or change. We know that nurse that if we continue the way we're going, certainly in America, we are going to collapse. And experts are saying this time and time again, it's not sustainable. So what's going to collapse hospitals and nursing care in hospitals and acute care facilities that will collapse.
[00:32:22] And what do we need to keep that going? We need nurses to be able to function at the bedside. In their nursing environment. And that's not going to be technology that does that for us. We need the help. We need auxiliary help to do this. And I think to your point, we need more energy generally speaking.
[00:32:40] And when you're talking about burnout, one of the things that I've become. pretty convinced of is that burnout happens when our value system is being sacrificed over and over again because we're just out of congruence or out of alignment with who we are, what we're here to do the way that we want to live our lives and do our work.
[00:32:59] And [00:33:00] so to your point, nurses are definitely Sacrificing themselves and sacrificing their value system to try and function in this really difficult complex healthcare system all over the world. So with that, you get more and more tired, it just is a fact that's what happens, right? I really appreciate your perspective.
[00:33:19] Now, Jennifer just coming to a close now what is the date of the release of your book? And maybe we could even have you come back at some point and tell us more about that. I'd love that. It will be the last week in January and the first week in February.
[00:33:34] But I will be delighted to come back and and share a little bit of, the response I've had from nurses. Yeah. That's awesome. Thank you so much for being with us on the show, Jennifer, and all the best with your new book release. And I wish you well. Thank you so much, Trace.
[00:33:51] It's been a pleasure speaking to you. Thank you so much. Yeah. You as well.
