Primary Sources
Primary Sources: With Dr. Holly Wei
East Tennessee State University’s Dr. Holly Wei earned a 2022 Book of the Year Award from the American Journal of Nursing (AJN), considered the profession’s premier journal.
The leadership textbook titled “Visionary Leadership in Healthcare: Excellence in Practice, Policy, and Ethics” was the first-place winner in in AJN’ “Nursing Management and Leadership” category. Wei is a professor and associate dean for Research and Scholarship at ETSU’s College of Nursing. She co-authored the book with Dr. Sara Horton-Deutsch, director of the University of San Francisco and Kaiser Permanente Partnership. Read more about Dr. Holly Wei.
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Transcript:
Dr. Holly Wei
So how can we create that environment to see everybody as the owner? You belong here,
and you are the owner. And when they are the owner, they want to be involved. I remember
I read a quote that said if you invest your money, you get your return. But if you
have emotional involvement, then you get participation.
Melissa Nipper
Welcome to Primary Sources, a podcast produced by East Tennessee State University
that highlights the important research happening at ETSU. Joining us today on Primary
Sources is Dr. Holly Wei, Professor and Associate Dean for Research and Scholarship
in the ETSU College of Nursing. Dr. Wei, along with her co-author Dr. Sara Horton-Deutsch,
recently won the Book of the Year Award from the American Journal of Nursing, which
is considered the nursing profession's premier journal.
The book, which we will learn about more in this episode, earned first place in the Nursing Management and Leadership category. It challenges nurse leaders to look to the future to create an environment reflective of excellence and also provide strategies for addressing the challenge. She has served as a nurse researcher since 2001. She joined the ETSU faculty in 2022. Dr. Wei, thank you for joining me on Primary Sources.
Dr. Holly Wei
It’s definitely my honor, Melissa. Thank you so much for your invitation.
Melissa Nipper
Your award-winning book is titled “Visionary Leadership in Healthcare: Excellence
in Practice, Policy, and Ethics.” So starting with a general view of leadership, how
do you define a visionary leader?
Dr. Holly Wei
A visionary leader is someone who focuses on creating a vision for the future and
inspiring others to make it a reality. It involves setting clear goals, creating a
sense of purpose, a sense of belonging, and motivating those around them to act and
achieve the desired outcome. And also, visionary leaders have strong communication
skills and act as mentors -- and can look at the big picture while inspiring others
to work together. And these leaders also look at uncertainties or challenging situations
as opportunities to learn and to move forward.
Melissa Nipper
One thing I noticed about your book is that although it's written from a nursing perspective,
it has applications for health care professions across the board. So what are some
of the traits of visionary leadership in health care that you really drill down on
and discuss in the book?
Dr. Holly Wei
So mainly, as you mentioned, the authors, the majority are nurses. Initially, we wanted
to develop a leadership book for nursing. And so while we were doing that, as you
all know, right now interprofessional collaboration is the key for success. So nursing,
we cannot survive as an isolated profession. We have to work with others, develop
this interprofessional mindset and collaboration.
So while we're doing that, I said, “Well, there is no way we can isolate nursing leadership from other health care professionals.” So then we just opened it up to health care in general. So I wrote some leadership principles, but I think down to three for now. So visionary leaders see the world differently. They embrace the unknown as opportunities for innovation, experimentation, and pioneer for new opportunities.
And also visionary leaders in health care, we can see how others see the vision. It's not like, “I go, go, go.” I mean, they are communicators to see there's where we want to go. Let's work together and go there together. And I always give an example -- I also heard this one -- let’s say if we go hiking.
I just go, go, go. You know, there's the place I want to go -- and people dragging behind me. And that would not be a leader; that's a hiker. You know, we have to say what that's what we want to do, this is how we are going to do it. And that's the end result: We want to go there together to see the beautiful place together.
The third way I see visionary leaders is they want to turn vision into reality. If we always say we have a big vision, we have a big dream -- but if we don't act on it, that is a fantasy. That's not really a reality. How can we turn everything we envision into reality? So this comes with some strategies the book gives to see how we can go there. You know, we have a vision. Now, I want to go, maybe, to Paris and I, you know, the beautiful place, but I have to have a plan how to go there.
Melissa Nipper
One other thing I wanted to ask you about the book is [about how] it highlights the
value of leadership in times of disaster. And recently we've come through an unprecedented
time, the COVID-19 crisis. So what leadership lessons have we learned from the COVID-19
pandemic that can be applied across health care professions and specifically nursing,
when it comes to leadership?
Dr. Holly Wei
Yeah, this book is kind of timely; this book was developed during the pandemic. And
then we saw the needs, what we need to do as leaders. We planned it during the pandemic,
and then developed it during a pandemic, and it was written during the pandemic. So
a lot of content, actually, is very pertinent. This book has five parts.
[In] the first part, we talk about the leadership theories in general. So the first chapter, the whole chapter, talks about from main theory up to now, visionary. In between, we have transactional, transformational, and so many other leadership styles. Right now in the hospital, because of the magnet program journey, we like to have transformational leadership. So nurses are very familiar with the transformational leadership style.
So I want to say there's not one leadership style that will cover everything. So, as we can see, is really a transition like from the beginning to we talk about the leaders who were born -- you know, you were born as a leader. I mean, I don't deny that. So some leaders really do have that trait and that character and behaviors to be a leader.
However, gradually now we know leaders can be developed. And leaders are learners; learners are leaders. So I cannot just give you a five-hour talk, or you cannot just be in a day of a seminar or workshop and you will be a good leader. No, we have to learn constantly. And I listen to podcasts, I listen to videos, listen to talks -- just every day. In the morning, as soon as I get up, I turn on the podcast or whatever the leadership talk, and I start my day. And that really brings an energy to me. So if I feel down, I just turn on the leadership talk; that gives me, feed me my energy. So I really think for, for that piece, what I want to see is that the pandemic really brought some insights for us.
What can we do to really lead others during challenging times? So I just gave a talk, actually, about leading during challenging times. One of them is to really be inclusive and cultivate a sense of belonging. So what I did, I just published another article called “To Revisit the Ethic of Belonging.” And look at the face of the other, just to see, instead of to start by your face or by your appearance, how can we go beyond as a human being and care about you, a human being? So that's really number one. We have to be really caring for each other and build the trust in relationship to move forward. And of course, other things I included in the five parts. One, the first part is about leadership and organizations.
The second part is about building nurses’ work environments. How can we build a healthy working environment, mitigate organizational trauma, foster resilience, and improve interprofessional collaboration? So that's the second part. And then the third part we talk about ... introduces and explains ways to apply novice leadership theories to practice. During this part, Dr. Jean Watson wrote about care and leadership. In health care, is not just a linear relationship.
There are so many stakeholders, so many relationships and changing all the time. Let alone the pandemic, just even on a daily basis, is just that the change is very complex, the situation. How can we lead in that situation that’s not linear? And then the fourth part talks about leading change, innovation, and about collaboration. And the last part is re-envisioning the future of health care and about the wisdom.
That's where you can see leaders have developed. We build the experience. I mean, I'm sure where we are today was not where we were thinking 20 years ago. So we change, we evolve. And then the last chapter, we call for leaders to create a more connected world through ethics of face and belonging. So that's where this book is really giving us a step-by-step through these five parts to talk about leadership during the challenging times. For myself, and also I feel like there are mainly, I would say, about six principles. One is building trust. And this trust -- especially I heard about the Appalachian region, the history and the trust and mistrust. Even during COVID-19, the vaccinations -- we can see a lot of mistrust there. They don't want to get it. Oh, some people have reservations about that.
So how can we build trust? And that's a leadership skill we have to learn. And I remember I read a book about trust as a piggy bank: You put it in and you withdraw. [If] the trust, the actions we withdraw are more than we put in, then we lose our trust. So we really have to keep our promises and do what we set out to do and to thus build trust. In other words, to develop a growth mindset.
The leaders have -- we have to learn. We have to read and learn every single day. And afterwards, you can just debrief yourself to see: What did I learn today? What's the one thing I learned today? What is one good thing I did today? We can try that way, and that will also create our responsibility and accountability. Another thing is it’s about ownership, ownership mentality.
Instead of blaming -- just like, “You didn't do this right; you didn't do this right” -- to see what I can do to get this process better, to help this situation, to really own our problem and our accountability. I always give an example to see: Okay, if you are a renter of a house or owner of the house, we have totally different mentalities. As the owner of the house, what do we do if the AC needs to be changed or something?
Drop it on the floor, I better pick it up now. Otherwise nobody can do it. We do improvement. If I need to add a window, I need to do this. Then we have the power and responsibility to do it. As a renter, if something's not right, even the light bulb or the fence, what do I do? I don't fix it.
I just pick up the phone and call management, “Hey, this is not working.” So that's what the leadership does: What can we do to build ownership mentality among our team members instead of [when] something happens, they blame one other or they complain to me or they just let the manager do the job -- like, “This is not my job; this is a manager's job.” So how can we create that environment to see everybody as the owner? You belong here; you are the owner. And when they are the owner, they want to be involved. I remember I read a quote that said if you invest your money, you get your return. But if you have emotional involvement, then you get participation. During good times, everybody's good.
You know, everybody's happy. I mean, I come to work, and we are good. Usually during the difficult time, that's where [it] shows leadership. That's where we need leaders. So that's the time to see how can we prepare our team to have the ownership mentality and then they can just take on the [attitude of], “I want to make this place better,” instead of leave to another place.
There's also the turnover and other issues. The first one is to really convey altruism, promoting positivity. And we have to show [that] I care about you. So for others to feel that I really act on, that I really care about you, it's not just like, “Hey, this is our work today.” [We need to] to really get to know you as a person, as an individual. And encouraging self-care.
So this, I know, self-care, resilience, those terms are really overused, and people already don't want to hear about it. But that's the thing that will keep us renewed so that we can move on. Students, nurses, and physicians -- we all need that gas station. I always tell my Ph.D. students, the journey is long, but make sure ... if we go somewhere, what do we do?
If we have a long journey, we set the vision and then we look at the map [to see] where we go. And then we also set up where we can take gas stops and rest stops. And so the leaders, maybe we need to pocket in those times so that they will feel re-energized. And sometimes our mind is now like it's growing and it needs the nutrition.
The nutrition can be seen by example, by seeing good things and listening to some positive talks and motivational talks. So that's why promoting the self-care is very important. And then maybe system-wide, we can develop some break times. You know, one of the facilities I worked with used my energy model to build a Tranquility Room and to really help them build that environment to show we care about you.
We encourage you to take breaks during the work time, as needed. And the last one is magnetism. What that means is if you want to attract people, you know those words are like a magnet: You attract the similar people as you are. So if we want to [attract people], who do we want?
We want positive people. We want people to take this place as home, as where they belong. And so we need to be that kind of person. We need to be a positive leader. We need to be an influential leader. We need to be a caring leader. Then, who will we attract? We attract those people. Even the people who are here may be different by looking at you. You create that environment, you change that environment, you take the lead or take one person to change the environment.
Melissa Nipper
So much of what you're saying is so inspirational. I love the examples and the analogies
you use with ownership and refueling. I want to go back to one thing you said, because
it really makes me think about what we're doing here at ETSU. You mentioned that leaders
can be developed, and so what do you see that we're doing here at ETSU to develop
leaders in nursing, health care, or any profession that they choose to go? What are
some of the things that we're doing to cultivate leaders?
Dr. Holly Wei
I noticed that the university and the colleges are very supportive and encouraging
of faculty development. For example, the university provides tenure-track and tenured
faculties with protected time for research into scholarship. They receive reduced
workloads so that they can focus on their research in the scholarship. From a research
perspective, the university provides faculty with scholarship and mentorship opportunities,
and also has a series of workshops to support faculty in conducting research.
At our college, we also have various programs and initiatives to support faculties such as research Grand Rounds, Distinguished Leadership Series, writing workshops, and faculty support circles. During the research Grand Rounds and Distinguished Leadership Series, we invite nationally- and internationally-known researchers, scholars, and leaders to present each month, aiming to help faculty start or strengthen their programs of research, and to promote faculty development and leadership skills.
Through the writing workshops, we invite nationally-recognized scholars to help faculty write and publish. These are some of the activities I have noticed, and I believe the university and colleges will continue to support faculty's needs for success.
Melissa Nipper
That's great. Thank you. So what role specifically does nursing research and scholarship
play in helping to address the challenges that we face with the nursing shortage?
Dr. Holly Wei
Yeah. So right now, no talks can be talks without talking about nursing shortage.
I think a nursing shortage is one aspect of what right now the pandemic left. You
know, we all see the hurricane left, and we see the massive situation we have to fix.
To be honest, I think nursing shortage is not new. Pandemic only made it worse. Even
before the pandemic, we already saw that.
We talk about nursing shortage. We talk about turnover rate and burnout. And then suddenly, before we even fix the issue, then the pandemic came, and it made it really worse. So, yes, nursing research, what we do is -- research, if without application, it is no use. Basically, we have to really do research to see what we learn from it, what we can do. How can we apply research to practice, to our daily life?
Before the pandemic, my research, I studied health care providers. Before that, I was, you know, studying patients, population, parents. My population at that time was parents of children with a critical illness in the hospital -- NICU, PICU. And then every time they talked about their experience, how the experience in the hospital was really depending on the health care providers, how they were treated, how their actions affected their experience.
And then after that, I did the post-doc study. Then I studied the health care providers. Okay, what is it that you do that actually affects patients? So while I was doing that, I saw the interprofessional collaboration and the essence. There's a publisher I know of -- among the most downloaded articles said that the essence of interprofessional collaboration is a caring culture.
I have to care about what I do. I have to care about my cause. I have to care about others. I care. That's why I want to collaborate. And I care about you. I want to help. That's what brought so many health care professionals actually come to work. They said, “I really care about my patients. I care about my coworkers because if I call out to my coworkers, they will take over what I was supposed to do.”
So that's how we started that. And then also another model I mentioned about is care. Care is about competence. We have to be competent in knowledge and then we have to have altruism. We have to really see, I want to do this for you, for your benefit and be responsible. And also being empathetic. So that's that. But during that time, I saw this stress and then I asked, “Well, you feel stressed. What do you do to really reduce your stress?” So then I have that as I build a self-care model, develop some self-care strategies. So that's what the researchers do. We found the problem and we tried to do another study to see how we can we can help mitigate that problem. So I found this one, and then I developed some strategies for self-care and based on those and also science, I developed the self-care energy model.
So that's an example to see how we can use research to really help nurses on a daily basis. And then I worked with Dr. Jean Watson and also my previous dean, and a third a mentor, Dr. Sonya Harden. So she was just so good. The three of us, we developed the Resilience Building Model, based on Dr. Jean Watson's human caring theory.
So how can we, through caring, care for ourselves, to build our resilience. And then now we do all this research, and then we come back to serve the nursing profession, to serve ultimately the patient. Because a patient feels what we do. I have an example, you know: One time, this just stuck with me for all this time.
So I was always bubbly, you know, like smiling and being nice. And just one night, the third night, I'm just really tired and just went to work and then finished the bedside report. I left. I went back to the room to start my night. The mom said, “Are you okay?” I said, “Yeah, I'm okay.” [She said,] “I see you didn't smile during the reporting time.” So just that expression. And they notice.
Melissa Nipper
They notice, yeah.
Dr. Holly Wei
It is amazing. So that means nurses, physicians, health care providers -- the self-care
is very important. If we don't take care of ourselves, we come in tired, we come in
not in a good mood, [we] affect patients’ experiences. So that's very important --
and affect our tone, affect our communication, affect so many -- and think there's
a ripple effect. Another patient told me about 20 years ago, and he said that the
cheapest and best and most efficient way for nurses towards patient is smiling.
So I remember that every time I talk to a patient, I talk to anyone, I put a smiling face on because that can change the dynamic, change the interaction, change the environment. So self-care, resilience, I know those two terms already were used over and over again, it’s not without a reason. So we have to help nurses, physicians, health care professionals really see the importance to do self-care and to be resilient and to really live a healthy life.
Melissa Nipper
I love conversations like this and the examples you give that show the applications
of research and how you just describe in such a good way about how it's really changing
outcomes and changing patients’ lives. I want to shift gears a little bit to the type
of research that's currently taking place at ETSU, specifically in your college, the
College of Nursing. So what are some interesting research articles and grants that
are coming out of the College of Nursing right now?
Dr. Holly Wei
Well, College of Nursing, we have seven nurse-led clinics. The seven nurse-led clinics
really serve the population in need. 44% of our population in those clinics are really
uninsured or insured, but not really through maybe private insurance. So we have this
prime opportunity to serve the community. Through the seven nurse-led clinics, we
have at least about 10 program support like HRSA, which really helps to build the
program to serve those populations. And then we have in the College of Nursing, we
have the [study of] substance use and prenatal substance exposure on children's health,
on infants’ health. And then we have to have research related to promote [understanding
of] the homeless population.
And we have research geared towards students’ well-being. We have research towards nurses’ well-being. And also we have research about how to develop student success. So that's some very nice, dynamic programs towards patients, nurses, and students. And we try to pay attention to patient population in a variety of populations -- diabetes and in women's health and children's health and mental health.
So it's really ... that's the beauty of nursing. I was very fascinated about one phenomenon. Still, so far, it's fascinated me that in the college, we all study the same material, you know: pediatric and med-surg and geriatrics. We study all this. But once we graduate and you can see just all over, you know, so many settings. So that's where we are.
So we're usually where we are, that's where our passions are. And then we develop our research, program of research, in that area. Palliative care's another area and home health. It's definitely dynamic, and I'm very excited to see. ... Right now I have met all the tenure-track faculty. I'm in the process of meeting all the tenured faculty. And just by listening to their research interests and then to see, we can do this together. I can compare with this team.
Melissa Nipper
On that note, here in academia, you have such a unique role. You're working with the
next generation of nurses, nurse researchers, nurse educators. How do you want to
inspire or nurture these next nurse researchers?
Dr. Holly Wei
I always see academia, you know, again, every time I talk, it's like we have to start
with a purpose -- and always see life without purpose, that's tiring. Life with a
purpose, that's enlightening. Like, for example, if we have anything, usually I work
hard, you know, day and night and weekend, and it's not like work work. It's that
I do something I'm passionate about.
We all want to set the vision. When I talk to my students, I always kind of like the visionary term through the book: I set a vision. I said, you know, I look at you, we talk about this, and I really see you being at this place. I see you at this place. And how about you?
And then when I talk to students or talk to whoever wants to pursue nursing or pursue a higher degree, for example graduate school, doctorate, or master, then when I encounter those students, I talk to them and I kind of build the vision together. Even with the faculty: We build a vision, we build somewhere we want to go together.
Then, get them excited, get them motivated -- not only motivated, get inspired. Motivation to say, okay, I’m motivated. But inspired to see from inside out. I want to get them inspired for the big picture so then they can see their purpose and to create a purpose, create meaning for their journey. The journey would not be easy, but if you create the meaning of your journey, there's where you want to go, then you can work actually tirelessly. Don't feel burned out.
Melissa Nipper
Thank you for your passion. Thank you for what you do to ignite that passion and that
purpose in our students. I can feel and sense your passion for what you do. And thank
you so much for joining us today on Primary Sources, Dr. Wei.