In this episode Tony King, ICU Educator at the Epworth Hospital, speaks about the changing role of the educator, how to manage reluctant learners, the importance of engaging with the broader education team and much more...

Podcast Transcript

Wayne: From Ausmed Education, hello and welcome to the second episode of the Care to Learn Podcast series.

I’m Wayne Woff and each month we sit down with interesting and influential professionals working within healthcare and education.

For this episode we’ll be talking to Tony King, an educator at the Intensive Care Unit at the Epworth Hospital in Melbourne.

Tony is an experienced educator who is passionate about empowering people through education. He strongly believes that with knowledge comes confidence, choice and job satisfaction.

In today’s episode we’ll speak about the educator’s role as a mentor, coach and role model, and the importance of collaborating with the broader education department. Tony will also provide some tips on engaging the reluctant learner, striking a balance between teaching hard and soft skills, and giving effective feedback.

Wayne: Great to have you with us here today Tony. We’ll kick off by getting you to tell our audience a little about your professional background and your journey to your position now as an ICU Educator.

Tony: Thanks Wayne. I started my journey at the Austin Hospital over a decade ago, and I’ve been very fortunate to always have really great role models within the education space. The educators at the Austin ICU have been in their roles for over twenty years - almost all three of them are around that ilk – and they’ve been fantastic mentors.

Pretty early on I was interested in moving into education. Over my years in ICU I’ve completed a number of stints in different roles and always found myself drawn to the education side of things. Eventually the opportunity opened up at the Epworth Richmond ICU and I just jumped for it. And here I am now.

Wayne: So, you’ve been in that role now for how long?

Tony: A touch over a year. And before that, at the Austin I’d filled in for the educators when they had leave and things like that. I also did undergraduate teaching, lecturing at universities and a few bits of pieces here, there and everywhere.

Wayne: I’ll be really interesting to hear your response to the next question given the context of your time at the Austin and now as the Educator at the ICU at the Epworth. From that perspective, what do you think a great education and training program looks like?

Tony: I’ve been very fortunate that I have experienced two workplaces that have a fantastic culture. I think when you talk about an education program working and what makes it work, it really speaks to the culture of the workplace; it never falls down to one or two people.

I think it’s a culture that values learning, that values education and the educators who are facilitating the education. The educators don’t have to hold all the knowledge but they should really be there to facilitate learning and development, and that’s certainly the experience that I’ve had.

One of my colleagues has just retired from the Epworth and she’s been working in an education capacity there for twenty five years. So I’ve now come into the Epworth and reaped the benefit of what she’s laid the groundwork for.

I think an education program that’s working is one that people are interested in, that they’re engaged in, and where education is really valued throughout the whole workplace.

Wayne: And just to take that a little bit further, obviously with any workplace - and education particularly - you’ll come across challenges, blocks and difficulties; could you speak to us about what you consider some of those challenges to be, and what are your responses to those challenges?

Tony: I think the biggest barrier or block to education that I’ve ever experienced in all my years is dedicated education time. I think there is absolute value in bedside teaching in the clinical context, but if you’re looking to aspire to the deeper, more critical thinking you really need to get people out of the clinical environment, where they are in a headspace where they can really take in and think about what they’re being exposed to and what they’re hearing, free of distraction.

You really can’t analyse and synthesise information if you’re listening to alarms. Particularly in ICU there are a lot of distractions and you have to get people out of that environment. That’s the biggest barrier that I’ve ever experienced in both workplaces is getting people freed up in paid time so they can develop themselves.

Wayne: And taking that just a little bit further in terms of making an assessment of group learning needs as opposed to individual learning needs. Is that something that occupies your mind?

Tony: I think it’s quite easy to identify the group learning needs of a department – you look at what your core business is, you look at what you do often and then you make sure that people are skilled in that.

Identifying individual learning needs is a lot harder because it takes time and investment. You need to speak to people, you need to look at what might be coming up in the future of your department and then seeing if your workplace has the skills needed to provide safe and effective care. It does take time and a bit of thought.

Being an educator, I’m very mindful that I don’t want to be busy all the time. I need to allow some time to think, to appraise and evaluate what we’ve been happening, and then ensure that what I’m doing is what the workplace needs.

Wayne: So it would be fair to say that in a role such as yours the relationship with your colleagues, the people that you’re seeking to facilitate education with and for is most important.

Tony: When you talk about relationships, I don’t think you have to be friends with people, but I think you need to invest in getting to know your staff because that’s the only way you’re going to meet their needs or hope to meet their needs. Certainly when it comes to reluctant learners, that’s certainly something where you just need to invest the time.

Wayne: I’m interested today to explore how you would strike a balance between important clinical skills and technical skills, and the other skills which are no doubt hugely important within the ICU environment, whether it be communication, debriefing, negotiation or dealing with stressed and grieving families. Can you just speak a little bit about how you would make decisions around that balance and what are some of the factors you consider?

Tony: I think you’ve identified probably the hardest thing for any educator.

Identifying the hard skills is quite easy because you can review what you’re doing and what you think the skill needs are of your staff.

But really, you can train anybody to complete a skill or a task. What you’re really trying to appeal to are the core elements of what makes a nurse, a nurse. I don’t like the term ‘soft skills’ because I think it de-emphasises the importance, particularly in nursing, of those skills. Skills like empathy, compassion and listening are crucial to nursing and you hope that people are well-equipped with them if they come into our profession, but it’s not always the case. To develop those skills it really comes down to mentoring and coaching, and again it comes down to investing the time.

It’s becoming more and more of a pertinent issue in intensive care as modern ICUs now are increasingly isolating for clinicians. You often have a one-to-one ratio, the nurses are often inside the bed-space and you can’t really see your colleagues around you, and they can’t see you. So that peer-to-peer supervision where you see how well somebody interacts with a patient or family doesn’t happen as much because people aren’t seeing the interactions of their senior colleagues around them, and seeing what did or didn’t work well.

And then having your own interactions and being able to step out of the bed-space and ask your colleagues for some feedback. Those interactions are becoming few and far between.

So now the role of the educator is becoming more and more critical. Every interaction that we go into the bed-space with, I make a very conscious effort to engage with the patients or consumers, and try to model that effective communication. So I think more than ever, the role of the educator as coach and role model is really important.

Wayne: Could you comment on whether you’ve seen that rising in importance since you started as a nurse? Because it’s my view that it used to be very prevalent – and I have a nursing background that goes back 30 years – and then I think we lost it for a large chunk of time, but that now there’s a re-recognition of the need for the coaching, mentoring and modelling that you were just talking about. What have you seen over your journey?

Tony: I think nursing is coming full circle in that regard. I think probably for the last 10 to 15 years there has been a real emphasis on critical thinking, recognising deteriorating patients and a lot of other hard, clinical tasks and assessment skills. And I think potentially nursing lost its way a little bit there in terms of over-emphasising the importance of checking vital signs, and maybe losing a little bit of what it means to be a nurse, which is that compassion and being there for your patient and trying to advocate for a more holistic picture.

The National Standards, putting the patient at the centre again, has helped, and I think nursing is starting to rally around that again. Emphasising the importance of the role of the nurse in this very busy, acute context of intensive care, and re-emphasising that it’s all about the patient, their loved ones and what it means for them and ensuring that our care is in keeping with what they would like.

Wayne: And in terms of another issue that I think is on the radar particularly in a setting such as ICU, is the issue of burnout for staff. As an educator I would imagine it’s very much on your radar. What have been your educational and organisational responses to that?

Tony: Burnout is a very big issue. And educators have a very unique contribution to an organisation in this space in that we don’t often sit under the umbrella of the managers of each department, educators are usually in their own department. So we’re in a unique position in that we don’t really answer to a unit manager of a department.

It’s something you don’t really appreciate until you’re in the role of an educator, just how much counselling and support and professional coaching you do to your staff group. I really underestimated just how much of a professional resource you are to your staff, as an educator, and just how powerful that role is in inspiring people about their profession again and reigniting that passion as to why they became a nurse in the first place.

I think it can be somewhat punitive at times with the national standards and accreditation and all of the quality markers that we’re scored against these days. I think it’s very easy for a nurse to get down on themselves and think: ‘here we go again, it’s more of that quality stuff’. So that role of a counsellor and a mentor is really important for an educator.

But the other side of that is that I firmly believe that education is power. That if you can provide people with education, so that they feel well-educated and more confident in their role, that they’re less likely to feel burnt out in their role; that they feel more comfortable and confident about what they’re doing, and it provides them with choice: if you’re well educated and you do find yourself spinning down that rabbit hole of feeling burnt out, if you are empowered with education it opens up choice to you, so that you can try something different.

Wayne: I think that’s a really helpful insight, and it’s maybe a way of looking at it that people at times don’t see, in terms of being well-educated, well-supported and confident in what you’re doing, that there are options. That if that scenario does unfold, that there is the option to move on and look for other challenges.

Tony: I think people sometimes can feel trapped, like there aren’t any options available. And education provides those options.

Wayne: I’d just like to pivot back to the reluctant learner. Your thoughts, insights, tips, commentary about people that you meet that had that resistance to learning and how you would seek to work with them.

Tony: I think the first thing to do is just take a moment to reflect and think: ‘am I creating barriers, or is the workplace creating barriers that’s making it difficult for this person to engage?’. Often that’s not the case, but it’s still a very important step to take.

Then if you conclude that it is the learner themselves who is reluctant, there’s still something that’s motivating this person to come to work every day. If there isn’t, that’s another issue, that’s a performance management issue.

But if it’s just an issue of them being reluctant to engage in learning and education then you’ve got to think about what the motivation is for this person to come to work, and trying to engage with them. And again, you’ll have to invest some time if you have one or two reluctant learners, to feel out what is their motivation for coming to work and how can you leverage off that so that they feel engaged.

Workplaces are huge things, and you can’t ever expect 100% of your workforce to be fully engaged at all times, so maybe you have to accept that you have a small cohort of people who at this point in time are a bit disengaged. That’s fine, but you can’t forget about them. You have to think about why they’re feeling that way at the moment.

Wayne: I think that’s very true. From a professional point of view, that sense of persistence with staff can turn things around. Have you had examples of people having been quite reluctant and improving over time?

Tony: Absolutely. I think that sometimes we forget that we’re all human and that we have lives outside of work.

It’s completely reasonable that people go through periods where they’re more engaged or more disengaged with their workplace. Provided that they’re still delivering safe and effective care, I think that’s absolutely fine and it’s to be expected somewhat. Just ensuring that you don’t forget about those people and that you continue to provide them with opportunities to re-engage with the workforce and the education department.

Wayne: You mentioned before that in your organisation the education department is separate from the unit structure in the organisational chart, could you talk about your interaction with the broader education team and what that provides to you?

Tony: I think as an Intensive Care Educator you can provide a lot of clinical support to your fellow educators. You’re in a unique position in intensive care that you’re seeing the deteriorating patient regularly, so those assessment skills are our bread and butter. So you can provide that context in the hard skills to your fellow educators.

But the skills of an educator don’t really change, no matter where you’re working, so there is still a lot for us to learn, as ICU educators, from the education team across the whole hospital. Getting out there and having those discussions is very important.

The education department recently had a workshop and as we went around the room sharing our experiences, a lot of people realised just how much synergy there is with our frustrations. So absolutely we can each support each other in our workplaces.

Wayne: Terrific. We’ll close off our Care to Learn Podcast with a few final questions. What’s one thing you have learnt in the past month that has really stuck with you?

Tony: At the workshop we were talking about feedback. I use a particular technique called SBI (Situation Behaviour Impact), but we just went through some alternative models. It highlighted again for me the importance of planning feedback, it’s not something that you just do off the cuff. Particularly if you’re dealing with someone who is a reluctant learner or who is underperforming, you have to plan those conversations, and think about what the motivation is for this particular person at this particular time. So planning is key.

Wayne: What’s your favourite personal learning tip?

Tony: Using every available resource.

In this day and age it’s unrealistic to think that you’re going to have all of the information you need at the tip of your tongue. Having the internet, YouTube, journals and textbooks all at your fingertips, people shouldn’t be afraid to search far and wide.

When I’m grappling with a difficult concept I’ll read about it across four or five different platforms until finally the penny drops. You’ve got to have that ‘aha!’ moment for those difficult topics to fall into place. I always tell people to go and read those blogs, texts, whatever it takes.

And certainly YouTube is an amazing resource these days. Last year we were doing some training with staff around cardiac surgical advanced life support and we encouraged staff to pull up some videos on YouTube if they were ever struggling to remember an algorithm. There’s no harm in ever doing anything like that.

Wayne: And across your substantial educational journey, what’s the best advice that you’ve ever received about lifelong learning?

Tony: The key thing that resonates with me is that you can empower yourself through education.

Education gives you choice.

If you present yourself as knowledgeable and engaged with your workplace, people will seek you out to ask your opinion and advice which will only increase your job satisfaction.

It will also increase your influence in your workplace and you’ll be less likely to suffer things like burnout. And if you’re engaged and knowledgeable opportunities will come your way.