Welcome to Digication Scholars Conversations.
I'm your host, Jeff Yan.
In this episode, you will hear part two of my conversation with Sharyl Toscano,
professor at the School of Nursing at University of Alaska, Anchorage.
More links and information about today's conversation can be found on Digication's
Twitter, Facebook, and Instagram.
Full episodes of Digication Scholars Conversations can be found on
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If it becomes busy work, to be honest, I, I, I tell people, I'd rather you then
don't ask them to reflect because now they have this really negative association
with a reflection and they're like, Oh, you know, I don't want to do this.
This is boring.
Oh, this is, this is just you.
I actually heard about, I heard a student say this and I was so sad by it.
They said when, um, they were advising another student
actually, I overheard this.
They said, Basically, the professor wants you to stroke their ego.
Oh, my.
And, and you can see why though, right?
They would think that.
Because they are saying, the professor taught you a bunch of stuff this semester.
At the end they are saying, what did I, what did you learn?
If you say, I learned all the stuff you taught me, hey, that's the right answer.
Wow.
Right?
That's sad, right?
Yeah.
That's sad.
That is not exactly what you're looking for.
That's when I like,
please stop asking them to reflect because you are really actually, um,
if anything, you, you push them further into the hole of that they will never
get out of, you know, because if that's how they think about this section,
um, it, it becomes Not only busy work, it actually was for your benefit.
It wasn't even for them, like, it wasn't even busy work just to,
all right, we have to get it done.
It was more like a, oh, well, you just needed, needed some reassurance
that you've done it for you.
Yes.
Isn't, you know, sometimes I get with the essentials, oh, that's
just for accreditation, which it is a great way to show that you've
met the standards, but that's not really the point of the assignment.
That's just sort of one of the.
Extras, right?
That, oh, because, you know, when you go through accreditation for different,
you know, whatever program, you have to show examples of student work.
Um, so, yes, I, you know, I, I do, I tell the students, well, yes, it
is a great example of the work that you've done here, but that's not really
why that we do the assignment, um,
uh, because we can pull that work together in other ways.
The portfolio is just a nice way to do it.
But the key point to the assignment is actually that one of the reasons
it made me think of doing this is, uh, I saw students, particularly more
recently, you know, um, we've kind of passed our golden years in nursing,
I think, going into a different era.
But, you know, they just, Um, They just go through school and they, I don't, there
wasn't seeing a lot of acknowledgement of what they'd accomplished.
They're just like, I just need to get through school.
I just need to get through school.
And I wasn't really that student.
I love school.
Like school was, I'm still in school.
Right.
So I obviously just
You never left.
Yeah.
I
love school.
And so I wanted to kind of leave them with some appreciation for the, like, show
them what they've actually accomplished.
So this, this project actually kind of, you have to review everything that you've
done for the, across the whole program.
And they're doing it right before they graduate.
And most students will share at the end, they're like, well, this, you
know, I wasn't really excited about this to begin with, but I really
feel like I've done, I didn't realize how much I'd actually accomplished,
how much I'd actually done here.
And so they do that right before.
I love that.
I, I do wish that More people allow students to have more opportunities
to do that more frequently and early.
Um, but this idea in my mind of, um, not just any students, any, any humans,
anyone to have the, to get given some time and space to say, here is a body of
Work or body of things that you've done.
It doesn't have to be work, right?
It could be play, it could be other kinds of, you know, experiences
and achievements and whatnot.
The ability for someone to have the time and space to just go, here's a
body of things that you've, you've done.
Um, some people, you know, think of it as sort of integrated learning.
But I, I think that there's, I, I love that, but I also
think that there is a, um,
a really interesting, almost like neurological model that
gets structured around your self worth and your sense of self.
And so
to me, every time that You know, anytime that someone gets a chance to
say, Hey, let's take a look at your body of work, or you have to present
your body of work, maybe not in the like, like formal presentation, but
more like telling a friend, telling a new person that you never know
about, you know, doing a podcast.
That, that it, it sort of builds additional like neuro, like, you
know, connections in your, in your brain that says, ah, that's
the kind of person that I am.
This is how I, this is how I do life, you know?
Yeah.
I think that's amazing.
I think that's a, what a gift that you, you give your students.
Just kind of flip the lens a little bit.
Yeah.
I think it's, I think it's wonderful.
This is why I, I, I I wish that people make that a bigger part of life in
general, so it's not like, Oh, well, now that you're graduating, look what
you've done in this last four years.
But I always feel like, you know, what happened this week, you know?
I
feel like when you have adolescence, you could have like, Those are
your parenting successes, right?
Well, that's how
you keep yourself sane.
Um, can we, would you mind if we switch the topic for a moment?
I, I know that you also work with, um, I mean, there's been a, uh,
um, a pattern of you working with natives, the native population.
Yeah.
Sounds like first in, in, uh, Well, it's definitely in, in, in both in
Hawaii and Alaska, but maybe elsewhere.
So have you that,
um, For indigenous, mostly just Hawaii and Alaska.
Yeah.
And can you tell us a little bit more about that?
What is that?
What does that mean?
What is the work?
What is it like?
What did you do?
Um, yeah, so in , um, you, in Hawaii I worked the, um, Hawaiian
population, but also American Samoa, Tonga, um, other populations.
Um, I was more the health center there.
I was more in the, um.
Working in the military, you know, which is its own, um, culture.
Uh, so mostly I worked with students.
And one of the things that was really unique in Hawaii that I noticed is no one
in Hawaii says, why aren't you a doctor?
Which, nursing is And so much so that sometimes when students
weren't successful, they were actually happy because they
actually didn't want to be a nurse.
And I was expecting all this disappointment, you know, when
they're, when they actually were like, Oh, thank goodness, you
know, cause they actually didn't.
Didn't want to do it.
So that was a big, big
culture.
Is it just a general culture?
I
think it's something unique about when I was in Hawaii, it was just very much,
you know, other places people often say, well, why aren't you a doctor?
Why?
You know, it's like a, but not there.
Like nursing is very respected.
And so, it was kind of a very unique experience while, while I was there.
Um, but definitely like the storytelling that we've been talking about is very
integral to both Hawaiian and very much so in the Alaska Native population.
And I would say I've worked more closely with the Alaska Native population
like here because I've been with the, the, the hospital since 2012.
So, um, and with fam working a lot with families and So when, when
families come in for health care, like Anchorage is a hub, and so we
get families from a lot of the rural villages that will come to the hub.
Whereas on the adult side of the, of the hospital, sometimes you get
patients from the hubs, but there's more access to adult care at the
other hubs that aren't Anchorage.
And so, you know, when you think about, um, You know, a lot of things
we've been talking about as far as the nonviolent communication, it's, it's
a very non-confrontational culture.
And so, um, often, and it's not hierarchical like the hospital, the
hospital is owned by the people.
So the patient is the owner, it's a customer, owner is
the word that he Mm-Hmm.
is used.
And so it really changes the dynamic in the hospital because, you know, somebody
who's, you know, doing housekeeping or, um, you know, is at their desk or, you
know, even the provider, they all may own the hospital, you know, the owner.
And so all of these sort of, um, levels of hierarchy, for me, I've noticed is
really nice because that's removed.
And so I feel like Like
this is the This is the big boss, and then you're the second and the third big boss.
Right.
I, I don't
feel that as much there.
And, and so, um, but the stories, like often I would bring students over to
the hospital too sometimes, and I would disappear, like literally for 40 minutes.
They'll say, well, where were you?
And I was like, well, I just, Got the greatest story.
You just, if you go into a room and you start talking to an elder and you just
hear the most amazing stories because, um, the culture there is amazing storytelling.
Um, you know, once it was about the last time that this person was in
the hospital was actually when she was a young girl and it was during
the earthquake, the big earthquake.
And so, but it's a different way of doing health assessment because Before I went
into the room, the patient was um, very anxious and the nurses were having trouble
providing care.
And then I sat down and talked with her and I figured out where
the anxiety was coming from.
She was sort of thinking back to her last time.
It's a different hospital.
They actually built a new hospital, but for her, all these things had
happened the last time she'd been They call it the native hospital.
That's their name for it.
But, um, and so I don't know, it's just, I don't know if that answers your
question, but it's a very different way of, it's more of a narrative medicine
approach that I would take with, um, my patients at the hospital where I
try to figure out the story as opposed to like coming in with a, you know,
checklist of what are your symptoms?
You're not going to get very far.
If you approach health in that way, um, or I've seen people approach
education where they have this list of things they're going to go through
to educate as opposed to, um, sort of integrating it into your daily care.
Yeah, it's been a gift to work with the Colt.
I just, um, it's one of the, it's probably the best hospital I've worked for, I
think, uh, as far as just the population.
And, um,
I don't know, it's just, it's just been a real gift to work
there.
I think that is so amazing.
Um, I can, I can see why you are wired the way that you are and
what draw you to all of this work.
Um, do you think that there is something, what are some of your
observations in terms of, you know, you talk about storytelling, right?
It's a big part of the culture, it's a big part of the ability to tell these
amazing stories and, and have gathered so many stories, but only we all have
lots of lived experience, but we don't, at least in sort of the, the sort of
mainland, you know, Western culture, you know, we don't think of these as
stories, we don't collect them, we, we just sort of, it happened and that was
it, maybe it's more like the, you know, you tell people at a bar, you know, like,
but, but, you know, But there are many cultures where stories are treasured.
You collect them like you are, you know, like, like people
collect certificates, you know.
Um, and I don't want to say, it's not the vain way of saying,
hey, I just have a certificate.
It's just like, you really value them.
They are useful.
It can come in, in handy at some point in your life, you know.
I think there is something so beautiful about that, that we are almost kind
of, for some reason have missed the boat on, you know, like I see a lot of
students, for example, going to school and I'm talking even K 12 schools, right?
Um, where you had talked about, you know, NVC being used in certain models, right?
In the more mainstream sort of traditional school model, I see students,
including students coming, you know, I'm sure coming to your classes,
where they go, I have an assignment.
Tell me what I need to do.
Tell me what the expectation is.
How do I get an A on this?
Right.
I'll do it.
Not only do I, when I do it, I'll do a good job at following all of those
things, but the second that I submit it to you, or hit the submit button,
whatever, you know, whether it's a paper or technology, it doesn't matter.
The second I do that, I'm done.
Right.
I don't think about it ever again.
It's not part of the story that I keep.
In fact, I get to forget it.
Right.
Now I've done it, so you grade it, and then it will exist as a some kind of
percentage in my grades, and that's it.
I think that's a, there's something there that, that makes me feel really sad about
because that narrative, that accumulative sort of narrative, that body of work,
um, is so incredibly powerful and useful.
Where, when I think about these very fragmented, fragmented Pieces where
the person does it in almost like a very short term, short memory game.
You just kind of do it and then you just don't think about it anymore.
It's
almost like, um, to me, it feels like a waste of time.
It feels like that time just got lost.
Because you didn't get much out of it.
It's sort of the what's on the test phenomenon.
Yeah, right.
You study for a test.
At the end of the test, you just kind of like, you just really go,
I did well on the test, but you really just, even if someone asks you
that same thing again in like three days, you'd be like, I have no idea.
I knew it three days ago, by the way.
I've had these as an, you know, as an educator, I've had these, you know,
classes where I've, you know, I've been like, I feel like you're, I'm on fire,
you know, I have these great stories pulling out all these concepts and ideas.
And, you know, the students are engaged and then.
Always at the end of the class, somebody will say, so which,
what if that is on the test?
I'm just
like, oh
my gosh, you know, it's always kills me.
Yeah.
What do you think are some of the, it seems like that you're very in tuned
with what students are doing these.
I mean, you talked earlier about sort of going from, uh, you know, nursing has
changed, you know, you're talking about team nursing and things that you weren't.
That you said, you know, that's not how I was trained or how I practiced before.
Um,
and of course that probably means that, you know, you also have to now change
in how you teach your students and new skills, new ways of teaching and learning,
and then you had talked about certain, you know, sort of, you know, need to, Figure
out how to take care of themselves and dealing with burnouts and stuff like that.
If, you know, it's sort of like a very like, you know, sky view level
looking at nursing education right now.
What are some of the, what do you think some of the big, um, either
where some of the hurdles but also some opportunities are in advancing?
You know, the field and making, I love your vision of, Hey, they shouldn't
even have to be resilient because it implies that something's wrong.
They have to just survive it.
But how do they naturally just kind of thrive it because
it's just an enjoyable thing.
Well, by the way, I think that it's probably correct me if I'm wrong, but
I think people, most people want to go into nursing because they, they, they
can get joy out of helping other people.
That's a
common, yeah.
Right.
Or they've had some life experience that has brought them close and
they've recognized all that.
How important
that would be to bring it to another person.
Yeah.
You know?
Yeah.
That's such, these are such worthy, like, root level, like, directions, you know?
So what happened and how do we, like, what are some of the
opportunities now that you see?
Maybe team nursing is part of the thing?
I don't know.
I mean, I don't know enough about it.
Can you tell us more?
Well, for that, I'm hoping that, I think the team structure happened
during, you know, The pandemic, like it was a necessity because
you just didn't have the people.
So you, you know, my personal philosophy is that the, you know,
that's not the model that's actually going to be the best moving forward.
But sometimes you have to drop back to these survival modes where the
emphasis might be safety, efficiency, you know, you, you, and you, you
lose some of those other aspirations during times of, you know, extreme.
Circumstances, but sometimes I think on the admin side or the hospital side,
they see the cost savings of those now.
Right?
And so,
well, because you've cut some corners, so there's some savings.
You have to realize that the corners you cut, someone's paying for it.
There's a different cost somewhere.
And so there's always this, um, you know, there's that side that they want,
you know, more nurses, cheaper nurses, you know, there's, and there's been
less unionization of nurses compared to the past where, you know, that those
sort of things are kept in balance.
So I think right now there's, you know, and I'm not, I'm not in the sort of
Nurse Management Arena, but there's definitely this sort of conflict
between, you know, staffing ratio.
There's been legislation trying to regulate staffing ratios of
nursing and there's always been lots of lobbyists that come out.
In many states, it hasn't been successful convincing, you know, the consumer that
this is going to somehow make their care worse because, you know, I don't think
they understand, um, That when you have a nurse who has too many patients that
that's actually what is driving your care, not necessarily that, you know,
they're sending in these arguments and about, you know, this is decreasing
their access because it's You know, the provider will only be able to take
care of this number of patients, but, you know, in health care, it's hidden.
Quality is hidden, right?
You don't know.
Your surgeon might, you know, be nice to chat with or, but you
really don't know the quality of surgeon that he or she is, right?
And in the other areas, Quality is not as hidden.
You know, if you buy a dress and it falls apart in a week, like, you
know, that that was not very good.
You know, if you have poor quality healthcare, you might
not know ever, or that might not.
You might not realize it for, for years.
It's too late.
Yeah.
And so anyway, I'm kind of got off on tangent, but there is this sort
of things happen during pandemic time that are emergency and you know,
there was legislation and things that allowed for that to happen,
like changing some of the rules.
And now as we're starting to get back into those, those rules are, they're changing.
We don't need those rules anymore.
Um, I think sometimes they're looking at the cost difference, but I think
that students do have to be prepared for, um, what they might see.
You know, are they going to be asked to kind of function
in a more team like scenario?
And that's more where you're task oriented.
So instead of having the care for one patient, uh, which is kind of
somewhat of a safety nut, because you have somebody who has eyes on them.
what's physical therapy doing, what's speech doing, what are the docs
doing, what, you know, the nurses usually has eyes on all of that.
Um, so there divide more in tasks.
So this person's doing medications, this person's doing procedures.
Um, we're delegating all this to CNA or LPN.
Um, Probably, it's more like the system when I very, like 1994, you know, it
was myself, a new grad, I would have 10 patients, the LPN would have 10 patients
and really at the time, the LPN, although I, you know, I, she, I was, she was
really in charge of me, if, if, to be honest, because she had, you know, she'd
been in nursing for 40 years and, you know, um, um, But as far as the licensing
agreements and things that they could do, you were sort of not their supervisor,
but you were sort of the lead of the team.
So there was this kind of strange dynamic there when, um, they were really
extremely, so I'm not dismissing the value of LPNs because I learned a ton
and I wouldn't be the nurse I am today without the LPNs that I worked with.
But back then, um, The acuity was very different.
We had patients that don't even stay overnight anymore.
So you'd basically out of those 10 patients, one or two would be sick and
the rest were sort of your standard post op, um, patients that nowadays
go home, like you don't even see them.
And so when implementing some of this team based, that's when it
becomes really stressful because you have extremely sick patients.
Um, and you just, it's very stressful.
When you start being responsible for more than say, I think, uh, in Peds anyway,
it's like four in the NICU, we have three.
Um, but on some of the adult floors, they can see six to eight, maybe more patients.
So if you think about that in an hour, they're supposed to touch
base with that patient every hour.
So if you have six to eight in an hour, You're just
constantly running around, you know, yeah, you can't, yeah.
Yeah.
So it's really, um, you, you know, it's, Nursing, uh, nurses are costly, I suppose,
but it also costs more to close the unit.
So there's all these kind of cost drivers there.
Um, but I think one of the bigger things is to give nursing, new
nurses, a voice of when it's unsafe.
And so how do they, how do they express that?
And, um, You know, what are the rules and regulations around that?
Like, you can't abandon a patient.
If you show up and you get an assignment that's unsafe, you can't leave
because that's abandoning a patient.
And many, many of the boards of nursing, you can get disciplined for that.
So, so it's how do they document that unsafe assignment without
having consequences to their license?
And how do they make change within the system they're in?
Um, sort of in a productive way.
Um, so kind of focusing on some of those tools.
By the way, coming sort of full circle, I, I feel like that those
tools that we're talking about.
Uh, the kind of reflective storytelling and conversational, you know, sort of
tools that you're preparing with your students, nonviolent way of communicating
those things, ways to be able to, to, to do things without judgment and not
blaming to, you know, in any specific people or a person and just being able
to calmly go in and look at a situation.
Yeah.
And I can see like, as soon as you flip it, when you're not attacking the person.
And you're saying, you know, I'm feeling really scared.
You know, if you start off with that, the manager is like, what?
You know, instead of you did this, this, and this, I was like, I'm, I'm
putting me into this position.
I've
said that I'm, I'm scared.
And they're like, okay.
Their ears open.
Right.
When you,
But it does require that they also share a little bit of their vulnerability.
Because when you're using any of the storytelling or NBC, you, you,
you are a little bit vulnerable.
So that takes a little practice to be open to that when, you know,
sometimes your first instinct is to just You know, keep quiet and
practice is in fact, what's so healthy though, you know, like in a, in the case
of you be then being able to do it with you in a, in an education environment
in a class where, you know, they are hopefully safe from themselves, from
you, from their, their colleagues so that you can, they can practice that
because I think it is a skill, isn't it?
It's a skill that you practice enough that.
You'd then be able to use that in a situation.
And by the way, this is kind of amazing to me.
Because people talk about
reflection in this, as this very nebulous, abstract concept.
That it's like, if you've done it, or done it well, or experienced it, you
know it, and you feel great about it.
And you learn from it.
And that's kind of it.
But if you haven't, you know, I have no way to tell you what it is.
Um, it's like telling someone about riding a bicycle or swimming or love,
you know, like, yeah, I don't know how to describe it, but you actually
just kind of created a very solid,
um, Example of how that reflective skill can really be used in a, in
a very productive practical way in how do you confront situations with
this case, even with the actual skill of doing the confrontation itself.
But just mentally, first of all, how do you confront that situation
when you're like, I'm scared, I'm in danger, I'm in, uh, you know, I, this
is not fair or this is not right?
Because it may not be in nursing, right?
Um,
I really feel like that there's a lot that, well, I certainly have learned
a lot, but I think that a lot of our listeners will learn from this in how,
for me, a very, a very advanced set of, um, topics that you've discovered,
sort of one after the other, that I really feel like that whether I'm
teaching in a STEM program or in a.
You know, in the arts or humanities, I could borrow a lot of what you are saying,
um, and use it very positively for sort of general, you know, education and pedagogy.
I really do.
I think that it's, you know, you've created, you've lent us a
really beautiful insight to this.
Um, I especially love this thing that at the end that you said, I don't even think
that you thought you, you, you, you did it on like sort of like deliberately,
but I was like, wait, hold on a minute.
So all of those communication and processing skills that you
have students do, which is in.
You know, the way that you teach them how to reflect could be
used, in fact, to communicate with someone to solve a problem.
So it's no longer this abstract, just, you reflect and you feel great, and then
you now go home and get a better sleep.
It's more like, no, literally, I'm in trouble.
I needed to go in and talk to someone about something, and I'm
using, borrowing some of the skills to go in and do that communication.
I think it's lovely.
That's my hope that they'll use it.
Well, Sharyl, I feel like that, um, there's much more
that we can learn from you.
And I hope that, um, we get to do that again soon.
Um, but today I think this is a good, um, first chapter of Sharyl
and her wisdom from nursing.
Um, but really like, I think there's so much to unpack, you know, your experience
with, um, You know, um, Native Alaskan, especially now, you know, all of these
kind of, um, I mean, I haven't thought about a culture that is, you know, based
on, that is so, has so much, plays so much value on narrative, for example.
That's a, that's a, that's a, that just opens up so many possibilities
in my mind, like, right away.
Um, so, we gotta talk more.
But, um, for today, we will, we will pause for now.
Uh, hopefully we can, we can talk more again soon.
And, uh, Sharyl, I, I can't thank you enough.
Um, you've, uh, this is, this is, this is incredible for
me as a learning experience.
Um, I, I appreciate you so much.
Thanks, Jeff.
It's been fun.
Thanks.
All right.
Take care.
Coming up next, we'll be chatting with Kyle Hewson, Vice Chair and
Clinical Associate Professor in the Doctorate in Physical Therapy
program at Stonybrook University.
Here's a quick preview.
So the idea that They put up a PowerPoint that they did in their
first year with two or three people.
Even just to show them how advanced they've become in some of their
presentations by the third year, you know, they have this and that, and they're
just, their references are awesome.
And they're able to pull in a video or something.
So just, and they feel so much more comfortable because they say, Oh, I
was such a nervous person that first time I had to get up 80, 80 students.
You know, so, so it's kind of neat.
You know, that.
See you next time!