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Welcome to The NICU Translated Podcast, where we break down the complex world of the NICU into clear, relatable insights for families and the professionals who support them. Hosted by Mary Farrelly—a certified NICU nurse, doula, and educator—this podcast is your go-to resource for navigating the NICU with confidence and compassion.
Whether you’re a doula looking to better support NICU families, a healthcare professional seeking deeper understanding, or a parent preparing for or living through a NICU journey, you’ll find actionable tips, evidence-based guidance, and heartfelt stories to inspire and empower you.
Each week, we’ll explore topics like:
-NICU 101: Terms, diagnoses, and medical equipment explained.
-Preemie care basics and developmental milestones.
-How to advocate for your NICU baby with confidence.
-Emotional and trauma-informed support for NICU families.
-Insights from NICU professionals and families who’ve been there.
With episodes featuring expert advice, list-style guides, and real-life interviews, The NICU Translated Podcast is here to equip you with the tools and knowledge to make the NICU journey less overwhelming and more empowering.
Subscribe now and join our community dedicated to bringing more joy and less trauma to the NICU experience—because the NICU is only the beginning.
Let’s navigate this journey together.
Mary Farrelly (00:00)
Many nurses enter healthcare because they want to make a difference and then somewhere along the way they start to feel stuck, exhausted, or invisible inside systems that don't seem built to support them. My guest today, Claire Phillips, is a nurse, educator, and systems thinker who helps nurses understand why this happens and what to do about it. Claire has worked in emergency care, hospital leadership, and health tech and now teaches nurses how to map their impact, lead strategically, and influence systems without sacrificing their well-being. In this episode, we're talking about power, burnout, leadership, and what it really looks like for nurses and other
professionals to create change from the inside.
Mary Farrelly (01:10)
Hi everybody and welcome back to this week's episode of the NICU Translated Podcast. I'm so excited to welcome Claire Phillips to the podcast.
I was just telling Claire before this, I'm selfishly so excited to talk to Claire today and to pick her beautiful nurse brain about all things system and changes and how do we make culture shifts in a very entrenched world? And how do we do that while navigating potential burnout and feeling powerless and all the many different aspects.
of care that really come to a head in a NICU setting. So before we dive into it, do you mind sharing a little bit about who you are and I guess how did you get to this point in your career as a nurse? Because as we know, nurses can, our path takes us many winding roads. So I'd love to hear your
Claire Phillips (01:56)
I went to a small liberal arts college and I ended up majoring in sociology and anthropology. So I took a lot of classes about different social structures and I really fell in love with healthcare and its messy, messy problems. And so I took a lot of like medical anthropology classes. I took one class.
⁓ on the sociology of health and illness. And in that particular course, we dove into the different ⁓ healthcare professions. And that's when I fell in love with nursing, learning about the nursing model of care and the whole person care, theoretical foundation of nursing care versus cure model. And I decided that nursing seems like a really worthwhile profession and way for me to like learn the healthcare system from the inside.
because I had this like sociologist growing inside of me that wanted to like study these systems and help fix them. So that's why I got into nursing and then I went and I got a master's in nursing after my bachelor's and between those two degrees I actually took a gap year and was an au pair in the Netherlands which is I only mentioned because now I live in the Netherlands so sometimes people are like how the hell did you end up there? That's how.
I fell in love with the Netherlands when I did my gap year. So lots of falling in love in that college time period. And yeah, so I got my master's in nursing and then I started working in the ER. I worked in the ER as a nurse for three years and the last year of that was during the COVID pandemic. And then in the beginning of 2021, I moved into a nursing leadership role in a different emergency department. And
Mary Farrelly (03:09)
Ha
Claire Phillips (03:30)
That was really great way to see a different sort of perspective on nursing and the healthcare system from an operational leadership perspective. And it was timely because at that point I was finishing up my Doctor of Nursing Practice degree in Health Innovation and Leadership. So I was like learning leadership skills and systems change practices in school. And then I was putting them into practice in my nurse leadership role.
Also, during that ER time period, I started a company Nursing The System, which was really born out of me. I just started a blog talking about my sociology studies as an ER nurse and what I was seeing and hearing from my colleagues and talking about all of the messy problems of working in an ER through a sociology lens.
And I got really good feedback from other nurses just on Instagram or who found my blog that it was helpful to have like language to put to the hard stuff they were facing every shift that we didn't necessarily know how to describe, but knew was contributing so much to our frustrations and feeling a bit helpless in our ability to actually help patients beyond like the care moment with them.
And yeah, so I just, had so much like organic interest in my little sociology nerd brain applied to nursing that I started to think about how I could expand that work and make it a more like concrete part of my professional life. And so I started, yeah, my business nursing the system.
And now I live in the Netherlands, so fast forward a few years. I live in the Netherlands. I work as a manager at a health tech company, doing really cool, innovative stuff in the clinical trials world, helping make that more accessible for patients and caregivers and easier to find. So yeah, that's where I'm at now.
Mary Farrelly (05:24)
There's your winding road. This is, it's as I did not know your full backstory. I just wanted to share that I was pre-law. I majored in sociology for my first degree. I fell in love with nursing my senior year, took a gap year, worked as a nanny. And then a medical.
Claire Phillips (05:25)
Yeah.
⁓ hey!
Shut up! ⁓ yes, the stars align.
Mary Farrelly (05:45)
an MA and then went back for my second degree and then went into nursing at the bedside in the NICU and then went into admin and landed here where I feel like it got to the point where I was like I could see the systems. could see the, I could zoom out in a way that I felt like not everybody could. I feel like there is this like we in healthcare get so stuck in the details and then the nitty gritty of the day today literally like survival mode like truly that when we're asked
sometimes to take a step back in and see these bigger picture things that we don't have the words for it or it can feel a little overwhelming at times too. So let's kind of I knew like there's there's
Claire Phillips (06:23)
Yeah, totally.
Mary Farrelly (06:26)
theory right and then there's like the lived reality but let's just for those that are listening because it's probably a newer concept let's talk a little bit just about like systems theory and like the idea of of health care as a system like when did you start noticing the system and what were some of your biggest takeaways from systems thinking in a health care setting
Claire Phillips (06:46)
Yeah, well I think it's important to note that I went into healthcare like with the intention of studying the system. So I was aware of systems thinking ahead of becoming a nurse, which a lot of people discover systems thinking like in nursing school or just like working in a healthcare system and then realizing that like, okay, there are like ripple effects happening here in all these like overlapping layers. But that was not my experience. So...
Mary Farrelly (07:04)
Mm-hmm.
Claire Phillips (07:11)
I think for me the main like systems epiphany when I first started working was just realizing that the emergency department really was this intersection. I say this like all the time but when I tell my background story but like the ER really is an intersection of all of these broken social systems in the US. I was working in Minnesota at the time and
and just like looking in the waiting room and seeing every person in that chair is like impacted by at least one of these broken systems and here I am as a nurse like here to help but so limited in what I can really do and when you're like sending someone without a house back on the street in the cold in Minnesota because the shelters are full or you like can't get someone a bus token because
Mary Farrelly (07:52)
Mm-hmm.
Claire Phillips (08:06)
the social worker went home at 7 p.m. and it's 7 45 and you have to explain, you know, the limitations there. It's just, it's like gut wrenching and it, you just experience that like moment after moment after moment. And so I think for me, like the systems theory was already in my brain, but then entering into the nursing world and actually interfacing with patients, you were like, okay, now, now this is like really landing for me in a whole.
Mary Farrelly (08:16)
Mm-hmm.
Claire Phillips (08:34)
new way where I think a lot of people have sort of like the opposite experience where they're like, oh, I'm just like, I'm feeling this friction. That's how I like to describe it. This like constant friction as a nurse. And I don't know what's happening. But I, you know, theoretically knew that would happen. But then actually seeing it play out, you're like, oh yeah, no, I get why the nurses are tired, baby. Damn.
Mary Farrelly (08:45)
Mm-hmm.
Right, you had a system that had a face, that you put a face to the system and a story to the system. And then on the flip side, a lot of times people that are living in, it's like a reverse awakening. They're living in the trenches, they're seeing the stories play out and feeling like, this is an individual story, individual stories all over. And then all of sudden you have this moment and be like, this is the same story. Or this story has a bigger kind of meaning and interplay and how it plays,
like the piece of the puzzle that it fits into. And I love that you said that friction. Someone once said to me that it feels like they have their foot on the gas in the brake at the same time. They're wanting to go, they know what they need to do. And then there's also this stopping, like we can't do this, you don't have capacity, protocols, guidelines, all the things. And so that, I feel like, is a huge factor, whether people have the words for it, the label for it, to burnout, right? Like not knowing how to...
make actual changes or do the work as you feel it should be done can create this like dissonance and this disconnect. So how does burnout play into this when we're talking about I guess this epiphany or like whether or not someone realizes it or not? Like kind of the root causes underneath a lot of healthcare providers burnout, especially with nursing and being so forward-facing and patient-facing.
Claire Phillips (10:18)
Yeah, totally. I mean, we could talk about burnout for like a full calendar year while we're hitting record. But I think that like one of the... I think a big piece of the pie with burnout is feeling like you don't have agency. And that can be perceived or very, very real. I always tried, especially as I've like matured in this work, I try to be very clear about saying that like you might very well be in a situation where you definitely like you truly have limited agency.
Mary Farrelly (10:21)
Point.
Claire Phillips (10:45)
And I don't want to tell someone like, just try harder to make change and have that be like the blanket statement if their energy is not actually going to get them anywhere. Like, I want all of your like energy investments to be strategic. So yeah, I think the core thing with burnout is feeling like you don't have agency and
So I think with the systems lens, my goal is always to help nurses and nurse leaders be able to effectively calculate and determine where they have agency and how much of it they have, and then how to strategically exert influence within those pockets. Because we can look at any complex system, even not that complex of a system, even in a company of three people. ⁓
Mary Farrelly (11:30)
Mm-hmm.
Claire Phillips (11:31)
and you might say, well, like, I'm not the boss, I don't make the final decision. It's like, well, that's certainly true. Your CEO is gonna make the final call, but like, how can you influence your CEO? What suggestions can you make? How can you make those suggestions? When do you make those suggestions? So you do have those pockets of agency, but then when you get into a more complex system, like let's say a NICU, right? A massive NICU at like a teaching hospital and you've got all these different players and stakeholders and bureaucrats involved.
the map of how you can like wiggle your influence through that system becomes a lot harder to visualize. ⁓ And so I think the more complex environments we put ourselves in, the more difficult it is to see our agency. And I think that is when you're at higher risk for burnout because you're just like literally looking through a forest and you don't see any light. Now there might be a path there, but you might, you know.
Mary Farrelly (12:07)
Mm-hmm.
Good luck.
Claire Phillips (12:27)
You have to look for it. You gotta study. And in a job like nursing, sometimes you don't have the capacity to do the studying, to do the weed whacking, to find the path. you're given, if you measure your capacity from one to 100, at the end of a shift you're at 99, that last 1%, you're like, I gotta drive home, baby, I can't.
Mary Farrelly (12:28)
Listen.
Okay.
Claire Phillips (12:49)
to sit here and think about how to make change. So I think, yeah, I think sense of agency and then like also your emotional and physical and mental capacity to like find the path to effective change making. Those are very real challenges that nurses face.
Mary Farrelly (13:06)
Yeah, think that sometimes the lens that I can see this through is like both sides. I I live like a dual, I wear a doula hat and I wear a nurse hat and I speak both languages fluently. So I feel like sometimes people in healthcare.
or even looking outside of healthcare, like as a patient or a doula into healthcare, they assume, you know, like, why aren't they doing better? Why aren't they doing more? Like, there's all these gaps. It often feels like it falls on the back of the nurse who is already at basically max capacity in every new initiative, every big change, either came from a nurse or is going to be implemented by a nurse at the end of the day, nine times out of 10. So there's this disconnect sometimes by like the reality of like, truly like the capacity of a bedside nurse.
within the system that they're in. And so often, also I feel like sometimes in the culture of nursing and in different units, the bigger picture system kind of intentionally keeps nurses busy or overwhelmed or understaffed to a certain extent because it makes it easier. If you're fighting within each other and you're kind of nitpicking at the tiny granular details, there's not enough time to take a step back, as you said, and look at the bigger picture and try to implement real change. We can feel really frustrating, but I also
feel
like there's so much opportunity for potential.
Impact changes that don't take like massive overhauls of like a full Burn it all down to build it back up as much as I was I would love to do that sometimes It's just like this is not working Can we do it again, but that doesn't work because the people are still sick. We still have to show up every single day and ⁓ The world keeps spinning So it's not the same as like a company Restructure where you can really just stop everything and pause it and then restart again It just has a different flavor of it, too but let's
Claire Phillips (14:39)
Mm-hmm.
Mary Farrelly (14:51)
kind of bring it to the practical lens of it to a certain extent. So if you have a nurse in the NICU and you're seeing, I'm gonna go from the two angles here, if you're seeing like these moments of impact and...
key places where like your raw spots you're like this is this is something that I could change like I could impact this one aspect of my shift or my care or my co-workers experience. I know that one of the things that you do in your program is kind of like mapping out your impact so I would love to talk a little bit about what that would look like like on a micro level on like an individual thinking about listening to this and be like how can I make this change in my unit what does that look like?
Claire Phillips (15:30)
Yeah. I think one of the first things that I would recommend people do is understand where they sit in the change ecosystem. So I, yeah, my mini course, you literally said the name Map Your Impact is walking people through the exercise of charting how much social power they have in their work environment. And then also how much knowledge they have in their work environment.
So social power can be like the relationships with your team members. It can also be like if your daddy owns the hospital, that's social power, right? So it's not just like the most like by the board sources of social power. It's also like if you know X, Y, Z person is like cheating on their partner who also works and then you're like, that's social power. How we use that we can make decisions about. But like I really urge people to get creative and think about like where do they have social power within.
Mary Farrelly (16:14)
Mm-hmm.
Claire Phillips (16:24)
their organization. If you are like the manager of a unit, you have more formal social power than maybe a bedside nurse does, but not necessarily more total social power ⁓ because we have influence in many forms. So I would get clear on do you have a lot of social power, a medium amount of social power, or a little bit of social power? It's sort of in comparison to the other people in the change ecosystem. So your unit or like maybe your hospital
Mary Farrelly (16:34)
Hmm.
Claire Phillips (16:51)
wing like if you're like outpatient or inpatient. And then look at how much knowledge do you have and knowledge isn't just clinical knowledge but also institutional knowledge. So like are you like can you recite the policy handbook front to back? Do you know where everything is stored? Do you understand the like bureaucratic processes to get things approved? Like all of that is a form of knowledge. So do you have a little bit of knowledge? A medium amount of knowledge or a lot of knowledge?
And then based off of how much social power and how much knowledge you have, that puts you in a particular place in the ecosystem. And I always say that no matter I call the four different, I won't get into all the details, but basically like you can sit in four different positions in the ecosystem based off of these two things. And every single...
person, whether you're a novice or what I call a champion who has really high knowledge, really high social power, versus novice, which is low and low, both of those individuals have a role to play in making change. But when the novice tries to move like a champion or a champion is moving like a novice, that's where you feel extra friction because you're going to be trying to get things done as if you have all the social power in the world. But really, you're like brand new to the unit. You barely know anyone.
Maybe you have like a fair amount of knowledge, but not that much institutional knowledge. You just like have 20 years NICU experience somewhere else, right? That might still put you in that novice position and novices need to move very differently until, you know, they move into a champion role by acquiring social power and knowledge. Very differently from a champion, for example. So I think the most important thing with sort of mapping that path through the woods.
Mary Farrelly (18:12)
Mm-hmm.
Claire Phillips (18:30)
this weird analogy I've never used before, we're just gonna keep rolling with it through the episode. Yeah, you first have to know where you're starting and what tools you have, and then from there get strategic about how you move forward. And I think once we go through that initial exercise, people are like, my gosh, I feel so much better because I don't feel like I need to show up as this master champion of change.
Mary Farrelly (18:33)
I'm loving it. Very winter.
Claire Phillips (18:55)
I can see that my role is to help with implementation right now, where my role is to ask more questions or ask to observe while I build up those social relationships. Like that is the most strategic thing for me to do. I can see this need. I know that like at my last hospital, this is the way we washed our hands before touching the babies. I again, don't know anything about the NICU. But like this is.
Mary Farrelly (19:15)
I love it when
Claire Phillips (19:19)
This is the practice
that worked really well at my last hospital where I read this in the literature. But I know that if I bring that up in huddle, it's probably not gonna land. But I'm gonna find a high knowledge, high social power person on my unit who's well connected. And I'm gonna like drop that article in their inbox or I'm gonna be like, hey, Mary, you know everything about the NICU. Have you seen this? And then it's on champion Mary to actually get that moving and you can help, right?
knowing who's in your ecosystem, where you sit in the ecosystem, and what's gonna be a waste of your time and your energy and gonna feel like pushing a boulder up a hill and what's gonna feel easy peasy lemon squeezy. These little micro actions that are actually creating pretty significant ripple effects in the system itself.
Mary Farrelly (20:06)
That is fascinating and also so helpful too. I feel like that is such a relief, as you said, like for people who know someday that they have capacity to be a champion.
Right? Like sometimes you know in your heart, like that's, that's where you're going, but you're not there yet. And so sometimes I feel like, especially with, with younger nurses or someone who, as you said, is switching roles and was maybe a champion in their old unit and is now a novice and like that kind of fall from, fall from glory to a certain extent and how that system works in nursing, which is also fascinating, seniority and transferring roles and how that all plays out. but it is kind of like that moment of clarity. I like I can,
still make change, I have a short term and a long term. Like this is where I'm at and what I can do today versus what my goals are for implementing this tomorrow. Which can feel, depending on your personality type and your human design and all the, any of the things can feel challenging, but it is not following that kind of...
Claire Phillips (20:47)
Totally.
Mary Farrelly (21:04)
patient path to a certain extent can lead to feelings of even more burnout because you're like, I'm trying, I'm shouting into the void. What am I doing? When you actually are probably incrementally are making change and having influence in ways that you're not even really seeing in that moment too, but can feel speaking from experience, very frustrating at times.
Claire Phillips (21:09)
Yeah.
Totally.
Yeah, 100 %
and like that frustration, I think we need to live with that because any sense of frustration that we have is just us recognizing an opportunity to make something better and that will literally never go away. If we all live in some sort of utopia with universal healthcare with zero percent infection rates, all babies happy, healthy, fed, right? There's still, we're still gonna look around at that world and be like, huh, you know what?
Mary Farrelly (21:29)
Mm-hmm.
Claire Phillips (21:49)
We can do this better. can have more free time to spend with our loved ones if we do it X, Y, Z way. And frustration is going to stem from that. That's just the little innovator inside of each of us recognizing that, we're humans. We're brilliant. We can do anything. We can make anything better. So I think instead of seeing frustration as the hurdle, it's really just your companion. That's just a sign that you're alive and paying attention. And I think that it's
Mary Farrelly (22:03)
Mm-hmm.
Mm-hmm.
Claire Phillips (22:15)
That alone can be a really helpful mindset shift. And I tell myself that literally every day. Yeah, exactly. And like I entered my current role in the Netherlands almost just over a year ago. And I'm in a new industry. I'm now in clinical trials. I health tech like this is not I'm coming from an emergency department. Obviously it's health. So it's somewhat related, but.
Mary Farrelly (22:20)
like the gift of humanity, right? The blessing and the curse.
Claire Phillips (22:40)
I was a full novice and I was stepping into a manager role and I feel frustrated all the time but it's a healthy frustration and I can recognize it as such and try to like use it to fuel strategic initiatives and actions that I take rather than like taking that home and being like this is a sign that something's wrong, this is a sign I need to leave. It's like this is...
Mary Farrelly (22:54)
Mm-hmm.
Claire Phillips (23:00)
Frustration is my friend and it will always be here walking alongside me for as long as I live because I know
Mary Farrelly (23:05)
Right?
We'll always be doing better. And that's just how we're wired. And you know, like my lovely dog, like she's beautiful and she has her gifts, but she's not sitting here trying to be like, what's the best way to, you know, make my dining experience better? I mean, maybe she is, but she's very smart. But that's the gift of being a human, right? So we're always, um...
seeing problems and some of us sit and complain about them but other times I feel like you do want by complaining even inadvertently are trying to make and be the change. So I love that that idea.
Mary Farrelly (23:41)
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Mary Farrelly (24:24)
Taking it to the...
selfishly, the model of NICU doula work. So the idea of bringing potentially an outside person into an already established culture and system. This is something that a lot of the graduates of NICU Doula academy are working towards. Some of them do have healthcare backgrounds. Some of them have NICU family backgrounds. They were in the NICU family position and are now trying to integrate it and trying to bring this level of relief.
and potentially even widespread culture change in a positive way where all benefit and stakeholders can.
can see the long-term benefit, I guess benefit is the word for that, but what are some tangible ways for someone who is outside of a system potentially, who can maybe even step back and see a bigger picture in a different way, to thoughtfully take the first steps to impacting and integrating into an already established system like a NICU or a hospital system or a children's hospital? What are some thoughts on that?
Claire Phillips (25:27)
Yeah.
A couple of things come to mind. So I think what we were recently talking about with the kind of like knowing your position, that's really key. Like you don't want to go in guns blazing and be like, the medical model, blah, blah, blah. Like whatever, whatever it is, people would want to say. Like I'm sure that like with an outside perspective, this is usually the case. You're like, why do they do it? Like at my old school, at my old school, you want to be really mindful that you are the new person and just how to like
Mary Farrelly (25:48)
Uh-huh.
Claire Phillips (25:54)
tactfully enter the system and it's not so much about like being polite. It's about number one being strategic but also like knowing that yeah, well you're gonna you're gonna catch more flies with honey, right? And ⁓ it's really about building trust. So I think yeah, just being aware that
Mary Farrelly (26:08)
Yes, 100.
Mm-hmm.
Claire Phillips (26:16)
of your position as an outsider and the value that you bring, which is your unique perspective and your fresh takes, but also the orientation to have, is asking lots of questions, observing, and then connecting. Connecting is really key. like building those relationships, getting to know people, asking them if they like their job, how they came to be in this work, people love to talk about themselves. Those are some really tangible things that build trust quickly.
Mary Farrelly (26:30)
Mm-hmm.
Claire Phillips (26:42)
Kind of going off of the trust piece, think when you are, whenever you're trying to make a change, but especially as an outsider, stakeholder mapping becomes very important. And that can sound kind of like vague and theoretical and like someone at a desk should be doing that. But you can, you can do that like in real time in a NICU environment. Stakeholder mapping is basically looking at a stakeholder. So a person with a stake in whatever you're doing.
and ask some like core questions about them. So a couple off the top of my head are like, what is this person's greatest fear related to this environment? Right? You might look at the physician and being like, okay, their greatest fear is losing a patient. You might look at a nurse and be like, their greatest fear is ostracizing their colleagues. Right? These are just random examples.
Mary Farrelly (27:28)
Good.
Claire Phillips (27:30)
And
it can be different for every person, so it's not like every nurse is this, every physician is this, but as you like meet people and get connected to them, start to kind of map in your head like what are these people afraid of? Alternatively, what do they really want? Like what is the driving force? What's the carrot on the stick that they're going after? Like for one person is it job security, for another person is it to like revolutionize? NICU care. But knowing...
those two things can be really helpful. So there are incentives and disincentives basically to support you in your role. Those are things that you definitely want to know before you approach working with someone or as you're working alongside of them. Also, I think it's helpful to just kind of early on gauge how open someone is to what you are bringing to the table and just kind of clock it in your head. like, okay,
Mary Farrelly (28:19)
Thank
Claire Phillips (28:21)
I'm looking at Rob, the nurse. Rob's greatest fear is probably this. We're making assumptions, right? We're not going to ask Rob what's your greatest fear, but like Rob's disincentive to having me here is this. His best incentive for having me here is this. And also, if I had to from one to five rate how receptive he is right now today of my presence, would it be?
Mary Farrelly (28:30)
Love which we had to spare.
Claire Phillips (28:49)
know, what would it be? Maybe it's like a three, he's neutral towards you, great. But that gives you a starting line and then you kind of automatically... or it gives you a pause to like know how to approach, what was his name, Rob, moving forward. So I think that early stakeholder mapping can be helpful as well.
Mary Farrelly (28:59)
each person.
I love that perspective too, because one of the biggest pieces that has thus far prevented people from getting into the NICU setting in this sense is that the NICU is such an intensely vulnerable environment. there has to be, it's like trust.
on the nth degree, right? Because these are extremely vulnerable babies and families and people are like, you know, been burned before by people who are just innately curious about the NICU or maybe you're in there for the wrong reasons. I, it's a long game and I try to keep, you know, it's not gonna happen overnight. This type of really massive change that's coming from the outside is not something that comes, no one is going to be able to see the vision and execute it this fast.
are also notoriously extremely slow, even if you get all the stakeholder buy-in and you have everybody on the same page, you still have to wait for all the red tape to clear before things are happening. But also, going at it from a lens of collaboration, curiosity and collaboration is like my, if you want anything done in healthcare, it's curiosity and collaboration. The competition does not work. You're immediately gonna fire egos, you're immediately gonna get people to shut down. If people think that they're doing wrong, we're all trained in healthcare to fear doing something wrong.
getting in trouble beyond normal levels because this again the stakes are so high it's literally life and death at times so I love that idea of mapping out stakeholders to like it's really individual relationship building is where you're going to be able to integrate into this system and then once you're in once you're in the in the clogs of the wheel then you're able to like continue to maneuver your way and I love the language that you're giving to this like the visual of it like you're mapping your shifting on this different like trajectory from novice to
champion and it takes time but it's incredibly worth it. But let's say for example you're in the system you're doing your thing everyone's on board we're making the change. One of the biggest things when I was an admin was there's usually a lot of excitement around a pilot or putting something into place and then it's a couple months later and it's fizzled out and then by six months we're right back to baseline. So what insight do you have on maintaining a change that has been implemented once you're at that point?
Claire Phillips (31:16)
Yeah, well, that's a really great question. I think a lot of people who have ever successfully run a pilot can relate to that. ⁓ One of the core things that I would say is you need to set the environment up to make the new behavior easy. So. ⁓
Mary Farrelly (31:25)
Mm-hmm.
Mm-hmm.
Claire Phillips (31:38)
there's a sociological concept. I'm sure you're familiar with Mary and I don't remember the exact theoretical language, but when I teach it in my course, I call it the attitude behavioral split. So we can think about like people have attitudes like, yes, we should make this change. This is good. I am bought into this process and then the actual behaviors that they're doing. And so often,
Mary Farrelly (31:53)
you.
Claire Phillips (31:59)
across industries, just in our daily lives, we see like this rift between what we believe, what our attitude is about something, and then what we're actually doing. And a major like factor in that rift is our environment. So is it easy or is it hard to do the behavior? Because we're human beings, we are optimizers, we want to do the easiest thing, the most frictionless activity, which is why
Mary Farrelly (32:08)
Mm-hmm. ⁓
Claire Phillips (32:26)
as a nurse, sometimes you're denying people bus tokens because a social worker went home at 7:45 and you know you're going to be on the phone for one entire hour to get that bus token and you do the cost analysis and you're like, it's not worth my time, right? You want to give the person the bus token. You like see that they need it. You want to be that nurse, but also you're like, I don't have capacity, right? It's too hard. That's the friction. So when I am implementing
Mary Farrelly (32:37)
Yep.
Thank you.
Claire Phillips (32:50)
a change project, designing a change project, and we want to think about maintenance, or some people call it sustainment. We want to think about how are we removing friction from this process? How do we make this new thing the easiest thing people have ever done? If they trip and fall, they're going to fall into the right behavior. That is super, super critical and often overlooked, like shockingly overlooked. And because what it means is you have to think like a designer and look at
Mary Farrelly (33:04)
Mm-hmm.
Claire Phillips (33:17)
the environment, look at the processes, look at ease of finding policies, and you need to make it so simple for people. And that is something that in healthcare systems we do not invest in. We do not invest in service designers. We do not invest in training our leaders to think like designers, to have the nurse patient experience in mind. It's all like, we need to be efficient without realizing that efficiency is directly gained from designing processes, environments well.
Mary Farrelly (33:43)
Right.
Claire Phillips (33:45)
So it's very, unfortunately, backwards thinking. So yeah, I would say think like a designer and think about how you can make the change that you want to see the easiest thing in the world and then just constantly be looking for points of friction and removing them.
Mary Farrelly (33:58)
It's so simple yet.
But as you said, it's an afterthought in healthcare entirely. It's always like, here's the policy, here's the protocol, we need to get it out fast, educate everybody, check them all off. And you're like, yeah, but how do I do it? I don't have enough equipment. I don't know where the drawer is. I don't know where this is. It can be really frustrating. And it's that Instagram versus reality mindset too. You buy the journal, you have the intentions to work out every day, it's all pretty, it's all lined up. But unless you build it directly in,
so easy you can't say no you're not gonna you're not gonna do it you're simply not like we're we're wired to make change but we're also really bad at sustaining change
Claire Phillips (34:36)
Totally. Well imagine
if like all of your best friends were at the gym the same time as you. The gym was literally next to your house. It never rains. You didn't have to go outside to get to the gym. They like, you know, after the gym, everyone cheers and celebrates you and then you get like a free sauna hour where you have no responsibilities. Like everyone would be at the freaking gym. It would be so easy.
Mary Farrelly (34:43)
Yeah.
Easy peasy, I'm up.
Claire Phillips (34:57)
Yeah, but I think,
like in all seriousness, I think what we need to advocate for as people leading change projects or even just involved in change projects is carving out space so that this kind of design work and this level of systems thinking can actually occur because this is not the stuff that happens when you're like, pedal to the metal, go, go, go, can't stop to eat lunch. It requires someone to stop, breathe, observe.
talk to people and as like this would be speaking to like probably unit leaders specifically and even higher up is like you need to create margin in your workforce in order to allow these insights to develop. It's not enough to be like, all right, nurses, just like pay attention to what's hard and write it down and then do better. Yeah, it's like, well, someone has to be responsible for taking that feedback and then doing something with it. ⁓ And that can be
Mary Farrelly (35:40)
Yeah, you get her. ⁓
Mm-hmm.
Claire Phillips (35:49)
you know, that can be one person who's like the change manager who can do that. But even better is when everybody has a little bit of space and everybody is a change maker and has capacity to be removing these friction points as they go. So like when I look at my health tech team, I manage a team of 10 and they're all clinicians and they're spread out all over the world. And they, like one of my...
core focuses over the last year has been turning each of them into an effective change maker so that I am not the only one responsible for making improvements, right? And they're not just like throwing up ideas because they have great ideas, but I'm also making sure they have this space, the capacity and the competency to actually leverage those ideas into actual sustained adjustments. And I just, I wish so much that
Mary Farrelly (36:34)
Mm-hmm.
Claire Phillips (36:39)
that everybody was able to do that in their own sort of like units of influence. Because it's transformative what people can do when you give them, when you're not working them at 99 % capacity, but at 80 % capacity and then all of a sudden you're more efficient than you ever would have been if everyone was at 99 % capacity because you had a moment to freaking think.
Mary Farrelly (36:42)
Mm-hmm.
Right, you were able to use your brain instead of, you're able to get out of that sympathetic fight or flight all the time and sit in that like rest and digest. Like I'm gonna literally be processing this. I'm gonna have the, and feel valued in a way to have this space, like to be able to think and to be able to implement and to be able to do a project well from start to finish. Because I feel like that often would be like even the clinical ladder designs that so many healthcare systems have within the magnet model in the US.
at least is like, you want to be Clin 3 to Clin 4, but we're not giving you any nonpatient care time to do this. You're just going to do it while you're taking care of patients at max capacity and then wonder why it doesn't work. I think the answer to everything in healthcare is staffing, Better staffing, more time, and access to resources. But I love just hearing the words about it and just simplifying it.
and really having that way space to think and to ponder and to innovate because especially with nurses, like we are so dialed in and so capable. It's just really being able to find those moments of calm.
and advocating for them too. If anything, you're starting to make change, and this is where I started too when I was being tapped to be the nurse educator in our unit, and they're like, well, we're also not giving you any NPC time to do this. Well, you simply won't be onboarding any new hire nurses because you're not recognizing my value, and until my value is being recognized, I can't give you the value that you need. So it ended up mutually developing into a role that had actual time to do the
Claire Phillips (38:05)
Exactly.
Mary Farrelly (38:30)
correctly but in order to make change I feel like the first thing the first step of advocating sometimes is like advocating for the time the space and the resources to do it and do it well.
Claire Phillips (38:39)
Yeah, and
I don't, wouldn't want anyone like listening to me like, well, you know, I don't control staffing when staffing sucks on my, in my department. So I mean, that's great for people who have it. ⁓ because you do have pockets of agency, even if you are in a chronically short staffed environment and they're like literally hundreds, which I talk about on my podcast. like, go listen if you're curious.
Mary Farrelly (38:45)
Yeah.
Mm-hmm.
Yep.
Claire Phillips (39:05)
But I think that like the key thing is I see so many, so many helpers, like healthcare professionals, whoever, who are high achieving, who really wanna make change. And they think I just have to do more. I just have to do more with my eight hour shift or I just have to do more when I get home from work. And I think there's actually so much power in not doing more and in fact doing less. So even within your shift,
Mary Farrelly (39:22)
Mm-hmm.
Claire Phillips (39:29)
I guarantee that you are doing things that you feel like are necessary or are like are making improvements or whatever it is, but you could probably be doing 1 to 5 % less activity and more observation and thinking and then you'd find that oh actually there are different ways that I can move or conversations that I can have that are actually going to amplify my impact.
So it's not necessarily like your only lever is waiting for staffing to come along and save you. You can, this is not for everyone. Cause I know someone's listening to this like, you don't know my unit. Well, maybe I don't know. But every team is different. But I just see that over and over again with the people that I work with, they come saying like, I can't make change or something possible. I'm so frustrated. And then, we work together. They take change maker essentials and they're like,
Mary Farrelly (40:00)
Thank
Claire Phillips (40:20)
It's not easy, but we are doing it and I actually feel calm about it. That is literally the best we could hope for working in our healthcare system. goal achieved.
Mary Farrelly (40:25)
Mm-hmm.
It just takes
one of those like wins to see that you can make a change, whether it's tiny or not. And then you're like, it builds your own confidence, skills, and momentum. So sometimes it is just taking that space to ponder, pick one thing to put your stamp on. And then it slowly grows and develops and changes too. But tell us a little bit about how people can connect with you and find you and what offers you have for the change makers among us.
Claire Phillips (41:01)
Excellent. I am on Instagram. I'm nursing.the.system. And yeah, I'm on there every day sharing little tips and tricks and also sharing about my life in the Netherlands and yeah, life abroad. And then I also, of course, have different courses. So the first one we mentioned was my mini course, Map Your Impact.
This is like, can do it in two hours. It's designed to be like the biggest immediate lever that you can pull to start being more effective at making change at work and feeling less of that friction. And then the like bigger, more like university course program that I offer is Changemaker Essentials, which is a 12 week. I like to call it like an accelerated masters without the boring.
bureaucratic stuff in change leadership and systems thinking. So that whole program is to help you like design a career that you love and pick up all these tools to help you actually make the impact that you want to make throughout your healthcare career. And then if you're listening to this and you are the leader of a unit after Changemaker Essentials, I have a nurse leader specific sequel program, which is private coaching called Nurse Leader HQ.
Mary Farrelly (41:49)
Yeah.
Claire Phillips (42:13)
So those are the primary ways that you can work with me. But like I mentioned, I also have a podcast, just free resources every week called the Nursing the System podcast. And that's really fun and I don't plan on stopping anytime soon. So go take advantage.
Mary Farrelly (42:19)
Mm-hmm.
I just was listening in the shower last night to your episode about moving abroad and I was like, this is just so fascinating. Your podcast is great. I loved your brain is so incredible and that you're sharing this. feel like you're planting seeds everywhere that you go. the systems wise, you're putting ripples, you're planting those like little like, maybe I can do it. And then giving people a roadmap to the next steps is just so powerful so that we can go be the change and do the thing that we know is right in our heart and can feel better.
about showing up to whatever role it is that we have every single day and decrease that feeling of lack of autonomy and lack of power that we sometimes see in our patients, but we also sometimes experience ourselves. So it just takes those little tiny, tiny changes. I always say it's like the next best step. What's your next best step? We don't have to choose the world today. We just have to take that next best step so you can feel and design your life in a way that feels aligned with your values.
Claire Phillips (43:23)
Totally. And like we have a
responsibility to do so because if we don't do it, who's gonna do it? And we do not want to fall into cynicism. So building hope. Exactly. Hope, hope, hope.
Mary Farrelly (43:31)
Nope, there's always hope. Hope, hope, Love it.
Well, Claire, thank you so much for being on the show today. I'm just so grateful to be able to share your message and your knowledge and your expertise with the NICU community and talk to you soon.
Claire Phillips (43:46)
Thanks, Mary. Thanks so much. This was a great conversation.