Kimberly Long 0:00

Hello, everyone. Thank you for joining. We are excited to have Dr. Garrett Chan with us today. He is the president and CEO of Health Impact. Welcome, Garrett.

Garrett Chan 0:11

Thank you so much, Dr. Long. It's a pleasure to be here.

Kimberly Long 0:14

All right. I just would have a couple of questions prepared and I'd like you to share your thoughts on it. And the first one is: can you walk us through your journey to the executive level and the defining moments that shape the trajectory that you're on?

Garrett Chan 0:28

Thanks, Dr. Long. So I feel like I've been very fortunate in my career to have learned from really exemplary nurse leaders in all different parts of nursing. And as I think about my journey to the executive level, I want to just start from the very beginning when I was a direct care nurse. And I started getting involved in nursing leadership projects, whether it was on a quality improvement committee or whether it was on the policy and procedure committee. One of the things that I very much appreciated from my early nurse leaders was the concept that we need to, as executives, really think about the impact of our decisions on patients as well as frontline staff. Whenever we make a decision, we need to think about how that will make lives better and easier or how it might make lives more difficult, whether, again, patients or frontline staff. And back then, 30 years ago, it was really at the beginning parts of shared leadership, shared governance, and now professional governance, right? Where that same concept really runs through all of those ideas around shared leadership, shared governance, and professional governance. And so whenever I think about my work as an executive, I think about that first and foremost. I think the other thing that I learned early on was after I was a staff nurse, I became the clinical nurse specialist for the emergency department trauma and cath lab in my hospital. And in that role, I really thought about the importance of leading by influence or leading through influence as opposed to direct authority, right? So clinical nurse specialists who play an important role in the healthcare system, who maintain the professional standards of the specialty and of nursing, and also attend to the most complex and vulnerable patients in their service line or in their department. It really is important to learn how to lead through influence as opposed to direct authority. Because by leading through influence, you develop a keen sense of emotional intelligence, like what are the emotions that are going on in my team or with whoever I'm interacting with. You also have to have a vision of where you want to go and where you want to help the team to go. You need to be able to listen beyond just the initial challenges, which can be really representative of the symptoms of an underlying cause or issue and go beyond that, listening to those kind of symptoms or issues and digging down deep into what is the true root of the problem. You have to be able to have skilled negotiation tactics where everybody gets a little bit of what they want, but nobody will get exactly all that they want, unfortunately, which is a corollary to the concept of consensus building, right? Consensus building is really how do people get a little bit of what they want and have to give up some of what they want in order for you to achieve the greater good. And so as I think about my journey through my career to this executive level, those are some of the really important things that I have learned that have helped me in my role as the president and CEO of Health Impact, which is the California Nursing Workforce and Policy Center.

Kimberly Long 4:12

Wonderful. And you know, from your perspective, you know, there's a lot of opportunities that we have, particularly between healthcare organizations and academia. Based on your experience and your research and everything, what are you finding are some of the greatest opportunities to align those together more effectively?

Garrett Chan 4:34

Yeah, that's a great question, Dr. Long. And I guess what I would say is that in a recent publication that my team and I, along with Dr. Patricia Benner, who is a very famous nurse educator, one of the things that we realized in looking throughout her entire body of work that spans about 45 years or maybe even longer, that there's not a shared understanding of what nursing is. So I'm gonna use a non-nursing example to illustrate this point. So I'm gonna say a word, and I would encourage your listeners to imagine this word in their head. What does this word look like? And so the word is chair. So imagine a chair in your head, in your mind. And it might surprise you to know that the chair that I have in my head is pink, fuzzy, it is high-backed with armrests and lion's claw feet. So if that's not the chair that you're thinking of, and maybe some of you might have been thinking of a chair as a person, like a chair of a department or chair of a committee, if we can't all have the same shared understanding of what a chair is, how can we think that we all will understand what the concept of a nurse or nursing is, which is far more complex than a chair? And so some of the greatest opportunities in a publication that we wrote in Nursing Administration Quarterly last year in 2025, we talk about how we can create these shared understandings. And we've kind of codified it, if you will, in the concept of the North Star. What is the North Star of nursing? What is the North Star of clinical education? And if we're going to have more alignment between academic partners and clinical agencies, we need to be clear about that. And so in this article, we call upon academia practice agencies, accreditation agencies, and regulatory agencies to all get behind a single understanding of what nursing is and what clinical nursing education is. Once we have that shared understanding, then we're able to find opportunities to align better. I think the other thing that's a really important concept that has not been well explored in nursing or the research yet, but it's something that we plan to do at Health Impact over the coming 18 months, is start a conversation about what are the foundational pieces of information and nursing practice that nursing students need to have in the different specialties of nursing, like adult and gerontological health, OB maternal child health, pediatric, psych mental health, right? And as we think about this, we know that in nursing education, we're here to educate nurses as generalists. And then they start specializing immediately after they get into their first job, right? But what is the generalist education in pediatrics? Everybody's going to have a different perspective of what that is, right? Going back to the shared understanding. And so the next project that we're working on is thinking about what are the minimum requirements, what are the minimum knowledge, practice, and ethical issues in pediatrics, for example, that every nurse needs to understand and learn. And then save some of the specialty things for nurses who enter into the specialty of pediatrics. Because one academic institution will think here are, you know, A, B, C, D, E, F, G are all the things that nurses need to know as generalists and pediatrics. But another academic institution may say, well, it's, you know, XYZ. And so for clinical agencies, we when we get the new grads into our organizations, as, you know, perhaps in a nurse residency program or perhaps in a uh just a general orientation program, we don't know where everybody is starting from. And so these are the two greatest opportunities. One is to have a shared understanding of what nursing is and what clinical education should be for nurses. And then the second is what is generalist education? What's specialist education? And how are we educating everybody in the same areas of nursing practice?

Kimberly Long 9:22

Oh, that's wonderful. Now I'm going to combine the last two because I think they're very closely related. How can academic leaders better prepare nurses for the reality of today's healthcare system and to influence legislation and regulatory decisions that are impacting nursing? So, how can we better prepare them for realities, including the influence that you mentioned earlier and the legislative things that are impacting the work that we do?

Garrett Chan 9:50

Right. That's a great question. And I'm gonna answer the first one first. So, one of the sayings that Dr. Benner uses all the time, which is, I think, a really great and pithy saying, is the best model of the real world is the real world itself. So, as academic leaders and faculty members and even nurse educators on the clinical agency side, think about nursing education and preparing nurses for the practice of nursing, is to think about what are the real world, use real world examples. For let me just give you an example. So, way back when I was precepting a nursing student as a registered nurse in the emergency department, we went into a patient's room and the patient had heart failure with pulmonary edema, had liver failure with ascites, had hyperglycemia, borderline diabetic ketoacidosis, and had HIV. The patient was uptunded, was hypotensive. And so we went in to see the patient. I did my nursing interventions, I talked with the patient's family. And after doing my initial assessment and doing my initial interventions and providing comfort and education to the family, we left the patient's room and my nursing student turned to me and asked me, what textbook can she go to to find out how to take care of this type of patient? And I thought, I don't think there's any textbook that will tell you about a patient who has heart failure with pulmonary edema, liver failure with ascites, borderline DKA, and HIV. There is no textbook. And so I bring this as an example because how we're educating nurses is in these very specific and siloed concepts. We teach about heart failure and pulmonary edema. And then another module we will teach about liver failure and ascites. There's a great opportunity for nurse educators and nursing faculty to put that all together and say, now you have a patient like this, which is a real world patient. And let's think through all of that because there's no textbook that will be able to help you understand how to take care of this type of patient. And so those are the realities of the patients that we see today in healthcare systems. And it's the real world. So everything, whether it's in the classroom or whether it's in clinical or whether it's in simulation, we need to make sure that we're sharing with the students what the real world looks like and how to prepare them for that. I think the other question about influencing legislative and regulatory decisions is congruent and probably in line with what I just said. What is the real world? What's happening in the real world? Now, legislative and regulatory decisions are largely focused on protection of the public. And we want to make sure that the public is protected. What are some of the things that we know that nurses can bring to clinical practice that are safe and high quality? And we must make sure that those things are represented in legislative and regulatory decisions. We always have to think when we consider legislative and regulatory advocacy, again, that it's to help protect the public, but also a big thing is right now the issue around access to care. How can we increase access to care? How can we make lives better through nursing practice and nurses? And so as we think about our legislative and regular decisions, we want to make sure that that's first and foremost in our mind. Well, yes, we might want to advance nursing practice and the scope of practice, which is really the lawful or the law framework for saying who can do what under what circumstances and be reimbursed for it. So a scope of practice is the legal framework that says who can do what under what circumstances and get reimbursed for it. We should always think that the reason why we need to make legislative and regulatory decisions is to improve the lives of people who live, work, or visit California. And by keeping those people front and center and you making sure that those are the reasons why we're asking for changes legislatively or regulatorily, that we are not really focused on turf battles, which has been the traditional way that legislative and regulatory decisions and advocacy has been made, but really that we're here for safe and high-quality patient care through nursing by improving access to care.

Kimberly Long 14:52

Dr. Chan, thank you so very much for taking the time this morning to share your thoughts and expertise with us. I appreciate you so much. And I look forward to hearing the completed podcast and getting an opportunity to just relive all the information that you've provided for us. Thank you so much, Dr. Chan.

Garrett Chan 15:13

Thank you so much, Dr. Long. It's been a great pleasure.