Grace Swartzendruber

Rose L. Horton, MSM, RN, NEA-BC, FAAN

Rose L. Horton, MSM, RNC-OB, NEA-BC, is the Founder & CEO of NotOnMyWatch Consulting Partners, an LLC she created 3 years after coining the hashtag #notonmywatch. She created the hashtag out of her frustration at the rising rate of maternal & infant morbidity and mortality. As a nurse she believed that nurses, as the largest healthcare employee contingent, have the power to change the trajectory of morbidity and mortality. The hashtag is a call to action for all nurses to use their collective voices to support, listen to, advocate for, and follow evidence-based practices in caring for all birthing people.

Rose is a Women & Infant healthcare executive leader working as a Specialty Director at Emory Decatur Hospital. She is passionate about safe and equitable care for all women. Rose speaks on the topic of maternal & infant mortality, resilience, empathy, communication and diversity, equity, and inclusion (DEI) locally, regionally, and nationally.

Rose served as the 2012 President of the Association Women’s Health Obstetrics & Neonatal Nursing (AWHONN), a 25,000-nurse member association that is pivotal in creating, supporting, legislating, researching best practices, and evidence-based care of women and newborns.


In this episode, we interview Rose Horton and take a deep dive into the burnout that people in the healthcare space are feeling and some tips and tricks for combating burnout. 

Main Questions Asked

  1. I think that burnout is something most folks can describe or identify with, but how do you see burnout most commonly manifesting or what are some signs or symptoms of burnout that people may be experiencing or seeing in others?
  2. What do you think has contributed to the rise in burnout or do you feel like it has always been there?
  3. In what ways why do you think that folks in the healthcare system may be more susceptible to feelings of burnout?
  4. How are the feelings of burnout and compassion related to one another?
  5. What does compassion look like to you?
  6. Having compassion can seem like a big ask for someone who is feeling burnt out, what tips or tricks do you have for folks to start exercising compassion towards themselves or towards others?
  7. What does burnout and compassion look like at the systems level?
  8. What is the one thing you would want all listeners to know about burnout and/or compassion?
  9. Where can folks go to learn more about managing burnout and compassion?


Nicole: [00:00:00] Hi everybody, and welcome to the Woman-Centered Health Podcast. Today we are speaking with Rose Horton, executive Director of Women and Infant at Emory Decatur Hospital about burnout and compassion. Before we start our interview, we wanna thank all of you for listening and let you know that you can earn CE and get key takeaways, resources, and transcripts by visiting our website, women-centered Also, Stephanie and I put this podcast together in our free time and often use our personal funds.

So please consider supporting us. You can support us by subscribing and giving us a five star rating on iTunes or wherever you are listening. And if you are able to offer a financial donation, please visit our website and click the support us tab. All right, let’s meet our guest.

Stephanie: Hi again, rose. Thank you so much for being on our podcast again. So first for the listeners who didn’t hear the first episode you were on, could you provide a little bit of details about your background?

Rose Horton: Of course I’d be happy to. Hi Stephanie. Hi Nicole. [00:01:00] My name is Rose Horton and as mentioned, I am a nurse by education, training and passion. I love the, our profession and have always worked with the birthing community. And currently I’m working, as the executive director of Women and Infant Services, at Emory Decatur Hospital in Atlanta, Georgia, where I have oversight of labor and delivery.

Mother, baby, the neonatal intensive care unit, lactation, and education ob the education.

Stephanie: Thank you. And just for our listeners, rose and Catherine Hill of AWHONN, were on our November episode. November 22, number 64, and they talked about the respectful maternity care toolkit. So if you are a clinician who is caring for, people who are pregnant, please check that out. it is super helpful, with a lot of tips and strategies on how to best [00:02:00] communicate with patients, which is what we’re all about.

But today, like, Nicole said, rose is gonna talk about burnout. So, in our last episode, we asked you what informs your perspective. So this time, could you answer that, but kind of keeping it into the compassion fatigue and burnout framework. So what informs your perspective there? And in other words, why do you do what you do and what is most valuable to you?

Rose Horton: Yeah. So I am, I believe a naturally resilient person. my cup is always half full and overflowing. and during the pandemic though, I realized that I was not my best self, even though I was doing a lot of sessions on resiliency for. The rest of the organization. I was at my best self. And as I was approached to do, a keynote for, an organization, I said, you know what?

I’m gonna, I’m gonna put [00:03:00] my experience during the pandemic into this presentation. I’m gonna talk about me, I’m gonna be the center of it. So, um, that’s exactly what I did. And, it has been therapeutic, it has been healing, it has been transformative. And, the feedback that I got from, the session that I did was really, really, really great.

It was lots of tears and lots of laughter, which I think is incredibly therapeutic as we navigate what we’re hoping is the worst or the last of the, surges of the pandemic. So this is really about me as a nurse, as a nurse leader. , and how I was able to navigate through, this terrible pandemic.

Nicole: Well, I think we have a lot of listeners looking forward to this discussion, myself included. So like we said, today we’re gonna talk about burnout and compassion. So let’s jump right in. I think that burnout is certainly something that most folks can describe or identify with, but [00:04:00] how do you see burnout most commonly manifesting, or what are some signs and symptoms of

Rose Horton: I think that burnout, shows up differently in different people. I think it’s, it could be personal. what I see a lot and what I’ll speak to is just a lot of stress, anxiety. depression is another really great one. weight loss. , if you’re lucky. Weight gain if you’re not as lucky.

a lack of interest in doing the things that used to make you happy and make you joyful. apathy. Just a lack of any emotional energy about anything. joyless. I think that’s how it shows up in a lot of people that I’ve seen, and I had a lot of the same symptoms, myself, during the, during the pandemic.

Nicole: So Rose, I know you have some numbers kind of in your back pocket. What is burnout looking like, in the healthcare workforce community?

Rose Horton: And I think that’s a really great question [00:05:00] because, I remember doing a presentation in, in, uh, 2019 and talking about burnout and the data that I got from an article in 2019 and said, a third to half of all nurses and doctors in the US suffer from burnout. And that’s in 2019. So, when I did the presentation, I’m like, y’all, this is 2019, so can you imagine what, 2020 is like?

And we do have really good data, about, 2020. Some of the most worrisome data, I think, as we consider, burnout is that, from some data in 2020 that 40% of healthcare, workers are thinking about leaving the profession, because of the pandemic. And that’s, that’s really, really, worrisome because we have a workforce that’s already struggling, right?

We’re, we’re already don’t have enough, staff. And the thought of losing that much of the staff is, is frightening from a leadership perspective. It really impacts us in, in many ways as well. the demand for travel nurses has really [00:06:00] skyrocketed, and our ability to find travel nurses within a reasonable amount of time is nonexistent.

It used to be that you can find a, a traveler within like two months, but now you have to plan so far and ahead and the financial impact to healthcare organizations. the estimate is that 14 billion is being spent on contract workers or. travel nurses. And I think the final thing that I’m gonna speak to is, is turnover.

especially first year turnover. That’s the one that I pay a lot of attention to because, you know, you invest so much into the recruitment and the hiring and the onboarding process, and to have somebody leave in six months, eight months, 12 months, it’s really devastating, not just financially, because the cost of replacing a nurse is about $80,000, but it’s, it’s devastating and demoralizing to the team as well because of the emotional energy that you put into establishing that [00:07:00] relationship and trying to create, that teamness and that sense of belonging with that new hire.

So it’s a, it’s a vicious cycle that’s really, really hard for us to wrap our arms around right

Stephanie: so, . It sounds like the pandemic has caused a lot of burnout or is associated with a lot of burnout, but what else just contributes to burnout, especially for clinicians?

Rose Horton: I do believe that the pandemic exacerbated. our current situation, right? It really revealed our, the true sense of what’s going on. lots of things. Um, and one of the articles that I referenced, they talk about the workload, workload is, it’s hard. It’s hard out there, for nurses, you know, if you have four to five patients, that’s a really heavy workload.

Our patients are sicker, so there’s a higher acuity for patients. and layer on top of that incivility, there’s a lot of incivility out there as [00:08:00] well with, patients with their families maybe, and even incivility between, healthcare workers. I, I think all of that is really contributing to, to burnout.

one of the articles talked about, I think nurses are very, able to articulate the purpose of our work, right? We see value in our work. We know that we’re making a difference. but not having the supplies that you need and not feeling supported in your work, that’s something else that can, totally lead to burnout.

Um, technology. We love it when it works. , but not so much when it doesn’t. that was definitely a contributor as well to burnout out having technology that is not operational or not consistently operational, to decrease the burden. We know that we put technology in place because it’s supposed to make things better.

I mean, remember when we used to document with pen and paper and and the promise was, Hey, when we have this computer documentation, it’s gonna be so much easier, so [00:09:00] much clicking. but that’s hasn’t always been the case, right? It’s increased the burden for some people, especially for our providers. You know, they talk about burden related to clicks.

How many clicks do I have to do? so that’s something that we really need to pay attention to from an organizational perspective to ensure that we’re decreasing the, the burden for our team. So all of those things, you know, the workload and incivility and technology. , all of that are contri. All of those are contributors to burnout.

Stephanie: one of the things that, at least for me in my own experience, and some people may have already realized this before, but I really saw this disconnect happen with C O V I D, where as a nurse and a scientist, people like my own friends and family did not trust what I was saying. Didn’t [00:10:00] value what I was saying, because of all of this C O V I D.

Misinformation, disinformation. And I know, that for me personally led to a lot of burnout and, and confusion about, expertise. And so, I don’t know, like if you’re hearing things like that too, just kind of going from, I feel like healthcare professionals, not for every, especially marginalized group, which we’ve talked about, has always trusted healthcare professionals.

But I, I feel like, especially like, I think there’s always like these surveys, like nurses are the most trusted profession. and then to kind of see how that played out in the pandemic was really eye-opening, at least for me.

Rose Horton: No, I absolutely agree with that. I, I think that has had an impact. And you know, I’m on social media a lot and I see tweets of nurses saying that as patients especially, Early 2021, in the I C U S patients are dying. They’re still denying the fact that they have, [00:11:00] covid, uh, that covid exists, you know, as they’re dying, which, I could imagine is incredibly frustrating, to anyone because the goal is to limit exposure, mitigate exposure to the virus, right?

So that it limits, our sick patients and less people in the ED in the icu. That that’s our goal. that’s all that we want as healthcare, professionals. There’s nothing else in it for us than to ensure that everybody is, is healthy. So it’s very disheartening to know that people don’t value what we’re sharing as the truth based on science, based on research, based on literature.

One thing that I talk about, as I think about my own journey, so as a pandemic, I clearly remember. October of, 2020, how excited and optimistic and joyful that I felt. I said, yay. It’s been eight really terrible heinous months. But this is behind us because we, we don’t have [00:12:00] one. We have three vaccines with proven efficacy.

You know, everybody’s gonna get the vaccine and we’re gonna, we’re gonna be done with this. and again, what the pandemic really exacerbated and displayed to us was that as a nation we’re incredibly divided. and that division led to a significant amount of misinformation led to the politicizing of the, vaccines and.

it led to our nation as an industrialized nation having one of the lowest, vaccinated rates in all industrialized nations. So as you asked that question, that’s exactly where my mind went to Stephanie is because we are, we are divided as a nation, and we clearly saw that in early 2021 and the subsequent two to three significant surges in 2021, that resulted [00:13:00] ultimately in over a million people in the United States dying.

So that’s, that was really huge. And, as we consider the essential employees, that’s us, that’s nurses and physicians, all healthcare workers, respiratory therapists, surgical, scrub, sex, you name it, we’re the essential employee and we were just about decimated by the pandemic. It’s been really tough.

Nicole: Well, and another thing you brought up too, and I think this is a definitely a conversation to have too when we start talk about tips and tricks is, is dealing with the incivility, you know, even from clinician to clinician. But you know, I’ve, I’ve heard in of quite a few nursing circles that I’m in that they’re like, everyone just seems more mean.

They’re like, they’re just more rude. And, and I don’t think, you know, the people I’m talking to like aren’t expecting you to like bow down to ’em, be like, oh, thank God the nurse is here. You know, praise be, but I mean, it’s just like not even being respectful towards [00:14:00] them. And, you know, I had one friend said, you know, it’s really hard.

She’s like, I used to. , she’s a diabetic educator. She’s like, you know, it used to be, and there was a huge influx with, diagnosis of diabetes during the pandemic. And she’s like, it used to be you might have like one kinda mean person in the day kind, you know, that might ruin your day. She’s like, and now I feel like it’s switched and you maybe I have one nice person.

It’s like they think it’s my fault that they have diabetes and they’re taking it out on me. And she’s like, it, it’s just exhausting to have like that total flip. And, and so I think, if later, again, kind of put a pin in this, I think giving some tips and tricks on dealing with that. I think that also might be of interest to our listeners.

but in what ways do you think that folks in the healthcare system may be more susceptible to feelings of burnout? Or do you think OBGYN clinicians are a particular or at particularly high risk for burnout?

Rose Horton: [00:15:00] I think that we’re all impacted. equally, I don’t think it’s unique to, a service line, you know, not cardiology versus ortho versus, others. one thing that we did notice during the pandemic, which we definitely, spoke to is that we were not as impacted in our service line as the emergency department.

we were not as impacted as the ICUs. You know, we were not as impacted as, the Covid units. Um, and we recognized that and we were very, very thankful and we did as much as we could to support those who were, impacted by it. So I don’t think there’s a higher rate of burnout, within ob.

I think all of us are impacted. equally I do think be by virtue of the work that we do, we’re service oriented. as nurses, we care. Caring is essentially what we do. I think that’s why we’re suffering at such a higher rate of burnout. I was thinking, [00:16:00] earlier about the whole concept of alarm fatigue.

I don’t know if you remember that, that that whole concept and, joint commission had, A statement about, about alarm fatigue. And we know that alarm fatigue happens because, we hear the alarms all the time. and it no longer has a desired effect, you know, to alarm or to alert us that, that something is wrong.

And I think the same thing could be said about healthcare and about nursing. You know, we, we care a lot. caring is akin to, compassion. And when we care so much and we continue to pour into other people and pour and pour and pour, and then there’s nothing left to give, you know, it really leads to that compassion fatigue.

so I think we’re more susceptible to it by virtue of the work that we, we do. You know, it’s, it’s not, Automation. It’s, it’s all about the emotions. It’s all about caring. It’s not just task. it’s about the heart as well. So I [00:17:00] think that’s what leads to it. I saw a really great definition of, compassion that I want to speak to.

This definition of compassion, this article is, is dated 2017, so not super old.

Compassion is a holistic understanding of a problem or the suffering of another with a commitment to act, to solve the problem and or alleviate the suffering. And I love that. That’s what compassion is about, and that’s what we all want to do as nurses. We want to alleviate the, the suffering of others.

but what happens is that because we’re Consistently and continu continually focusing on everyone else but ourselves. We’re pretty empty and we don’t realize that we’re empty. and then we’re in that, compassion fatigue, you know? And the definition of compassion fatigue is a condition characterized by emotional and physical [00:18:00] exhaustion leading to a diminish ability to empathize or to feel compassion for others.

and that’s the worst place I think we can be as healthcare providers when we don’t have that ability to empathize. and we don’t have that ability to care and to, be compassionate so we’re not as focused, on alleviating the suffering of others, that that’s, that’s all bad and we don’t want to be in that place.

Stephanie: Yeah. So you talked a little bit, I think in your response there about compassion and burnout. Can we, can you talk more explicitly about how burnout and compassion are related to each other?

Rose Horton: I think that they are, closely , you know, knit together. When you think about that, again, as you’re thinking about what we do as nurses, you know, our job is to provide compassionate care. It’s in our code of ethics, the ANA code of ethics, is that we treat everybody with compassion and with respect.

So [00:19:00] it’s really woven into the fiber of everything that we do as nurses. And when you’re doing that heart work and you’re consistently met with barriers, . And the barriers could be that of staffing, of inadequate resources, of incivility, of a leader that does not support you. as you layer on all those barriers, then your likelihood of having burnout because of, of all of that increases, and then you, you’re not able to provide, to provide that care.

And, you know, I purport that our, our patients can tell, when you’re doing something, in a tasky way versus out of the abundance of the compassion in your heart, I think it’s very visible for, for our patients. So I think there’s a really, clear correlation between, compassion and burnout. And I haven’t done any research, but I would imagine that folks who have jobs that are more task oriented, that you’re [00:20:00] working, you know, in isolation.

That you’re accustomed to, that being your workflow, I think it would be easier to deal with versus dealing with people. And we know that working with people has a potential to be laborious. It has a potential to be exhausting because you’re taking on all of that emotional energy of that person that you’re carrying with.

You know, if you have somebody who’s coming through the emergency department and they’re in a significant amount of pain, you know, pain, scale of 10 outta 10, that energy you’re feeling, that energy. You know, if you have somebody who’s coming, you know, into the ICU and they’re extremely frightened and overwhelmed, you’re feeling that energy.

So I think our work requires a higher level. , emotional energy and being in that space with other people who have that emotion, and by virtue of the fact that we’re humans, we feel that, you know, and it becomes part of the emotion that we’re dealing with as well. So, I can see very easily how burnout [00:21:00] could be the results for healthcare providers.

Stephanie: So this is a, a, a question that is not in here, so if you don’t want to answer, that’s fine,

Um, but I, I recently, went to a lecture by somebody, and they talked about, Compassion fatigue versus em, empathy fatigue. And she was saying something about how compassion energizes it doesn’t cause fatigue.

Have you heard that? And, and what are your thoughts about it?

Rose Horton: I have heard that and I think it’s really, I think it’s interesting. I do think compassion energizes, but I think it’s to a point. It’s like any other resource, right? It’s not continuous and always flowing. I think it’s it, it becomes a point when you’ve exhausted all. , your compassion, in one place or maybe over a series [00:22:00] of places, and then you really feel tapped out, you know?

Uh, and that’s the word that, I’ve heard many of the nurses. I’m just, I, I’m just tapped out right now. I need a break. I need somebody to watch this patient because this patient is a lot and I feel like I don’t have anything to give to this patient. Uh, which is why I really love that framework, that empathy framework, because it makes perfect sense.

and I am using it from, um, Brian Pagan. Brian and I, uh, we became friends over, Twitter, and I say that’s tongue in cheek, but he posted it on Twitter and I loved it so much, and I reached out to him. I’m like, Hey, Ryan, can I use this? Because this is amazing. It’s like, oh, yeah, yeah, absolutely, use it.

But when you look at the framework, I think it makes perfect sense. So the framework has, it has four stages of empathy, which starts with discovery. You go from discovery, so you’re noticing that someone needs something to immersion, you’re immersing yourself into the situation, and then a connection is formed.

So the, the third phase is connection, but the [00:23:00] fourth stage of this empathy framework is detachment. And I do feel like in, in healthcare, and the work that we do as nurturers as, wives, partners, mothers, I feel like many times, and maybe I’ll speak personally, That we feel like we have to continue to be connected and to be immersed consistently.

And the truth of the matter is we can’t, it’s not healthy. It’s not sustainable. What we need to do is we need to take a step back and have some compassion flooring to us to fill our cup so that we can be rejuvenated and then go back to it. I think that’s the missing piece. Um, and I think that’s why you have that compassion fatigue.

because we’re consistently, again, I, especially as women, and healthcare, my husband’s a nurse and I know that our, we experience life very differently, owed to be a male. [00:24:00] but we’re gonna stay with the, with the women now. but we experience it differently. And, things that my husband’s able to do, I remember when we were both staff, nurses and my unit would call and say, oh my gosh, your husband dying.

I’m like, okay, I’ll be right in. You know, and he would gimme like the side eye. He’s like, you’re off. I’m like, I know, but they’re dying. You know? His unit would call, we’re dying. He wouldn’t even answer the phone. He’d be like, no, I’m off. You know? And I think there was a, a healthy amount of detachment that I had to learn over many years that I can’t be everything to everyone.

Right? I have to make sure that I’m okay first. and that, that I, I have been, rejuvenated and I’ve poured into myself so that I can pour into other people. I think that detachment is the opportunity that we have. And I, I do love that framework. So even though compassion could be invigorating, There’s only so much that you can do.

I think everyone needs to periodically say, I need a, I need a moment,

Nicole: Yeah, I think discussing [00:25:00] that detachment is really interesting and I, I heard this like a really long time ago and whether it’s, it’s a fact or not, I had never really looked into it. It just resonated with me because I am one of these people. But they had talked about how there’s, there is a very surprisingly large amount of nurses who come from like alcoholic background families.

And it’s, and it’s this like natural enabler cuz that’s like a lot of things that can happen when you, when you grow up in these types of families is like you, you may become an enabler and I am an enabler and so when I think about. , how many clinicians out there, come from these types of backgrounds that might, have kind of grown up in these like enabled ish type environments.

And then when you think about as nurses, I feel like we’re just, so a lot of times can just be professional enablers, , and, and so this idea of detachment also, I’m just, and I, and I hope we get into this conversation again, I don’t know if this is when we wanna [00:26:00] pin for tips and tricks or get into it now, but I, I would suspect there’s a lot of people out there who are like, yeah, how do you detach?

Like how, you know, when you come from enabling or you come. From that kind of background, maybe you didn’t have great boundaries and now all of a sudden, you’re in a professional where a lot of boundaries get crossed. Right? And like, where are the boundaries? And a lot of these very personal interactions with patients.

And so I think this, this idea of detachment, I can see that being a critical piece that, that folks aren’t doing, whether they are consciously aware of it. And so I think this is a good conversation. So for folks listening, yeah, what are you doing to detach and, and Rose, maybe you could talk about, what, what does that detachment piece look like?

at a practical level,

Rose Horton: Yeah, I think that’s a great point. And, I do agree many of us have different motivations as to why we went into healthcare. I think the, at the crux of [00:27:00] it for all of us is we wanted to make a difference. We wanted to save the world in our own way. I’m gonna save the world, you know, and the reasons why we wanna save the world, of course, differs for all of us.

so I definitely get that. and that’s attachment piece. How do you achieve that? That is a tricky one. I remember, uh, within our organization, one of the questions that we have in our press Ganey, in our employee, Survey is, um, for our leaders. I, I think it’s for everyone, but I pay attention to it because I have leaders who report to me.

and the question is I am able to disconnect from work and, throughout the pandemic are engagement scores in my service line within my, my leadership team remain pretty high. I have an amazing team of leaders that are fully engaged, but that was the one question that was consistently low. and it made sense.

we hung around like a three to a [00:28:00] 3.2 out of five, and it makes sense. when you consider, there’s a lot that I can say here. I, I won’t stay in the soapbox too long, but I’ll just, I’ll just tap on it for a minute. When you consider this misnomer that leaders have. 24 hour responsibility. I mean, who made that up?

You know, and how sustainable is that 24 hour responsibility? Stop it, you know? I think just that in itself, it creates problems for us when you believe that you are always on, and I can take a vacation, but unless I’m out of the country, people are always able to get in touch with me and they’re always able to at least send a text.

Do you know what’s happening on the unit? I, you better be glad you’re not here. You know, that that doesn’t foster detachment, you know, people, people suck you in. So we had some intentional conversation in my leadership team about detachment. and I [00:29:00] am a big proponent of leaders taking time out. I try to get my leaders to take a week off every quarter, like.

Take off at least three weeks, at least three weeks a year because your job is incredibly hard. You need a week, you need consecutive, you know, five, seven days off, every quarter. so that’s number one intentional in telling them, please take time out, take time out. The second intention is that when you’re off, we take you out of several things cuz we chat by, by text, right?

We have all these text threads. So if you’re off, you’re not in the text thread because you’re off and the expectation is that you’re off. And I had conversations with the leaders to say, please ask your team not to reach out to you when you’re off, to really respect you and nurture and support you enough to say she’s off.

I’m not gonna. anything to her [00:30:00] no matter what, because there’s always another leader covering for you. So we need to do that. But it’s just that intentionality of, of separating and saying, you know, I need a moment. You know what, guys? I’m gonna turn my phone off. I’m gonna revel in, two hours of no phone, no vibrate, no nothing.

Can you support me in that? but just those small steps in ensuring that you’re able to detach. We talked a lot about finding things that you love to do and doing those things without any interruption. If it means going for a walk, going for a hike, going for a run, working in your garden, do that without any, interaction with your team.

it’s definitely easier for our staff nurses, even for them. It’s hard because now we have these. , what we call, text blast that we send to everyone. When, you know, all the patients come in on the bus, it’s like, oh, I’ll send out a blast. So everybody gets a text. And I, I hate that. And I ask the [00:31:00] team, please be intentional.

I know it takes a minute, but look at the schedule and look at people who are off on vacation and don’t send them a text blast. Because there are people like me who have big hearts and they get the blast and they’re on their vacation staycation and they’re like, okay, I’ll come in now. We don’t want you to come in.

but just finding those opportunities to really step away and be detached from your, your responsibilities at work really make all the difference.

Stephanie: I love that detachment. I was listening to a podcast recently, and I don’t think it was, it was about clinicians or healthcare industry, but it was just about burnout in general. and they talked about almost like this move in a lot of companies to, not only incentivize vacation, but to offer, I don’t like a consequence if you do email when you’re on vacation or Um, so I thought that was kind of interesting. Not that I’m like love, [00:32:00] you know, giving people punishments, negative consequences or whatever, but I just thought it was really interesting like that some companies are moving to this. Not only do we not want you to work when you’re on vacation, we’re gonna prioritize that.

Message so much that we’re going to ne give you a negative consequence if you work Um,

and, and,

I think that’s well intended, at least . I don’t, but Yeah. Yeah. I, but it is so important, to have that time out. And one of the things I see a lot of nurses sort of kind of give the eye roll to, like when we do things at, at the hospitals, like, oh, self-care, let’s talk about that word, self-care.

it almost seems like that’s like a buzzword and then it, it almost like adding to our plate. so now like not only do we have to do our normal work now we have to do yoga or [00:33:00] mindfulness exercises or, so could you talk a little bit about like self-care and then versus like compassion, I guess, for yourself?

Rose Horton: Yeah. No, absolutely. we have a saying here is that you’re not gonna yoga your way into wellbeing. You know that that’s, that’s not gonna happen. And you’re right. Um, because yoga doesn’t, I love yoga, but yoga does not resonate with everyone. Right. and we had a really robust conversation, a group of us talking about self-care and, one of my colleagues who’s a millennial, he said, listen, taking a break is not self-care.

He’s like, that’s, that’s the minimum requirement. You need your break. You know, so don’t, don’t lower the bar that much that you are thinking that, oh, I got a chance to, to use the bathroom. I remember as a staff nurse coming into shift and somebody said, I haven’t used a bathroom in 12 hours. I’m like, yikes.

your poor bladder. That’s, that’s [00:34:00] nothing to be proud of. Don’t say that to people. You know, why not? What was happening that you could not find time to pee in 12 hours? I can’t believe that the whole place was on fire for 12 hours. You know? So I do think that we need to, be careful about the whole concept of self-care.

When you think about burnout and wellbeing, wellbeing is really a holistic, a holistic look at our wellness. You know, it’s not just, it’s not just one thing. So it’s not just your physical health, it’s also, uh, your mental health, your health and your relationship, relational health, the health and your teamwork.

So wellbeing has to be a holistic approach to us, and it can’t just be that. Yeah. I’m gonna give you some, some coupons so you can come to the employee. Health, workout, section, the gym that we have on campus so that you can work out. No, that doesn’t really matter. even massages. The big thing that we’re doing now is like, oh, everybody get a free [00:35:00] massage.

That, that, that doesn’t matter. We have to look at it in a more holistic fashion, which is why I’m so excited in our organization, we’re, have started a wellbeing department. That’s the only focus, and the goal is that we’re gonna weave in wellbeing into everything that we do. It’s gonna be the lens that we use to make decisions as we’re creating staffing matrix.

You know, our goal is to one day to have that conversation using my wellbeing lens. I think the staffing matrix lack. This or wow, this matrix really supports wellbeing. I mean, can you imagine, I’m super excited about the feature of, of, integrating wellbeing into everything that we do, but it has to be something more holistic.

It’s not just one thing. It’s not just your body. one thing I’d like to say though, as we talk about, I know we’re not quite at solutions, but as we talk about wellness and yoga, I think we have an opportunity [00:36:00] to normalize counseling and couch time. That’s something that should be incentivized. You know, that you have taken time to have a conversation with a professional about how you feel.

Because I, we don’t do that enough in healthcare. We do not do that, and I really want us to normalize, seek some couch time, have a conversation with someone. Be your true, authentic self. I think that’s the road to recovery for many of us and getting us out of the compassion fatigue that we may be experiencing.

Nicole: Yeah. What folks can’t see is that, yeah, Stephanie and I are just like, bobbleheads, like, yes, yes, you need therapy. That neutral third party is where it’s at. Who has no stake in your life, and


Stephanie: And you know, that’s what I, I talk about this a lot with different colleagues of nursing or really [00:37:00] any healthcare profession, nursing physicians, what, you know, we see like globally speaking really traumatic things, with our, and then we may have our own trauma too, on top of that. but particularly I’m gonna speak for nursing because that’s what I know.

We as a discipline have done nothing to even like, help people navigate how to deal with that trauma or mental health even, like, maybe it’s not trauma, a big trauma, but. , we don’t, you know, if we have a patient who dies in childbirth, sometimes it’s just kind of ignored. and a nurse or the clinicians there in that case might have real issues.

and it’s kind of like we just kind of gloss over it or say, oh, sorry about your patient, or, you know, it’s all well meaning. But I think there’s really nothing at that [00:38:00] system level,


Rose Horton: I agree. I agree. We have, I’ll always remember, when I first started here five years ago, and we had a really significant, onward event and I asked the team to do debriefing and, a couple of the nurses, so there were like five of us in the room. I al and I invited someone from behavioral health, so everybody was in the room and we started doing introductions.

and then the person from the two people from Behavioral Health, they said their names and where they were from, and the nurse said, wait, you guys are from behavioral health? She’s like, oh, I thought you guys were from hr. I was like, well, why would we invite HR to a debriefing? She’s like, I thought you wanted to pull us in to tell us all the things that we did wrong.

I said, no, I wanted us to debrief because. , I feel like this was an emotionally charged event, and that you need a moment just to talk about how you felt, how you [00:39:00] showed up, how does it feel now? And the tears started to flow. She said, I’ve never had a debriefing before. I’m like, I’m, I’m so sorry. I’m like that, that, that’s the whole purpose.

So debriefing is great. It’s helpful, but even past debriefing, I think when you have such events that are traumatic and we get to determine what’s traumatic, right? There’s no definition. Trauma is what you perceive trauma to be. It’s so very important to, to have counseling and to have couch time and to say, Hey, this is what happened and this is how I feel about it.

And have someone help you navigate through those feelings.

Nicole: Oh, I think this is a lovely conversation

and is, is resonating on a lot of levels.

Stephanie: So you talked about this wellbeing department at your organization about, you know, using that as a lens to make even systems decisions. And we also talked [00:40:00] about like debriefing and, and counseling is what, is there anything else that you can think of?

what, like compassion or even just burnout looks like at the system level in healthcare?

Rose Horton: I think at the system level, it’s about a couple of things. It’s about turnover, especially that first year turnover. because that’s when people come in and they’re like, oh yeah, this doesn’t, this doesn’t resonate with me. So they leave. So I think it’s turnover. I think it’s apathy. I think it’s poor quality outcomes is another way that it shows up.

And the organization, you know, if, if you look at your metrics and your, your CLAPSI and your CAUDI and your ventilator associated events, all of that is, I, I think those are all signs of it. I think, and also turnover in the leadership ranks. I think that’s really telling as well because, uh, for the most part, leaders are diehard.

I just got a text from someone that I admire that works in a nationally, in [00:41:00] this major organization, and she’s like, Hey, I just wanted to let you know that I’m leaving the organization. I’m like, yikes. , why? You know? and we’re colleagues and not friends friends, so it’s like, I didn’t wanna say why, but I’m like, oh, I’m so sad.

Unless of course this was a good decision for you because the burden of the work was too much. And she’s like, yeah, the burden of the work was too much and that, that’s why I’m leaving. So, you know, it’s important to, to note that also, but I think those are the ways that, that, it shows up in a systemic level that we make decisions.

I was having a conversation with someone recently and I said, I just feel like sometimes, our C-suite, great, amazing, lovely people are not aware of the work that frontline nursing leaders are doing. They’re not aware of the challenges that frontline nursing leaders face every day. and cuz if they were, they would want to decrease the burden.

Um, and put some things in place [00:42:00] to ensure that, you know, frontline nurses shouldn’t work 50, 60 hours a week. That’s not sustainable. It’s not sustainable. And there are things that we can do to really, really mitigate that. So I think that’s, I think that’s how, how it shows up in the system, that disconnection, outcomes and, apathy and turnover.

Nicole: So, having compassion can seem like a big ask for someone who is feeling burnt out, but what tips or tricks do you have for folks to start exercising compassion towards themselves or towards.

Rose Horton: I, there are lots of things that we can do to start, to help facilitate more of the compassion, the resilience, the agility, any of those, the words that we choose. Cause I know words are matter, so I’m trying to make sure I cover all the words. I saw this really great article in 2020, you know, how to build your resilience.

And there were some things there that I, that I really love that’s really simple that I wanna highlight. one is positive beliefs. if you think about the whole concept of [00:43:00] appreciative inquiry, uh, one of the tens of appreciative inquiry is the words we use creator a reality. , the words we use creates a reality.

What are the words that we’re using? You know, if you come to work and you’re saying, oh my gosh, it’s a hot mess of garbage, it’s gonna be a hot mess of garbage. Right? Because the words you use creates your reality. So I think positive beliefs and, positive words of affirmation. Some people may think it’s cheesy, but it is not.

There’s science behind, you know, the words that you use and how it impacts your moods and your thoughts, and, and that if you say it, your brain believes it. Right? So I think that’s a great one. a strong social network is great. Not everybody’s privy to, uh, strong social network, but that’s helpful. being optimistic.

Another one on the list, which is my favorite, is laughter. I love to laugh. I feel very fortunate and blessed to have the family that I have. Cause, my husband and my daughters, [00:44:00] we all love to laugh and they’re all super funny. So the dining room table is like the best thing ever. and we know that, you know, laughter increases endorphins.

We know that, if you laugh for, I think it’s like 40 seconds, it’s like doing, 20 crunches. I don’t wanna do any crunches. I don’t wanna do any planks if I don’t have to. But I’m, I’m down for a good belly laugh that’s hurting my stomach and tears rolling down my face. Um, so I think laughter is a great thing, but the one that I really wanna talk about, Um, I got this from Harvard Business Review 2021, the benefits of Gratitude and Happiness.

we did the 30 day gratitude, challenge. within my leadership team, I got everybody in a journal. I said, listen, for 30 days, you’re gonna write every day three things that you’re grateful for, and it can’t be the same thing. So I got the journal for everyone. And of course, we had to do it at my house.

So, at bedtime, I would say to my husband, I am a [00:45:00] natural optimist. He is a natural pessimist. He’ll say that he’s a realist. He’s not, he’s a pessimist. but I love him with all my heart. So at bedtime, I would say, okay, okay, JD, what are three things that you’re, happy and thankful for? and at first he’d say, you and the girls.

And I’m like, you can’t say the same thing every day. but. . What we know from, from research is just by doing 30 days of gratitude journal, that it changes the neuro pathways of your brain. it changes who you are. And some of the benefits from the article is Better sleep, improve physical health, enhance sympathy, reducing aggression.

I’m, I’m all about that. self-esteem improves your mental stre strength. it enhances productivity all by focusing on gratitude. So I feel like that’s low hanging fruit that we all could do. Hey, what are three things that I’m super [00:46:00] grateful for? And it really fosters that, self-reflection gives you a minute to be introspective, to say, what am I thankful for?

Wow. A lot of really great things happened today. , a lot of great things happened, and that just really changes, our focus and it changes our mindset. And the last thing that I’ll say is to live in the moment when we’re looking towards the future, the place where we have no control, right. it causes stress and anxiety, but when we live in the moment, when we’re present in the moment, we find a lot more satisfaction, a lot more sense of self and belonging.

So, I think that’s the last one that I would say live in the moment.

Stephanie: I may have a other one, which I think kind of goes with live in the moment. But, and there’s no research behind what I’m gonna say, , other than my anecdotal, but I had to unplug from media, social media, the news, the

newspaper podcast about the news, whatever, because [00:47:00] I finally was like, is this serving me?

Rose Horton: What’s the value?

Stephanie: Yeah. And really realizing like that’s, that’s one. Perspective. The news and the perspective really is ultimately not to necessarily inform you, but is to get you to tune in and kinda, be a, be a audience for them

so they can Consumer. right? So you, they can get add revenue. And so anything sensational, it doesn’t matter the, the news necessarily.

but that has, at least for me, has worked tremendously

Rose Horton: Mm-hmm.

Stephanie: love those, I love those ideas. And the things that you said aren’t big tasks that you have to do, like an hour yoga class or even a 10 minute mindfulness exercise, like writing three things that you’re grateful for or telling someone, three things that you’re grateful for, you know, might take a minute.

Rose Horton: right?

Nicole: and Stephanie, I think. Was it [00:48:00] you or April recently sent? There was a Twitter thread. Okay, Stephanie then, um, this made me think about too, so I appreciate you brought up gratitude, but it was like called gratitude tennis or something like that. And so the point of this gratitude tennis was that you set a timer for three minutes with another person and you go back and forth volley, right.

Play tennis, saying what you appreciate about the other person because of course there’s a lot of great science, right, that you had talked about Rose that supports, the, the superpower of gratitude, but also there’s really powerful benefits to hearing that you are appreciated or what people appreciate about you.

And I think, you know, especially in the, the line that we are in, because we give so much, it is very infrequent that we receive. And I think that when, when I was reading this again, this Twitter thread, I was like, this is a wonderful [00:49:00] exercise because yeah, how often do, do we get to hear like, Hey Stephanie, I really appreciate that, you do this and, and the power of that.

And so, and these, he acknowledges that, I know this sounds corny, he’s like the set of timer, it’s three minutes, you know, and you can’t repeat the same thing. You’ve gotta say something new and, and to see what happens with that. And, and I could absolutely see where that would be really, really powerful exercise.

Stephanie: I think us as, as nurses, as women, that we have a hard time. Taking that positive feedback or, so like when we have a patient say, thank you for blah, blah, blah, you’re like, oh, that’s just my job. Like, you know, . And so we’re, we’re constantly sort of, trained, so to speak.

Nicole: we minimize and deflect.

Stephanie: shall I. Yeah.

Minimized and to split. It’s not about us. So I think that that really does make a lot of sense. Like not only is it really good to give [00:50:00] gratitude, but also to receive that gratitude and not have that opportunity to dismiss it or minimize it.

Rose Horton: right. And just embrace it. Somebody say, I was part of A covid, vaccine clinic. I said, guys, let’s bring it to the people. So they’re like, okay, rose, you bring it to the people. So we had , a Covid vaccine clinic, and the women’s, tower, you know, so it was all my people. I’m like, and I sent an email.

I’m like, I’m gonna be giving out, vaccine injections because I knew there would be some vaccine hesitancy. And it’s so funny, folks would consistently say, that’s the best injection that I got. I’m like, I know, right? It’s my superpower. Don’t tell anyone. But I totally embraced it, you know, it’s like, yes, this is, this is what I do.

Well, this is what I do well, and the word got out. Rose gets really great injections and I totally embraced it because I have heard that a lot my career. Of all the random things, it’s my superpower. I give, [00:51:00] I give good injections, yes.

Stephanie: Can I just say that I think, I don’t know if I said this, when you did our respectful maternity care episode, but I was like at least thinking like, can I have a baby again? Have Rose be my nurse, and now I’m like, can I go work in L & D and can be my boss,

Nicole: Just move to Atlanta and be part of this like wellbeing matrix thing. Sounds incredible.

Stephanie: seem like, oh, I like you’re just giving everybody a hug,

Rose Horton: Thank you. Thank you. It is my superpower.

Stephanie: it

Nicole: Yeah. When you were, when you had talked about in our last recording about how you like, introduce yourself to people again. You know, I gave birth almost eight months ago, so not that long ago. It’s still very fresh in my mind and I’m like, wow. Like, so how different that would be and Aw. . It was incredible.

Rose Horton: Yeah, it’s so easy. [00:52:00] It’s so easy to do, you know, just to be centered with your patient for less than four minutes. Tell me a them what you’re committed to and that decreases so much anxiety.

Stephanie: All right. Well we will keep trucking along here since we’re at an hour, So what is one thing that you want all our listeners to know about burnout and compassion?

Rose Horton: I think the one thing that I would say goes back to that whole concept of living in the moment. this is our current reality, but it’s not on forever. We have the power to completely reimagine healthcare now. That’s the opportunity that we have to reimagine it, and it’s not always gonna look like this.

So, I say that all of the time. The first time I said that in one of my resiliency presentation, , I had someone send me a, a screenshot. She’s like, I created a sign because I love it. This is our now, this is not our [00:53:00] forever. I’m like, yay. Yes. This is our now. It’s not our forever. so burnout does not have to be our forever.

We have some tips and tricks to really mitigate it and to get us towards the path of, wellbeing, towards the path of wholeness.

Nicole: this might be a hard right turn into the weeds. but you had mentioned, you know, talking about how we’re really in this space now where we can start to reimagine healthcare. And I know some, I’ve heard some criticisms of, you know, all this resilience research is cuz it’s like, the criticism is, is we say, well you need to be more resilient.

How do we make individuals more resilient? But the flip side of that is, well, why do we have to be resilient? Like what systems or what things are happening that are causing the need for folks to have to be resilient? And I was like, well that’s interesting, right? Because again, I agree that there is this like fostering resilience and looking.

It then kind of [00:54:00] that flip the table of, well why, why all this resilience need necessary are, what kind of trauma systems are we navigating and why can’t the systems change? And so I’m curious, and again, I know this was a hard right turn into the weeds, but when we think about re-imagining healthcare, what this could look forward like, how do we, how do we build in or change that with this mind of resilience so that, you know, maybe the onus isn’t all on us, but the, the system takes that and reduces and owns that.

Rose Horton: I absolutely agree. I don’t think it should be, solely our responsibility. I do think that the work that we do is potentially and likely traumatizing. it’s hard work. We shouldn’t mince words. it’s hard work. and I think. , anyone who’s been through healthcare will have suffered, trauma.

so by virtue of the work that we do, [00:55:00] butcher ride, it’s not just our responsibility. I love organizations that have moved to, my daughter works for an organization that has, unlimited p t o. Like, what, what is that? Tell me, tell me what that is like. You know, and I love the thought behind it is that you get to determine how much time you need off and when you need the time.

You just take the time. And I think that’s so great. So I think there are a lot of, system changes that we can put in place that would decrease. the burden for us so that there wouldn’t be a need for resilience, like going to work. And I remember as a new grad nurse, you pro, you guys probably remember also cause I was hired in labor and delivery, which was my dream job.

So what did I have to be sad about? I remember going to work every day super excited and super happy, you know, and with every patient and family that I was able to be with and be part of their birth, that just filled me up even more. so there was. , there was a [00:56:00] reciprocal relationship of give and take, you know, so that I would give and I would get as well.

Right. And I think that our systems now are more, we give and the system takes , you know, so there are things that we can do to change things up. and focus on wellbeing is, is one of ’em. I think, focus on our schedules. we can be very creative. Let’s reimagine flexible schedules. the pandemic forced us to do a lot more telemedicine, like mental health.

That’s something that we didn’t think we could do so effectively via telemedicine. But what else can we do via telemedicine that we haven’t done? We need to have that kind of group think to say, okay, white canvas, how are we gonna create it? And then allow. us. And I think the US as nurses to really reimagine it.

And then those who have the ability to write the [00:57:00] big checks to say, because I value nurses and you guys are closest to the patients, which is why we’re here. We’re gonna write a check, whatever you say we’re gonna do. So, to answer your question, yes, by virtue of the work that we do, it is traumatizing and we do need our resilience.

And yes, organizations have a responsibility to decrease the burden so that so that you have a give and a get, not just a give. And we take, I would

Nicole: I think you know that feeling valued is really critical. Cause I was reviewing the presentation that you had sent and there was a chart in there that had kind of these color coded blocks. One of them was, And I can’t remember the, correct me here, fill in the blanks for me.

But it was something to the effect of, you know, things that employers didn’t think was as important versus what they thought was important. And I think what happens is a lot of, executive folks thinks it’s all about the money. Like they just want more money. And Stephanie, she had recommended this book, humankind amazing book, and [00:58:00] the, the author of that book talks about that it’s not just about money.

And like, somehow we got this idea that everyone thinks you can motivate folks just through money. But really the big piece is valued. People wanna feel valued. And I remember looking at that chart and one of the big things in there that, that folks weren’t paying attention to is that it’s very important for people to feel valued.

And so I think, you know, and we imagine how do we build in resilience in this at a systems level is in what way are we making our. , the, our staff feel valued and pizza parties aren’t cutting it. Okay. Like, just stop with the pizza parties, please. . And, but, right. And so I think, I appreciate that you bring up value and that, and I think maybe we are at a point with this new generation, you know, when you think about unlimited PTO you know, it’s not about the money, but wow, could you imagine from a value perspective, like here I have someone who’s trusting me to like, make this decision on what I [00:59:00] need.

And like, how valued your daughter, I assume would feel, you know, in that type of position. And, and what does that communicate? How does that communicate value? And, and so I think that yeah. How are we building in value that

giving it.

Rose Horton: Yeah. No, I agree. Thank you for calling that out. And I think it’s, it’s super important because so many times, you know, nurses will say, well, if you give me more money, if you give me more money, and I share in information like this, and this is, we did this during the pandemic, you know, this, this study, was during the pandemic, from McKenzie, the McKenzie report.

this hasn’t changed. I remember getting this book, I was a nurse recruiter for one beautiful year in my life, and then, then it went away. But in that one beautiful year, I remember getting this book called 1001 Ways To, uh, reward Employees. and like one of the first paragraphs said, it’s not about money.

And I learned that it’s, it’s never about money. It’s about creating that [01:00:00] sense of belonging. You know, you belong here. So when you come in, you know that all that cheesy going to the bar, what’s the bar where everybody knows your name? but something like that, you know, but value by the manager and having that sense of, belonging and also having teammates that they can trust and have relationships with.

Those are the top three things that people want. Money is very low in it, but I think when we feel disengaged and when we’ve been disappointed and. We can’t get what’s really important to us and we defer to the other measurable thing, which is money, then it becomes about money. But at the crux of it, it’s like I, I and I, we had that conversation just this morning in our huddle, in our leadership huddle, cuz we talked about the, the pay.

And I said, you know what? We’re in a very tough financial period right now. All hospitals and healthcare organizations are going through it. I said, but what we do have control over is our culture and [01:01:00] creating a place where people feel like they belong. So let’s work in the area where we have control and, you know, let’s, let’s do that for our employees.

That the word gets out. You know what, that, uh, Emory Hospital in the suburbs of Decatur, uh, their pay is not the best, but geez, oh man. They’re nice people. I love when I get to work there. I love working with ’em because in this day of incivility, and, and hard work, That’s saying a lot. a whole lot.

Nicole: It is, and I agree. I think people will trade like, fine, if I’m gonna have to come here and be treated like garbage, then you’re gonna pay me for it. And that kind of becomes the surrogate for if you’re not gonna value me, than pay me more. And, and I agree with you, rose, that I would rather get paid less, but be in a phenomenal work culture and feel valued then get paid a lot and hate my life

Rose Horton: Totally, totally

Stephanie: Well, and I don’t know who in healthcare goes into this profession [01:02:00] thinking, I’m gonna make a lot of money . Like, that’s not why we chose this. Otherwise we might be a investment banker or or something else. Yeah. Because even if physicians make or surgeons make more money, that’s not why they go into that line of work.

Rose Horton: Not at all. And then when you think about another thing that I talk about, not just burnout, but I also talk about, the level and the rates of suicide. You know, it’s a real thing. It’s a real thing in healthcare. When you talked about surgeons, because they’re really high up there with a suicide rates, it’s like, to Nicole’s point, I don’t want a lot of money and I hate my life.

And think about, you know, jumping from a building, gimme the minimum. Let me be filled with joy and gratitude. because that’s something else that we don’t talk about enough in healthcare. the rate of suicide that happens for.

Stephanie: Yeah, that’s a really good point. I, I thought of that earlier and forgot to bring it back up.[01:03:00]

Nicole: Well, I think let’s task our listeners that you have to play one game of gratitude, tennis with someone at work and someone at home. And we can all try and fill our buckets a little bit. but Rose, you have given us so many wonderful tips and tricks. Where can folks go to learn more about managing burnout and compassion?

Do you have some resources you love?

Rose Horton: yeah, so in the references there’ll be a lot of really, really great articles that came out during the pandemic about, some simple things and some really great science. and also the American Nurses Association have, the healthy nurse, healthy Nation. They right now are doing this whole thing, on burnout.

So if you’re a member of ANA, there’s a survey that’s Live now, and also there’s some resources on Healthy Nurse Healthy Nation that is, live, right now. And you, I think you can get up to like 20 plus, CES if you participate in some of the [01:04:00] education. So I think that’s a really, a really great one.

I love Brene Brown. she has a lot of podcasts that are, available. I love all the talks about vulnerability because I think in essence that’s, that’s us. what we need to hear more about and to learn more about. and then just, just be intentional about, what is it that fills your bucket, you know, and you feel the most satisfied.

What have you done and how can you. Be intentional in doing more of that and carving out time in your calendar to, to do more of what makes you feel like your best self, because you deserve to feel like your best self.

Nicole: I wanted to make a quick plug too. I forgot to mention this earlier for our listeners, we do have an entire episode on humor with Karyn Bux man. She is a neuro humorist and yeah, you have some, I guess Forrest has some thoughts on humor too, . but yeah, she talks about how you can find humor, you know, even if you’re not a [01:05:00] funny person and it’s not about being a comedian, but just kind of finding those bright spots and she nerds.

Out on some of the, the neuroscience behind that, like mirror neurons and all that. I do not ask me what episode number it is as I cannot remember . Um, but yes, it’s, it’s, uh, humor with Karyn Buxmen. So feel free to check that one out too for our listeners.

Stephanie: Okay. So Rose, I would personally like to thank you so much for your time and commitment to advancing sexual and reproductive healthcare through communication.

Do you have any last thoughts that you would like to add before we end?

Rose Horton: What I want everyone to remember is that the power of nursing is our collective voice and our ability to reimagine the future. So we may not love healthcare right now. This is, this is a moment in time. Let’s reimagine something greater. We can together.

Stephanie: Thank you so much, rose.

Nicole: Yes. Thank you, rose.