Nurse Educator, Dr. Dianthe Hoffman

00:00] Michelle: You are really going to love Dr. Dianthe Hoffman. Her passion for teaching our new generation of nurses comes through loud and clear with her start in the Navy, mentoring Corpsman to her Peds and NICU days as a bedside nurse, then managing a busy NICU. And now as a nurse educator, she brings her knowledge and her gift for communication to a higher level. I love that she teaches her students to imagine their loved one in that hospital bed, driving them to empathetically care for others. She told us nursing is more than a job, it's a calling. And her work truly embodies that. Here is Dr. Dianthe Hoffman. You're listening to the conversing nurse podcast. I'm Michelle, your host. And this is where together, we explore the nursing profession one conversation at a time. Well. Good morning, Di.
[01:00] Di: Good morning. Hi, Michelle.
[01:03] Michelle: Hey. I've been so excited to talk to you for the last few weeks because you've had such a varied nursing career, and so we'll just jump right in and tell me a little bit about how you got started in nursing and, like, why did you want to be a nurse?
[01:26] Di: That's a great question. I do think I fell into it. And just now that I've been a nurse for so long, I can't imagine doing anything else. But I did start out when I was a kid, I wanted to be a pediatrician. And then once I got a little bit older, I really wanted to be a teacher. And I got into college and started out as a math major to be a math teacher. And I had my husband's family members, a few of them were nurses. And I had really never thought about being a nurse until then. And I took this is kind of a funny story, but I took physics in college and realized that I didn't want to be a math major anymore. And so I really thought about nursing. I loved anatomy and physiology and those kinds of things and how the body works, and I just kind of felt like it was something that everybody needed to know. And it just interested me so much, learning about your body and how you can help and get better and heal and those kinds of things. And so I switched and became a nurse, and I've never looked back since then.
[02:37] Michelle: That's really neat. I think a lot of times we don't get into nursing for reasons that other people think that we get into nursing. I wanted to be Quincy, Medical Examiner. I started watching that, like, in the mid-1970s, and I just thought it was so cool how he could look at a dead body and do all these tests and figure out how the person died. You started out as a math major and all that, and I'm sure those things have helped you in your nursing career. You definitely have to have math skills.
[03:18] Di: Yes.
[03:20] Michelle: So I met you when you were my nurse manager. Well, in pediatrics first, yes. And then I loved you so much that when you went to the NICU, I said, I'm going to follow her, and I never regretted it. NICU was my true home, and I loved it. So you did management, and how was that going from bedside to management?
[03:52] Di: Well, I also had experience in the Navy, and so when I first graduated, I actually went to school. The navy helped me with my career, and when I graduated, then I worked in the navy, and we had that kind of hierarchy as far as leadership and those kinds of things. And so I always kind of had that passion. And I loved we had Corpsman, and so I would they're like medical assistants in the Navy, and I loved mentoring them and showing them how to care for patients and role modeling and those kinds of things. And I feel like nurses, that's kind of our role anyway. But honestly, I loved bedside nursing, and I worked in the NICU, and I fell into the role of management. I wasn't seeking that role out, and I fell into it, but I just went in head on and just I had a great director. I remember Linda Stewart, and she really was a great mentor, and I think that has stayed with me forever. She role modeled in a way that she would give us direction and tell us our responsibilities and her expectations, but she didn't micromanage. She said, you know, here's your job, go and do it. And if we had questions, we could go to her and ask her for help, those kinds of things. But she trusted us, and she was able to tell what kind of person we were, so she just let us go. And I had good peers, too, that I worked with so good support. And I think my style was as a manager, the same way that Linda role modeled as a director. So expecting staff to do what they're supposed to do, but also being there if they needed help.
[05:46] Michelle: Yeah. I echo your sentiments on Linda, and I appreciate that type of manager. You know, one of the things that I've talked about before is sometimes organizations take a really good nurse, a really great nurse, she or he has good nursing skills, leadership skills, and they say this person would make a really good manager, but as you know, they're really different types of jobs. I think in your case, definitely, you turned out to be a great manager, and probably a lot of it had to do with, like you said, your experience in the military, and you're already a true leader. And I think the other thing that organizations don't do is really give their managers a lot of support.
[06:45] Di: Right.
[06:45] Michelle: So I'm glad that you got that from the upper management, but how do you think that having those leadership skills and being a manager prepared you for going into nursing education?
[07:02] Di: I think there's a lot of similarities, and I do have to say the negative parts of being a manager. I don't feel those with an educator. So it's like the best of everything. I feel like as a manager or a leader, you're mentoring your staff and you're providing the environment for them to be able to flourish and do their best. And that's what I feel like as an educator. My role is really to provide the environment, develop the curriculum, the clinical experiences, to give the students the best opportunity to learn what they need to to be a great nurse. And so it's not spoon-feeding them, it's not doing stuff for them. And so I feel like there are a lot of similarities there with management and education.
[07:50] Michelle: Yes. Okay, so I saw that because I went on the website you teach at Westmont College in Santa Barbara. Lucky you.
[08:04] Di: It's amazing.
[08:08] Michelle: So the Peds rotation is in second semester?
[08:11] Di: Yes.
[08:12] Michelle: Okay. And those students, I see that they come in so it's an accelerated baccalaureate program, and they come in with a BA or a BS. Is that right?
[08:25] Di: Correct. Yes. So they have to have a bachelor's already, and then they need to do the prerequisite. So if they didn't do that in their bachelor's, anatomy, physiology, chemistry, those kinds of things, and then also it's a Christian college, so there are some religion classes that they need to also have before they can get into the program. And then once they're in the accelerated bachelor's nursing program, it's four semesters, and it's all nursing classes. There are some, like a sociology and philosophy, but all of them are related to nursing. So they're just nursing, nursing, nursing.
[09:04] Michelle: Okay, so those students that are coming in because I know you also taught at was it Bakersfield State?
[09:12] Di: No, Bakersfield College. So yes, a two-year associate's degree program.
[09:18] Michelle: Okay. So do you see a difference in the students in their preparation for already having their bachelor's and coming into your program versus the undergraduates? Do you see a difference in those students, in their motivation to learn, in their own participation in their education? Do you want to talk to that?
[09:44] Di: Yes. I would say there are more similarities than I thought there would be as far as I think, just students in general with the internet and with the pandemic. I just think a lot of our students have been used to I don't want to say spoon feeding, but they have been used to what's going to be on the test. That kind of question, being very concerned about the grades and the exam. And I understand that too, because to get into a nursing program, you have to get A's and all of your prerequisites, and it's very competitive and those kinds of things. So they kind of come in with that mentality. I would say that one of the big differences that I've noticed is their writing. I do think these students with a bachelor's degree have a much better grasp on their English skills and writing skills. I'm trying to think if there are any other real differences that I see. The one big similarity that I think is really something that I'm passionate about right now in nursing is the focus on the skills and doing what's right as far as hand washing, starting an IV. Focus on that as opposed to what they really. I feel. Need to be focused on the whys and the critical thinking and keeping the patient at the center of their care. And so that's one of the things that I feel like just this new generation that we really need to make sure that all of us are doing the best with that right.
[11:31] Michelle: I think we do get very task-oriented and like you said, it is not easy to get into nursing school. You know, one of my frustrations, I did adjunct faculty for my local college for about twelve years and it was clinical only. It wasn't didactic, but we would have post-conference and I would be discussing a certain type of patient that they had that day and, you know, I would ask questions and I would just hear crickets chirping. Yeah, it was like, yeah, it's so frustrating. And nobody wanted to jump in there and answer the question. And then I was forced to call on someone, which is really uncomfortable for everybody. So that was frustrating for me. But along those lines of the baccalaureate program. So back in 2010, the Institute of Medicine said we want 80% of the nursing workforce to be baccalaureate trained by 2020. And now it's 2022 and we're around 47%, I think. So is that goal still relevant? I mean, we have a massive nursing shortage. And what do you think about that?
[12:56] Di: I think understanding the why they said that is important for everyone because there are studies and now they're actually saying maybe not, but there were studies at the time that showed patient outcomes were improved with higher degrees. So I think that needs to be more of our focus is looking at patient outcomes and tracing that back to figuring out why the patient outcomes are not as good as we want them to be. As opposed to focusing on more education. More teaching. Or whatever it might be. More trainings. More this. More this. Putting bandaids instead of really looking at what is the root cause for these lower-than-expected patient outcomes. I mean, obviously we want 100% no medical errors or medical errors, those kinds of things. But what are the things that lead to those errors? Is it ratios? Is it education? Is it leadership? Is it administration? Is it physicians? Is it poor communication? What are all the little things that lead to that? As opposed to just making this blanket statement that nurses need to have a bachelor's degree. And maybe that's true, though. Maybe there is some more with that. And yeah, that's something I'm really interested in because when I just went back to school, that was the big thing, talking about the goals and the education and all that stuff.
[14:32] Michelle: It's probably, like you said, all of those things we encounter every day. And I've read those same research studies about, you know, the more bachelor-prepared nurses you have, the better patient outcomes. There are also studies on the lower patient-nurse ratio. You have better outcomes as well. So I'm like you. I think it's probably a combination of everything and you're involved in teaching those nurses that are just coming into the profession. And so it's so important. And being a bedside nurse for 36 years, a lot of nursing students have come through our units, through our hospital, and I think sometimes nurses well, I don't think it's true nurses can be hostile to nursing students. And, you know, Florence Nightingale said nurses should never stop learning. But why do you think it is that we just quickly forget about what it felt like to be a nursing student, to be a new nurse, and then how can we, like, reverse that where we welcome our nursing students and mentor them instead of being really irritated by them, right?
[15:57] Di: I would say, for the most part, I do feel like bedside nurses have been very receptive and welcoming to nursing students. But there's always those few. There's at least one or two on every floor or in every unit that just you can tell that they don't want a student with them. And I think there are a few things or reasons for that. One I would say, honestly, is that they don't feel confident in their skills and they don't want someone watching them. They feel like they might not do things right and their self-confidence is low. The other thing I think is there's this mentality, I'm not getting paid to teach the student, and why would I be doing this teaching, I'm not their teacher kind of thing. And I think the third is that a lot of nurses right now are feeling overworked and, you know, this has gone on even when I was a student, so they feel overworked and burnt out and just stressed, and they just think, oh, this is another thing I have to do today. And so I think we need to really be on the front end, it's not okay to be like that. So, yeah, sure, they have reasons or whatever, but I really think the expectations from the leadership, from management, from the clinical education department, you can't be like that and be a nurse on my floor kind of thing. And so figuring out what's your issue, what's going on, but then also setting those expectations that if you're like that, you're not going to be welcome here on this unit. Anymore and maybe you need to find another position. And I feel like we've got to be a little more harsh with that. I also feel like it's a great opportunity to use with the students to just kind of discuss in general terms, not a specific person, but some of the things that they feel and the different characteristics they see in nurses on the floor and to use that as an opportunity to remember that when they graduate in their nurses, how they would interact with the nursing student.
[18:22] Michelle: Yes, I think that is a very important message for our listeners. You said it all. It has to come from the organization that we're not going to allow this. Just like bullying, bullying within our profession. You know, it happens and it's really sad and embarrassing. And I think sometimes nursing students and novice nurses take the brunt of that and it has to be exactly what you said, not be okay, this is not okay. And then really fostering nurses that are on those units to be mentors and to see what it feels like to mentor someone. And thankfully, now in our organization, they're giving mentoring courses and it's working out really well. So that's such a good point and it's something that we always have to stay on top of. So being a nursing professor, how do you assess if a student is really getting it,  like, absorbing everything? How do you make that assessment?
[19:47] Di: So we kind of get a sense or a feel, but in reality, we have to have some objective tools that we're using to assess that. In the classroom. didactically we're using exams and quizzes? And then I do ask questions in class and I wait. I used to have a really hard time with silence, so I would answer the question for them. Nowadays, if they ask a question, I'll say, that's a great question. Let's see if we can all look for the answer. I mean, they all have their computers with that kind of thing. If I'm asking a question and no one's answering, I just kind of wait for them to find the answer and then discuss. So discussions in class, exams, and quizzes, and then in clinic, this is really where we say the rubber meets the road kind of thing. And applying that knowledge that they've learned and talking one on one with them in clinic is probably the best way I can sense that they're getting it. So they have their care plan and putting it all together. What's going on with your patient? What's your biggest problem? What are your interventions? What are you going to do to help your patient today? And talking through all of that and really having them think, why am I giving this antibiotic? You know, why am I having them walk three times during my shift? Why am I having them do that? So really getting them to the whys of what they're doing and helping them really, really think. And when they start giving me that information without me having to ask, that's when I really feel like they're getting it. They know what they're doing. And then watching them with the patients, you know, explaining to the patient this medication they're giving them, why they're giving it side effects, those kinds of things.
[21:35] Michelle: Oh yeah, absolutely. And you can gauge all that from clinical. Have you had a student that, oh man, you just know they are going to be a great nurse. But then in the classroom with the didactic, maybe they have some test anxiety and they're just not hitting their marks where they need to be, like, you know, academically. But you know, they're in it for all the right reasons and all their wise and everything. What happens in that case?
[22:08] Di: I love those students, honestly. The other way around is when there are issues, but this is if it's purely testing anxiety. The one thing is that they need to pass the NCLEX, so we got to do what we need to do to get them to get those test questions right, et cetera. So we have a lot of resources nowadays. There's a bunch of NCLEX prep books and we really work on remediation, which is taking lots of NCLEX questions. But then looking at the rationale, why is this question right? And then spending some time just really making the tools that they need to really understand deeper some of these pathophysiology, those kinds of things. So we definitely, if they score less than an 80% on an exam, we get them right in the beginning and we'll start working on a plan together and then meet weekly with them, go over the things and we give them some steps, you know, some action steps that they need to take to get to where they need to. And then we meet the next week. Maybe it's like ten NCLEX questions a day. So we look at that and just kind of keep them on target because these are students usually who want to do it. They will put in the time, they just need some help figuring out what they need to do to get there. And then lots and lots of questions. Maybe it's making flashcards, whatever their learning style is. And then the other thing is, both the schools that I've worked at, do have a student success center. And so they will work with them on other things, test-taking strategies, their learning styles. So the best way for them to study and then we always have the opportunity, if they need longer, to take a test, they can do that too. And just whatever we can do to help them succeed.
[24:09] Michelle: That's so important. As an educator, what do you think? Speak to what you think is maybe the most pressing issue in the nursing profession.
[24:20] Di: I would say when I think about nurses at the bedside and nurses that I interact with and friends that I have, I feel like there's this lack of passion and a little bit of apathy and not all across the board, but I feel like and I don't think it's just instead of the pandemic, I think the pandemic has heightened that. But I feel like there is enough of a number of new nurses that I see that I'm not sure why they became a nurse. I feel like I see some apathy, some getting the paycheck mentality and not going above and beyond for their patients and I can't put a finger on what it is. What exactly is that? And are we allowing that? And how can we, as leaders, as educators, as nurses that have been in the profession for a long time, how can we make that not acceptable? We do have a shortage, so we have to be reasonable too. But how do we get there with that lack of passion, lack of empathy? Just I feel like nursing is way more than a job. You know, it's definitely a calling. And not to say that other jobs aren't important, but I just feel like if you are a nurse, you have to feel passionate about your work.
[25:56] Michelle: I agree 100% and I feel like, man, we're burnt. We are burnt as a profession. And like you, I think it did start before the pandemic. In the daily life of a bedside nurse, a twelve-hour shift, there are so many things to do, there's so many tasks and there's, oh my God, it's just overwhelming. And the patients are sicker, but we need to get them out faster, but we need to charge all of this and we need to know, oh my God, it's overwhelming. And then definitely the pandemic just blew it up. So, I mean, as a profession, we really have to fight that. And where do we get our hope from? Is it coming from the new generation of nurses that are coming in? Do you see a spark in them that maybe we've lost?
[26:58] Di: Well, I feel like as educators or anybody working with young nurses or nursing students, we have to keep reminding them or keep in the forefront, why do I want to be a nurse? And sometimes we need to look at these students and if they just don't feel that passion or they don't have coping skills, we probably need to talk to them about the reality of the profession and not sugarcoat it. Because sometimes I think, what am I doing? Setting all these students up for failure kind of thing. And so I think we have a role in preparing these students and teaching them the skills, not making school easier, not making being a new nurse easier, but teaching them the skills to cope with these stressful environments and stressful occurrences that are going to happen. How are you going to deal with this? How are you going to go back to work the next day? What is your passion? There's a lot of things out there, a lot of tools for new nurses, for anybody, actually. All of us. After your day, think about something good that happened today. Think about what was the best thing that happened in your day. Practicing, gratefulness, and thankfulness, those kinds of things. There are studies that show that all of this can help with your mental health.
[28:25] Michelle: Yeah, I mean, I do that. I do my gratefulness meditations. Those things are all so important. So you're at the top of your game. You have your terminal degree. Last year, you got your doctorate in nursing practice. Congratulations, by the way.
[28:45] Di: Thank you. Thank you.
[28:47] Michelle: But where do you go if you need, like, a refresher on a topic or a skill? Where do you go to get that?
[28:56] Di: You know, just speaking earlier, I wanted to mention when we were talking about being a leader and those kinds of things, one of the things about nursing is there's such a wide variety of jobs we can have in nursing. A bedside nurse, a manager, director, administrator, educator, clinical nurse specialist, clinical educator, school nurse, hospice, such a wide variety of fields. And one of the things I let go of, and even as a manager, I realized I am not the clinical expert, and I need to be okay with that. I am not the best NICU nurse. I am not the best Peds nurse. And so reaching out to those experts in the area, I think, is number one, and being able to know that you're not the expert in all of these things and pick one thing, you know, and be good at that. So I would say, clinical experts. The other thing is, honestly, there are so many good online resources, and just to put in a plug for one of them, like Osmosis, I don't know if you've heard of that, but that is a wonderful, wonderful resource where there are videos and they're showing and they're in plain terms. So when I'm trying to learn a disease process or pathophysiology type thing, that's one of my resources. And there's tons online, and they are reliable resources. And then the textbooks, online textbooks, or just whatever books I'm using right now. And then my peers, my fellow educators, or just anybody like that. So, yeah, I have a lot of variety of resources, and usually, whatever the issue is, I can go to the right person the first time.
[30:43] Michelle: Yeah. Wow. Well, you are certainly an inspiration to me and to our listeners. But who inspires you to be, like, a better nurse and a better person?
[31:00] Di: I would say, well, honestly, my faith, you know, I am a Christian, and so I feel like I've been called here to do good, you know, leave this world a better place than when I got here. And I just keep remembering that when I feel frustrated or overwhelmed or annoyed with things, that life is not easy. And then I think about all these other people that struggle so much more in their daily lives and if this is the worst of my problems, I can get through it. And then my family, especially my children, role modeling to them what it is to be a servant leader, a servant educator, a nurse, those kinds of things. And my students because I want to be the best for them because ultimately it's our patients that need to be the focus. And so I feel like, as I said, I'm not the best bedside nurse anymore because I've been out of it for so long. And my goal then is to create these awesome bedside nurses so that they can take the best care of our patients. And I remind students too, if you're struggling or you're feeling overwhelmed or whatever, think about your family members being in the hospital and you want the best care for them. And you need to think about that patient in the bed. They are someone's mother, someone's daughter, someone's sister, those kinds of things. And so you really, really need to keep that at the center of all of your work. And I think that'll keep us motivated and be better nurses and better people in general.
[32:40] Michelle: I love that empathy and teaching them what if that were you man, that's really powerful. Wow, this has been such a fun time with you. Are you ready for the five-minute snippet?
[32:58] Di: Ready or not, here it comes.
[33:01] Michelle: I know. Okay, so I'll just explain for a second what this is. These come from a digital marketer Travis Brown and he created these Pod Decks and they're just like hundreds and hundreds of really cool questions. They're fun so it gives us a chance to see you on your downtime on your off-duty side. So I'm just going to start with the timer and then I'll ask you the first question and we'll just see how it goes, okay?
[33:32] Di: Okay.
[33:33] Michelle: Alright. If you had a full year off with pay, what would you spend your time doing?
[33:40] Di: Traveling for sure.
[33:44] Michelle: I got a feeling you're going to.
[33:45] Di: Say that I want to go to Europe, I want to go to Sri Lanka, which is where my dad is from. And just explore all the different cultures and foods and et cetera.
[33:57] Michelle: Yes, eat and yum. If you had to dedicate the rest of your life to a cause, what would that be?
[34:06] Di: Oh goodness.
[34:09] Michelle: Hard.
[34:10] Di: Yes, that is hard. That everybody has enough to eat and drink and shelter over their heads. Every person should have a quality of life, at least the minimum quality of life. All the needs met, their basic needs met.
[34:30] Michelle: Agreed. Wow. What's the most surprising thing you've ever tasted?
[34:35] Di: Oh, goodness. I would say frog legs. That was a long time ago.
[34:44] Michelle: Oh my goodness. Yeah, I've never had them. What do they taste like?
[34:49] Di: Just not very good. Yeah.
[34:53] Michelle: Okay. What's the most common reason for people failing or giving up?
[35:02] Di: I would say not having the self-confidence that they need. And I believe that's related to a history of either people around them developing that or not including them.
[35:16] Michelle: Yeah, definitely. I interviewed a flight nurse who said exactly, just self-confidence. Like, that's really huge. What was the smartest decision you made this year?
[35:34] Di: This year my taking a job at Westmont. Yeah. We also moved to Ventura. I don't know if that was smart, though. It was great, but we'll see how smart it was.
[35:51] Michelle: Time will tell, right? What can you do to support someone going through a mental health episode?
[36:00] Di: I think just being there for them and letting them know that they're there. I think time just sitting with them and waiting to take their cues as far as reaching out for help and resources. So I don't know if I talk to you about my doctorate, but I did it actually with students on mental health, teaching them mental health skills, and how to cope with stress, anxiety, and depression. And I learned a lot through researching the topic and things that work and don't work and really it's a lot of work for people. They have to do the work kind of thing. I think just being with them and speaking truth to them and really encouraging them, but still they're going to have to do the work that they need to to get healthy.
[36:56] Michelle: Wow. What a great opportunity to have that for them and for you. Should people who commit violent crimes be given a chance at parole?
[37:08] Di: Yes. Is there a no answer? Do you want me to expand?
[37:13] Michelle: No. I mean, I think it could be yes or no for sure. Who's the one person that you would love to have as a mentor?
[37:23] Di: Goodness.
[37:26] Michelle: I know. They're so thought-provoking.
[37:29] Di: Like somebody famous or oh, you know, I don't know if you've heard of Adam Grant.
[37:36] Michelle: No.
[37:36] Di: He has a great podcast. He's an organizational leadership educator at Wharton College.
[37:44] Michelle: Okay.
[37:44] Di: And just I don't know, I listen to him a lot and just the things that he says and does and he's just super smart but personable and the things that he discusses.
[37:57] Michelle: Wow.
[37:58] Di: Yeah.
[37:59] Michelle: I'm going to check him out.
[38:00] Di: Yeah, he's really, really good. I like him.
[38:02] Michelle: Okay. Adam Grant. Cool. Alright, our time is up.
[38:08] Di: Yay. Well, we did good.
[38:11] Michelle: Yeah, you did it. You're amazing. I knew you would be amazing. I'm so happy that you agreed to come on and tell us what it means to be a nursing profession, an educator, a mentor, all the things that nurses need so desperately today. So thank you so much, Dr. Hoffman. And I'm going to get all your contact information. I'll put those in the podcast, show notes. So gosh have a wonderful rest of your day and week. And thanks for talking with me.
[38:47] Di: Thanks, Michelle. Always great to talk with you.
[38:50] Michelle: All right, take care.
[38:51] Di: Take care.