Welcome to Digication
Scholars Conversations.

I'm your host, Jeff Yan.

In this episode, you will hear part two
of my conversation with Sharyl Toscano,

professor at the School of Nursing
at University of Alaska, Anchorage.

More links and information about today's
conversation can be found on Digication's

Twitter, Facebook, and Instagram.

Full episodes of Digication Scholars
Conversations can be found on

YouTube or your favorite podcast app.

If it becomes busy work, to be honest,
I, I, I tell people, I'd rather you then

don't ask them to reflect because now
they have this really negative association

with a reflection and they're like,
Oh, you know, I don't want to do this.

This is boring.

Oh, this is, this is just you.

I actually heard about, I heard a
student say this and I was so sad by it.

They said when, um, they
were advising another student

actually, I overheard this.

They said, Basically, the professor
wants you to stroke their ego.

Oh, my.

And, and you can see why though, right?

They would think that.

Because they are saying, the professor
taught you a bunch of stuff this semester.

At the end they are saying,
what did I, what did you learn?

If you say, I learned all the stuff you
taught me, hey, that's the right answer.

Wow.

Right?

That's sad, right?

Yeah.

Yeah.

That's sad.

That is not exactly
what you're looking for.

That's when I like,

please stop asking them to reflect
because you are really actually, um,

if anything, you, you push them further
into the hole of that they will never

get out of, you know, because if that's
how they think about this section,

um, it, it becomes Not only busy work,
it actually was for your benefit.

It wasn't even for them, like,
it wasn't even busy work just to,

all right, we have to get it done.

It was more like a, oh, well, you
just needed, needed some reassurance

that you've done it for you.

Yes.

Isn't, you know, sometimes I get
with the essentials, oh, that's

just for accreditation, which it
is a great way to show that you've

met the standards, but that's not
really the point of the assignment.

That's just sort of one of the.

Extras, right?

That, oh, because, you know, when you
go through accreditation for different,

you know, whatever program, you have
to show examples of student work.

Um, so, yes, I, you know, I, I do,
I tell the students, well, yes, it

is a great example of the work that
you've done here, but that's not really

why that we do the assignment, um,

uh, because we can pull that
work together in other ways.

The portfolio is just a nice way to do it.

But the key point to the assignment
is actually that one of the reasons

it made me think of doing this is,
uh, I saw students, particularly more

recently, you know, um, we've kind of
passed our golden years in nursing,

I think, going into a different era.

But, you know, they just, Um, They just
go through school and they, I don't, there

wasn't seeing a lot of acknowledgement
of what they'd accomplished.

They're just like, I just
need to get through school.

I just need to get through school.

And I wasn't really that student.

I love school.

Like school was, I'm still in school.

Right.

So I obviously just

You never left.

Yeah.

I

love school.

And so I wanted to kind of leave them
with some appreciation for the, like, show

them what they've actually accomplished.

So this, this project actually kind of,
you have to review everything that you've

done for the, across the whole program.

And they're doing it right
before they graduate.

And most students will share at the
end, they're like, well, this, you

know, I wasn't really excited about
this to begin with, but I really

feel like I've done, I didn't realize
how much I'd actually accomplished,

how much I'd actually done here.

And so they do that right before.

I love that.

I, I do wish that More people allow
students to have more opportunities

to do that more frequently and early.

Um, but this idea in my mind of, um,
not just any students, any, any humans,

anyone to have the, to get given some
time and space to say, here is a body of

Work or body of things that you've done.

It doesn't have to be work, right?

It could be play, it could be other
kinds of, you know, experiences

and achievements and whatnot.

The ability for someone to have the
time and space to just go, here's a

body of things that you've, you've done.

Um, some people, you know, think of
it as sort of integrated learning.

But I, I think that there's,
I, I love that, but I also

think that there is a, um,

a really interesting, almost
like neurological model that

gets structured around your self
worth and your sense of self.

And so

to me, every time that You know,
anytime that someone gets a chance to

say, Hey, let's take a look at your
body of work, or you have to present

your body of work, maybe not in the
like, like formal presentation, but

more like telling a friend, telling
a new person that you never know

about, you know, doing a podcast.

That, that it, it sort of builds
additional like neuro, like, you

know, connections in your, in
your brain that says, ah, that's

the kind of person that I am.

This is how I, this is
how I do life, you know?

Yeah.

I think that's amazing.

I think that's a, what a gift
that you, you give your students.

Just kind of flip the lens a little bit.

Yeah.

Yeah.

I think it's, I think it's wonderful.

This is why I, I, I I wish that people
make that a bigger part of life in

general, so it's not like, Oh, well,
now that you're graduating, look what

you've done in this last four years.

But I always feel like, you know,
what happened this week, you know?

I

feel like when you have adolescence,
you could have like, Those are

your parenting successes, right?

Well, that's how

you keep yourself sane.

Um, can we, would you mind if we
switch the topic for a moment?

I, I know that you also work with,
um, I mean, there's been a, uh,

um, a pattern of you working with
natives, the native population.

Yeah.

Sounds like first in, in, uh, Well,
it's definitely in, in, in both in

Hawaii and Alaska, but maybe elsewhere.

So have you that,

um, For indigenous, mostly
just Hawaii and Alaska.

Yeah.

And can you tell us a
little bit more about that?

What is that?

What does that mean?

What is the work?

What is it like?

What did you do?

Um, yeah, so in , um, you, in
Hawaii I worked the, um, Hawaiian

population, but also American
Samoa, Tonga, um, other populations.

Um, I was more the health center there.

I was more in the, um.

Working in the military, you know,
which is its own, um, culture.

Uh, so mostly I worked with students.

And one of the things that was really
unique in Hawaii that I noticed is no one

in Hawaii says, why aren't you a doctor?

Which, nursing is And so much
so that sometimes when students

weren't successful, they were
actually happy because they

actually didn't want to be a nurse.

And I was expecting all this
disappointment, you know, when

they're, when they actually were
like, Oh, thank goodness, you

know, cause they actually didn't.

Didn't want to do it.

So that was a big, big

culture.

Is it just a general culture?

I

think it's something unique about when
I was in Hawaii, it was just very much,

you know, other places people often
say, well, why aren't you a doctor?

Why?

You know, it's like a, but not there.

Like nursing is very respected.

And so, it was kind of a very unique
experience while, while I was there.

Um, but definitely like the storytelling
that we've been talking about is very

integral to both Hawaiian and very much
so in the Alaska Native population.

And I would say I've worked more closely
with the Alaska Native population

like here because I've been with
the, the, the hospital since 2012.

So, um, and with fam working a lot
with families and So when, when

families come in for health care,
like Anchorage is a hub, and so we

get families from a lot of the rural
villages that will come to the hub.

Whereas on the adult side of the,
of the hospital, sometimes you get

patients from the hubs, but there's
more access to adult care at the

other hubs that aren't Anchorage.

And so, you know, when you think
about, um, You know, a lot of things

we've been talking about as far as the
nonviolent communication, it's, it's

a very non-confrontational culture.

And so, um, often, and it's not
hierarchical like the hospital, the

hospital is owned by the people.

So the patient is the owner,
it's a customer, owner is

the word that he Mm-Hmm.

is used.

And so it really changes the dynamic in
the hospital because, you know, somebody

who's, you know, doing housekeeping or,
um, you know, is at their desk or, you

know, even the provider, they all may
own the hospital, you know, the owner.

And so all of these sort of, um, levels
of hierarchy, for me, I've noticed is

really nice because that's removed.

And so I feel like Like

this is the This is the big boss, and then
you're the second and the third big boss.

Right.

I, I don't

feel that as much there.

And, and so, um, but the stories, like
often I would bring students over to

the hospital too sometimes, and I would
disappear, like literally for 40 minutes.

They'll say, well, where were you?

And I was like, well, I
just, Got the greatest story.

You just, if you go into a room and you
start talking to an elder and you just

hear the most amazing stories because, um,
the culture there is amazing storytelling.

Um, you know, once it was about the
last time that this person was in

the hospital was actually when she
was a young girl and it was during

the earthquake, the big earthquake.

And so, but it's a different way of doing
health assessment because Before I went

into the room, the patient was um, very
anxious and the nurses were having trouble

providing care.

And then I sat down and talked
with her and I figured out where

the anxiety was coming from.

She was sort of thinking
back to her last time.

It's a different hospital.

They actually built a new hospital,
but for her, all these things had

happened the last time she'd been
They call it the native hospital.

That's their name for it.

But, um, and so I don't know, it's
just, I don't know if that answers your

question, but it's a very different way
of, it's more of a narrative medicine

approach that I would take with, um,
my patients at the hospital where I

try to figure out the story as opposed
to like coming in with a, you know,

checklist of what are your symptoms?

You're not going to get very far.

If you approach health in that way,
um, or I've seen people approach

education where they have this list
of things they're going to go through

to educate as opposed to, um, sort of
integrating it into your daily care.

Yeah, it's been a gift
to work with the Colt.

I just, um, it's one of the, it's probably
the best hospital I've worked for, I

think, uh, as far as just the population.

And, um,

I don't know, it's just, it's
just been a real gift to work

there.

I think that is so amazing.

Um, I can, I can see why you are
wired the way that you are and

what draw you to all of this work.

Um, do you think that there is
something, what are some of your

observations in terms of, you know,
you talk about storytelling, right?

It's a big part of the culture, it's a
big part of the ability to tell these

amazing stories and, and have gathered
so many stories, but only we all have

lots of lived experience, but we don't,
at least in sort of the, the sort of

mainland, you know, Western culture,
you know, we don't think of these as

stories, we don't collect them, we, we
just sort of, it happened and that was

it, maybe it's more like the, you know,
you tell people at a bar, you know, like,

but, but, you know, But there are many
cultures where stories are treasured.

You collect them like you are,
you know, like, like people

collect certificates, you know.

Um, and I don't want to say,
it's not the vain way of saying,

hey, I just have a certificate.

It's just like, you really value them.

They are useful.

It can come in, in handy at some
point in your life, you know.

I think there is something so beautiful
about that, that we are almost kind

of, for some reason have missed the
boat on, you know, like I see a lot of

students, for example, going to school
and I'm talking even K 12 schools, right?

Um, where you had talked about, you know,
NVC being used in certain models, right?

In the more mainstream sort of
traditional school model, I see students,

including students coming, you know,
I'm sure coming to your classes,

where they go, I have an assignment.

Tell me what I need to do.

Tell me what the expectation is.

How do I get an A on this?

Right.

I'll do it.

Not only do I, when I do it, I'll do
a good job at following all of those

things, but the second that I submit
it to you, or hit the submit button,

whatever, you know, whether it's a
paper or technology, it doesn't matter.

The second I do that, I'm done.

Right.

I don't think about it ever again.

It's not part of the story that I keep.

In fact, I get to forget it.

Right.

Now I've done it, so you grade it, and
then it will exist as a some kind of

percentage in my grades, and that's it.

I think that's a, there's something there
that, that makes me feel really sad about

because that narrative, that accumulative
sort of narrative, that body of work,

um, is so incredibly powerful and useful.

Where, when I think about these very
fragmented, fragmented Pieces where

the person does it in almost like a
very short term, short memory game.

You just kind of do it and then you
just don't think about it anymore.

It's

almost like, um, to me, it
feels like a waste of time.

It feels like that time just got lost.

Because you didn't get much out of it.

It's sort of the what's
on the test phenomenon.

Yeah, right.

You study for a test.

At the end of the test, you just
kind of like, you just really go,

I did well on the test, but you
really just, even if someone asks you

that same thing again in like three
days, you'd be like, I have no idea.

I knew it three days ago, by the way.

I've had these as an, you know, as an
educator, I've had these, you know,

classes where I've, you know, I've been
like, I feel like you're, I'm on fire,

you know, I have these great stories
pulling out all these concepts and ideas.

And, you know, the students
are engaged and then.

Always at the end of the class,
somebody will say, so which,

what if that is on the test?

I'm just

like, oh

my gosh, you know, it's always kills me.

Yeah.

What do you think are some of the, it
seems like that you're very in tuned

with what students are doing these.

I mean, you talked earlier about sort
of going from, uh, you know, nursing has

changed, you know, you're talking about
team nursing and things that you weren't.

That you said, you know, that's not how
I was trained or how I practiced before.

Um,

and of course that probably means that,
you know, you also have to now change

in how you teach your students and new
skills, new ways of teaching and learning,

and then you had talked about certain, you
know, sort of, you know, need to, Figure

out how to take care of themselves and
dealing with burnouts and stuff like that.

If, you know, it's sort of like a
very like, you know, sky view level

looking at nursing education right now.

What are some of the, what do you
think some of the big, um, either

where some of the hurdles but also
some opportunities are in advancing?

You know, the field and making, I love
your vision of, Hey, they shouldn't

even have to be resilient because
it implies that something's wrong.

They have to just survive it.

But how do they naturally
just kind of thrive it because

it's just an enjoyable thing.

Well, by the way, I think that it's
probably correct me if I'm wrong, but

I think people, most people want to go
into nursing because they, they, they

can get joy out of helping other people.

That's a

common, yeah.

Right.

Or they've had some life experience
that has brought them close and

they've recognized all that.

How important

that would be to bring
it to another person.

Yeah.

You know?

Yeah.

That's such, these are such worthy, like,
root level, like, directions, you know?

So what happened and how do
we, like, what are some of the

opportunities now that you see?

Maybe team nursing is part of the thing?

I don't know.

I mean, I don't know enough about it.

Can you tell us more?

Well, for that, I'm hoping that, I
think the team structure happened

during, you know, The pandemic,
like it was a necessity because

you just didn't have the people.

So you, you know, my personal
philosophy is that the, you know,

that's not the model that's actually
going to be the best moving forward.

But sometimes you have to drop back
to these survival modes where the

emphasis might be safety, efficiency,
you know, you, you, and you, you

lose some of those other aspirations
during times of, you know, extreme.

Circumstances, but sometimes I think
on the admin side or the hospital side,

they see the cost savings of those now.

Right?

And so,

well, because you've cut some
corners, so there's some savings.

You have to realize that the corners
you cut, someone's paying for it.

There's a different cost somewhere.

And so there's always this, um, you
know, there's that side that they want,

you know, more nurses, cheaper nurses,
you know, there's, and there's been

less unionization of nurses compared
to the past where, you know, that those

sort of things are kept in balance.

So I think right now there's, you know,
and I'm not, I'm not in the sort of

Nurse Management Arena, but there's
definitely this sort of conflict

between, you know, staffing ratio.

There's been legislation trying
to regulate staffing ratios of

nursing and there's always been
lots of lobbyists that come out.

In many states, it hasn't been successful
convincing, you know, the consumer that

this is going to somehow make their care
worse because, you know, I don't think

they understand, um, That when you have
a nurse who has too many patients that

that's actually what is driving your
care, not necessarily that, you know,

they're sending in these arguments and
about, you know, this is decreasing

their access because it's You know,
the provider will only be able to take

care of this number of patients, but,
you know, in health care, it's hidden.

Quality is hidden, right?

You don't know.

Your surgeon might, you know,
be nice to chat with or, but you

really don't know the quality of
surgeon that he or she is, right?

And in the other areas,
Quality is not as hidden.

You know, if you buy a dress and
it falls apart in a week, like, you

know, that that was not very good.

You know, if you have poor
quality healthcare, you might

not know ever, or that might not.

You might not realize it for, for years.

It's too late.

Yeah.

And so anyway, I'm kind of got off
on tangent, but there is this sort

of things happen during pandemic
time that are emergency and you know,

there was legislation and things
that allowed for that to happen,

like changing some of the rules.

And now as we're starting to get back into
those, those rules are, they're changing.

We don't need those rules anymore.

Um, I think sometimes they're looking
at the cost difference, but I think

that students do have to be prepared
for, um, what they might see.

You know, are they going to
be asked to kind of function

in a more team like scenario?

And that's more where
you're task oriented.

So instead of having the care for
one patient, uh, which is kind of

somewhat of a safety nut, because you
have somebody who has eyes on them.

what's physical therapy doing, what's
speech doing, what are the docs

doing, what, you know, the nurses
usually has eyes on all of that.

Um, so there divide more in tasks.

So this person's doing medications,
this person's doing procedures.

Um, we're delegating
all this to CNA or LPN.

Um, Probably, it's more like the system
when I very, like 1994, you know, it

was myself, a new grad, I would have 10
patients, the LPN would have 10 patients

and really at the time, the LPN, although
I, you know, I, she, I was, she was

really in charge of me, if, if, to be
honest, because she had, you know, she'd

been in nursing for 40 years and, you
know, um, um, But as far as the licensing

agreements and things that they could do,
you were sort of not their supervisor,

but you were sort of the lead of the team.

So there was this kind of strange
dynamic there when, um, they were really

extremely, so I'm not dismissing the
value of LPNs because I learned a ton

and I wouldn't be the nurse I am today
without the LPNs that I worked with.

But back then, um, The
acuity was very different.

We had patients that don't
even stay overnight anymore.

So you'd basically out of those 10
patients, one or two would be sick and

the rest were sort of your standard
post op, um, patients that nowadays

go home, like you don't even see them.

And so when implementing some of
this team based, that's when it

becomes really stressful because
you have extremely sick patients.

Um, and you just, it's very stressful.

When you start being responsible for more
than say, I think, uh, in Peds anyway,

it's like four in the NICU, we have three.

Um, but on some of the adult floors, they
can see six to eight, maybe more patients.

So if you think about that in an
hour, they're supposed to touch

base with that patient every hour.

So if you have six to eight
in an hour, You're just

constantly running around, you
know, yeah, you can't, yeah.

Yeah.

So it's really, um, you, you know, it's,
Nursing, uh, nurses are costly, I suppose,

but it also costs more to close the unit.

So there's all these kind
of cost drivers there.

Um, but I think one of the bigger
things is to give nursing, new

nurses, a voice of when it's unsafe.

And so how do they, how
do they express that?

And, um, You know, what are the
rules and regulations around that?

Like, you can't abandon a patient.

If you show up and you get an assignment
that's unsafe, you can't leave

because that's abandoning a patient.

And many, many of the boards of nursing,
you can get disciplined for that.

So, so it's how do they document
that unsafe assignment without

having consequences to their license?

And how do they make change
within the system they're in?

Um, sort of in a productive way.

Um, so kind of focusing
on some of those tools.

By the way, coming sort of full
circle, I, I feel like that those

tools that we're talking about.

Uh, the kind of reflective storytelling
and conversational, you know, sort of

tools that you're preparing with your
students, nonviolent way of communicating

those things, ways to be able to, to,
to do things without judgment and not

blaming to, you know, in any specific
people or a person and just being able

to calmly go in and look at a situation.

Yeah.

Yeah.

Yeah.

And I can see like, as soon as you flip
it, when you're not attacking the person.

And you're saying, you know,
I'm feeling really scared.

You know, if you start off with
that, the manager is like, what?

You know, instead of you did this,
this, and this, I was like, I'm, I'm

putting me into this position.

I've

said that I'm, I'm scared.

And they're like, okay.

Their ears open.

Right.

When you,

But it does require that they also share
a little bit of their vulnerability.

Because when you're using any of
the storytelling or NBC, you, you,

you are a little bit vulnerable.

So that takes a little practice
to be open to that when, you know,

sometimes your first instinct is
to just You know, keep quiet and

practice is in fact, what's so healthy
though, you know, like in a, in the case

of you be then being able to do it with
you in a, in an education environment

in a class where, you know, they are
hopefully safe from themselves, from

you, from their, their colleagues so
that you can, they can practice that

because I think it is a skill, isn't it?

It's a skill that you
practice enough that.

You'd then be able to
use that in a situation.

And by the way, this is
kind of amazing to me.

Because people talk about

reflection in this, as this
very nebulous, abstract concept.

That it's like, if you've done it, or
done it well, or experienced it, you

know it, and you feel great about it.

And you learn from it.

And that's kind of it.

But if you haven't, you know, I
have no way to tell you what it is.

Um, it's like telling someone about
riding a bicycle or swimming or love,

you know, like, yeah, I don't know
how to describe it, but you actually

just kind of created a very solid,

um, Example of how that reflective
skill can really be used in a, in

a very productive practical way in
how do you confront situations with

this case, even with the actual skill
of doing the confrontation itself.

But just mentally, first of all,
how do you confront that situation

when you're like, I'm scared, I'm in
danger, I'm in, uh, you know, I, this

is not fair or this is not right?

Because it may not be in nursing, right?

Um,

I really feel like that there's a lot
that, well, I certainly have learned

a lot, but I think that a lot of our
listeners will learn from this in how,

for me, a very, a very advanced set
of, um, topics that you've discovered,

sort of one after the other, that
I really feel like that whether I'm

teaching in a STEM program or in a.

You know, in the arts or humanities, I
could borrow a lot of what you are saying,

um, and use it very positively for sort of
general, you know, education and pedagogy.

I really do.

I think that it's, you know,
you've created, you've lent us a

really beautiful insight to this.

Um, I especially love this thing that at
the end that you said, I don't even think

that you thought you, you, you, you did
it on like sort of like deliberately,

but I was like, wait, hold on a minute.

So all of those communication
and processing skills that you

have students do, which is in.

You know, the way that you teach
them how to reflect could be

used, in fact, to communicate
with someone to solve a problem.

So it's no longer this abstract, just,
you reflect and you feel great, and then

you now go home and get a better sleep.

It's more like, no,
literally, I'm in trouble.

I needed to go in and talk to
someone about something, and I'm

using, borrowing some of the skills
to go in and do that communication.

I think it's lovely.

That's my hope that they'll use it.

Well, Sharyl, I feel like
that, um, there's much more

that we can learn from you.

And I hope that, um, we
get to do that again soon.

Um, but today I think this is a
good, um, first chapter of Sharyl

and her wisdom from nursing.

Um, but really like, I think there's so
much to unpack, you know, your experience

with, um, You know, um, Native Alaskan,
especially now, you know, all of these

kind of, um, I mean, I haven't thought
about a culture that is, you know, based

on, that is so, has so much, plays so
much value on narrative, for example.

That's a, that's a, that's a, that
just opens up so many possibilities

in my mind, like, right away.

Um, so, we gotta talk more.

But, um, for today, we
will, we will pause for now.

Uh, hopefully we can, we
can talk more again soon.

And, uh, Sharyl, I, I
can't thank you enough.

Um, you've, uh, this is, this
is, this is incredible for

me as a learning experience.

Um, I, I appreciate you so much.

Thanks, Jeff.

It's been fun.

Thanks.

All right.

Take care.

Coming up next, we'll be chatting
with Kyle Hewson, Vice Chair and

Clinical Associate Professor in
the Doctorate in Physical Therapy

program at Stonybrook University.

Here's a quick preview.

So the idea that They put up a
PowerPoint that they did in their

first year with two or three people.

Even just to show them how advanced
they've become in some of their

presentations by the third year, you
know, they have this and that, and they're

just, their references are awesome.

And they're able to pull
in a video or something.

So just, and they feel so much more
comfortable because they say, Oh, I

was such a nervous person that first
time I had to get up 80, 80 students.

You know, so, so it's kind of neat.

You know, that.

See you next time!