Nursing the System

I just got back from California, where I spent a few weeks on sabbatical that culminated in my Grandma Marge's 90th birthday celebration—what she lovingly called her "dead or alive party." She said she wanted to be present for her own memorial service, and she deserved to hear all the nice things people had to say about her while she was still here to enjoy them.

This episode is a tribute to her. I share the story I told (through tears) at that party—about the summer I wrote a musical at nine years old, and how my grandma's particular brand of loving accountability gave me the courage to actually pull it off. And I connect it back to the question I sat with in that 89-degree barn in Lincoln, California: what does it look like to give nurses and nurse leaders that same kind of support? The kind that pushes you, holds you accountable, and doesn't rescue you.

• The story of my grandma's "dead or alive party" and the legacy she's built without ever holding a formal title
• The full Grandma Camp: The Musical origin story (writing it at nine, performing it with my cousins, having a pianist friend record the accompaniment)
• What loving accountability actually looks like in practice—and why it's the most underrated form of support
• How a single moment of being held capable by someone who believed in you can shape decades of your professional life
• How NLHQ is structured to provide that same kind of support to nurse leaders

• Influence doesn't require formal authority—my grandma built decades of impact without a title
• The most powerful kind of support is the kind that gives you just enough to stretch, then steps back so you can do the rest yourself
• Loving accountability means showing up steady, believing in someone, AND not rescuing them when the hard moment comes
• Every hard professional conversation I have now feels small compared to the one I had at nine, asking my cousins to be in my musical
• People don't grow the way they're capable of growing without scaffolding, community, and someone in their corner
• If you have someone like that in your life—a grandparent, a mentor, a friend—tell them what they've meant to you while you still can

This one's different. There's no framework, no five-step process. Just a story and a question I want you to sit with: who was the person in your life who held you capable? And who are you being that person for now?

Applications to Nurse Leader HQ open today, June 29th. If you want someone in your corner who will believe in you, push you, hold you accountable, AND not rescue you, that's what NLHQ is built to be.

A few clarifying notes I've been getting questions about:

• You don't have to be a formal nurse leader. If you're leading formally OR informally, NLHQ is for you.
• Works in academia? Yes.
• Run your own business? Yes.
• Project manager without direct reports? Yes—if you're doing systems change work, this is for you.
• Anyone who applies will have a conversation with me first to make sure it's a good fit.
• If you want to talk things through with me before committing, filling out an application is the best next step.

👉 Resources Mentioned

• Nurse Leader HQ application (open today)
• Changemaker Essentials
• Instagram: @nursing.the.system

A huge passion of mine is giving nurse leaders a map of what strong leadership actually looks like across all the dimensions that matter—because that map isn't something most of us are given by our organizations, our bosses, or our grad schools.

As I've been designing the Nurse Leader HQ curriculum hub for the new cohort joining later this month, I had to actually put those dimensions on paper. Which gave me the idea for this episode: a reflection and self-assessment tool, walking you through the seven dimensions of a strong leadership practice and 22 questions to sit with.

This is not a teaching episode. There are no right answers. Your only job for the next 20 minutes is to be honest with yourself and resist the urge to skip the uncomfortable questions—those are usually the most useful.

• The seven dimensions of a strong systems-thinking leadership practice
• 22 self-assessment questions to evaluate where your practice is strong and where there's room to grow
• Why discomfort with a particular question is usually the most useful signal
• How to use this reflection as a starting point for deciding where to focus your development

• A strong leadership practice is not a single skill—it's a set of dimensions, each of which can be developed deliberately
• The questions that bring up tension are the ones to sit with longest
• Self-awareness is not the same as having a structured practice; you need both
• This is not a test, it's a map—a way to see where you have strengths to leverage and gaps to work on

The next Nurse Leader HQ cohort is welcoming new members later this month, with applications open now. If you're working through an application this week, bring your insights from this self-assessment into our conversation before you join—we can talk through how to tackle the dimensions you want to grow in.

NLHQ is the six-month, high-touch fellowship for Change Maker Essentials grads who are actively leading teams. Monthly 1:1 calls with me, biweekly group calls, workshops, and ongoing support. I get to know your team, your boss, and your real projects—and you get a peer group of nurse leaders working on the same challenges.

If you haven't taken Change Maker Essentials yet, you can't join NLHQ this round—but you can still join the waitlist to get info for future cohorts. Link in the show notes.

• Change Maker Essentials
• Nurse Leader HQ (waitlist)
• Instagram: @nursing.the.system

You put in all the effort to design a change project. You launch it, you train the team, you celebrate. And then a few months later, you look back and realize nobody's doing it anymore. The momentum quietly died, and now you're back at square one.

This episode is about that exact problem—and what I actually do about it on my team at work. I'll walk you through my "Teddy and Judy" framing (visionaries vs. executors), why most sustainment failures are not actually people failures, and the concrete system I built with my team for Q2 of this year—which I lovingly themed "The Sea of Sustainment." You'll get the four-question monitoring plan and the three-tier triage system I use to keep change initiatives alive once the launch buzz fades.

If you're someone who's great at getting the plane off the ground but loses interest once it's airborne, this one's for you.

• Why most change projects don't fail at launch—they fail in the months after
• The Teddy/Judy framework (visionary vs. executor) and why you probably need to be both
• Why "people didn't follow through" is almost never the real explanation
• The four questions every change initiative needs answered before you call it complete
• How to distribute monitoring responsibility across a team without creating surveillance culture
• How to triage findings into three tiers—and why this distinction is everything for team trust
• Why the #1 instinct in healthcare ("they need more training") is usually the wrong answer

• Maintenance is cheap, remediation is expensive—but maintenance requires a system, not good intentions
• The real failure point of most change projects is the absence of any system designed to catch backsliding early
• People are always going to people; you have to plan for that
• Track behaviors, not just outcomes—behaviors are the leading indicator
• Cadence should earn its way down based on team performance, not just time
• When multiple people make the same mistake, the first assumption is not multiple people failing—it's that something about the system, training, or tool is broken
• Teams take their cues about what matters from what their leader pays attention to
• A triage system that treats widespread errors as individual failures will destroy trust; one that treats them as system signals builds psychological safety AND better diagnoses

This episode is the part two to the holding period episode from a few weeks back. The holding period was about being deliberate before saying yes; this is about being deliberate after saying yes—long-term.

If you've taken Change Maker Essentials and want structured support sustaining the leadership practice you built there, Nurse Leader HQ opens for enrollment at the end of June. The waitlist is where the application dates, the opportunity to book a discovery call, and all the details will be shared first.

• Change Maker Essentials
• Nurse Leader HQ (waitlist)
• Instagram: @nursing.the.system

This is my first-ever TV show case study episode, and it's one I've been sitting on for three years. After watching the pilot of The Bear on FX back in 2022 (the first episode is literally called "System"), I knew it was going to become content, I just wasn't ready. So I put it in the idea parking lot we talked about a few episodes ago, and waited.

This past weekend, a horrific stomach flu finally gave me the bandwidth to sit down and watch the entirety of Season 1 with my notes app open. What you're getting today is the result: 11 vignettes from the show, each one mapped to a specific leadership principle I teach in Map Your Impact, Changemaker Essentials, and Nurse Leader HQ.

You don't need to have seen the show to get value from this episode. I set up each scene before I analyze it. But by the end, you'll probably want to watch it. It really is a complete leadership case study packed into eight 25-minute episodes.

• Why formal authority is only the starting line—and what happens when you mistake it for the whole game
• How the workarounds we don't have time to fix end up being the most expensive thing on our plates
• How to bring people into a decision without asking their permission
• Why resistance is information—and the surface issue is almost never the actual issue
• How to refuse the false binaries the workplace hands you (team player or troublemaker, comply or resist)
• Why usefulness is the currency that authority cannot buy
• How language shifts are a lagging indicator of real culture change
• Why you cannot culture-train your way out of a structurally broken environment
• What it actually means to hold a line as a team member, regardless of where you sit in the hierarchy

• Authority + social power are not the same thing—formal authority is only a piece
• The workaround that becomes the workflow is never free of charge; it's costing you in smaller increments you've stopped noticing
• Bringing people into your decisions is basic respect for the ones who have to execute and live with them
• You have to hold the logic of the change AND the emotional reality of the person it's landing on—simultaneously, not sequentially
• People don't follow you because you're the formal leader; they follow you because you made their workday easier
• Sometimes the bold systems-change move isn't innovation—it's reinstating the clarity that got eroded somewhere along the way
• Psychological safety is not a policy, it's a moment—demonstrated by receiving hard feedback without flinching and responding with honesty of your own
• Unprocessed stress is not a private personal problem; it moves through your team whether you intend it to or not

If you've seen Season 1 of The Bear, treat this as a rewatch companion—pause where the scenes resonate with your own work. If you haven't seen it, listen anyway (each vignette gets full context), and then go watch it. Either way, look for the moments that map directly to your own leadership reality right now.

If you want to build your own leadership practice and avoid the pitfalls you just heard mapped out on Carmy and Sydney, Nurse Leader HQ applications for the next cohort open at the end of June. Heads up—this is going to be a quieter enrollment opening, so I won't be loud about it on Instagram. Make sure you're on the waitlist so you don't miss the details.

• Season 1 of The Bear (FX)
• Map Your Impact (mini course)
• Change Maker Essentials
• Nurse Leader HQ (waitlist)
• Instagram: @nursing.the.system

This one's a crossover. If you're on the System Sunday email list, it might sound familiar, I adapted this week's email into podcast form because I want podcast-only listeners to know there's a whole other arm of insights going out by email each week (and to be honest, this topic was just too relatable not to share).

With my California sabbatical 10 days out, I've been grinding through a massive May to-do list—and a few nights ago I caught myself in a classic trap: crossing off all the easy, low-consequence stuff while avoiding the heavy, high-consequence things that actually matter. So I ran my own list through a filter I use with clients. This episode is me walking you through that audit in real time, with my own messy examples, so you can do it too.

• The single filter question that cuts through to-do list overwhelm
• How to sort tasks into high, moderate, and low consequence buckets
• How to spot a low-consequence task "dressed up" as high-consequence (and the reverse)
• Why we instinctively reach for low-hanging fruit when we're overloaded
• How a skill you've mastered in one context (like work) has to be relearned in another (like life admin)
• Why "high consequence" includes positive consequences—the big levers, not just the emergencies
• The three questions to run your own list through this week

• When you're overloaded, you stop moving strategically and start moving emotionally—reaching for what feels good to cross off, not what matters
• We build lists, structures, and frameworks so we don't have to run our strategic brain 24/7—but if the system itself is skewed, your intuitive brain won't catch it
• High-consequence tasks feel heavier, so we avoid them—even when we know the payoff is huge
• High consequence isn't just "the IRS is coming"—it's also the big lever that unlocks ease and impact when you finally pull it
• Dread is data: if your list inspires dread, your prioritization system isn't matching your reality
• Leadership isn't about being perfect; it's about staying continuously curious about where you can improve
• The skill is holding both the big strategic questions and the Tuesday-afternoon ones—zooming in and out and adjusting your focal depth

• System Sunday email list
• Changemaker Essentials
• Nurse Leader HQ (waitlist)
• Instagram: @nursing.the.system

My default move is never to hand you a list of everything wrong with your organization—not because I think it's fine (I know it's not), but because I want to push you past the complaint and into the question: where do I actually have leverage?

But today we're shifting the lens. This episode is for the nurse or nurse leader who has already done that work—who's already been asking "where's my agency here?" and genuinely trying—and is now sitting with a harder question: should I keep putting my energy into this organization, or do I need to find one that's more fertile for change?

That question deserves a direct answer. So today I'm giving you a framework: the two things that have to be true for your effort to lead somewhere, plus a set of green flags and red flags to help you read your environment and decide whether to stay or go.

• The two conditions that must be true for your effort at work to actually go somewhere
• Why a personal vision is the filter that makes this whole decision possible
• Six green flags that signal your organization is fertile for change
• Eight red flags that signal an organization is structurally or culturally resistant to it
• Why landing in a resistant organization is not a personal failing
• The one strategic exception where staying in a "red flag" org still makes sense
• How an organization's type (startup, scale-up, established hospital) shapes its change time horizon

• Two things must be true for your effort to lead somewhere: you have a personal vision, and you're in an environment fertile for change
• "Fertile for change" doesn't mean perfect or innovative—it means there's enough openness that your effort can actually move something
• You don't need every green flag, but you do need some of them
• One red flag isn't a verdict; look across all of leadership, not just the person you report to
• Staying in a resistant org is sometimes the right strategic call—if you're deliberately extracting something (a paycheck through grad school, a skill, a line on your resume)
• If you're not extracting and not moving anything, staying is still a choice—and it has a cost
• Leaving a place that can't change isn't giving up; it's strategy

If you've done the work and still can't tell whether your org isn't ready or you just haven't found the right lever, spend a couple hours with Map Your Impact. You'll come out with a clear picture of what to try—then give it 90 days and watch whether the friction eases. That process is itself a useful diagnostic for the stay-or-go question.

If you've completed the Changemaker Essentials practicum and you lead people or projects, Nurse Leader HQ fellowship applications open at the end of June. Get on the waitlist so you don't miss it.

And if you're still working on your personal vision, Changemaker Essentials opens again in September—get on the waitlist.

• Do a real green-flag/red-flag audit of your current organization this week
• If you're stuck on the decision, start with Map Your Impact and give your plan 90 days
• DM me on Instagram and tell me where you landed—stay or go—and what tipped you
• Share this episode with a nurse or nurse leader who's been agonizing over whether to leave

• Map Your Impact (mini course)
• Changemaker Essentials (waitlist)
• Nurse Leader HQ (waitlist)
• Podcast episodes 14, 18, and 41 (personal vision)
• Instagram: @nursing.the.system

This one's a little different. Taylor (my right-hand at NTS) is putting me in the hot seat, running a Q&A pulled from Instagram submissions and a few of her own curveballs. I'm going in blind.

We get into a day in my life, what people get wrong about me, what moving abroad taught me, when I first realized I was a systems thinker, the things I'm still figuring out about running NTS while working full-time corporate, and a lot more. It's a little more personal, a little less curriculum—and if you've been around for a while, this is your chance to get to know me (and Taylor) a bit better.

This is Taylor's first episode where she has had to edit herself and being featured—if you liked the format, let us know and we'll do more Q&A episodes.

If you want to dig into Map Your Impact but aren't sure what's actually inside, there's a walkthrough video on the sales page where I break down the whole framework.

And if you're a nurse leader and your organization is looking for leadership development support, this is your reminder: NTS now works with health systems directly. If there's C-level buy-in at your org for nurse leadership development, let your leadership know we exist.

• DM us on Instagram with questions for the next Q&A episode
• If your hospital or health system could benefit from CME or NLHQ at scale, point your leadership our way
• Leave a review—it's still one of the best ways more nurses find this podcast

• Map Your Impact (mini course) - Podcasct Listeners get $10 off with code 'MYI10OFF'
• Changemaker Essentials
• Nurse Leader HQ
• Instagram: @nursing.the.system

This episode is not "Five Ways to Prep for Your Interview." It's about the relational and strategic dynamics that most people completely miss because they've been conditioned to think about interviews the wrong way.

The same mechanisms that have us sitting in bad dates and bad relationships are the same mechanisms that have us sitting in bad interviews and holding positions that aren't a good fit. So today, we're talking about how interviewing is like dating and what nurses and nurse leaders need to unlearn to actually find good fit on both sides of the table.

• Why most people walk into interviews with a fundamental power asymmetry in their heads—and why it produces the wrong behavior
• How nurses get socialized into being grateful for opportunities rather than selective about them
• Why "looking for the one" perfect job is the same flawed logic as looking for a soulmate
• Concrete strategies to move through interview nerves (without faking calm)
• What hiring managers need to do differently if they actually want to find good fit
• Why good job fit is a systems problem—and the interview is one of the earliest leverage points

• The interview is a mutual audition—you are also deciding whether this organization deserves your skills
• Nerves come from framing the problem; they shrink you into a smaller, less interesting version of yourself
• Silence is not the enemy in an interview—it's a signal of comfort and power in the dynamic
• People who run a checklist disqualify almost-right opportunities; people who stay curious end up in the right place
• You're not looking for the one perfect job; you're looking for the next right step
• If you gatekeep through intimidation as an interviewer, you select for people who are good at being intimidated—not people who are good at the job
• Your conditioning to "take what you're given" doesn't serve you, your team, or your patients

If you're in the middle of a job search, Interview with Intention is the practical companion to this episode. It's a weekend course that walks you through how to prep without sounding rehearsed, build your core four stories, approach negotiation, and walk away with a professional portfolio you can use for every interview after.

If you're a nurse leader doing the hiring, Nurse Leader HQ opens for enrollment this summer (end of June, early July). I'm currently developing a "How to Interview Effectively" training for the curriculum hub, so HQ members will have access to it on demand. Get on the waitlist to be the first to know when doors open.

• Interview with Intention
• Nurse Leader HQ Waitlist
• Change Maker Essentials
• Instagram: @nursing.the.system

This episode is a follow-up to last week's conversation on action bias—and it's one I think a lot of nurse leaders need to hear.

Today, I'm introducing a framework I've been using in my own work and with my nurse leader clients: the holding period. It's a structured pause between receiving an idea and committing to it—and it might be one of the most underrated leadership practices out there.

• Why action bias is trained into nurses—and why it becomes a liability in leadership
• The hidden cost of saying yes too fast (it's not just a full plate, it's a credibility problem)
• What the holding period actually is, and how it's different from avoidance or delay
• How to calibrate the length of your hold based on the stakes of the decision
• The three diagnostic questions to run every idea through during a hold
• How to communicate a hold to your team or your boss without undermining your authority

• Saying yes to everything is not responsiveness—it's reactivity dressed up as competence
• Most leaders are better at starting things than sustaining them, and the real value of any change is whether it lasted
• The strength of the pull you feel to commit is a signal, not a reason to skip discernment
• A holding period is bound by a return date—that's what separates it from delay
• Time alone doesn't do the work; what makes a hold substantive is what you do with the idea while it sits
• Your own ideas have to go through the same process as everyone else's—they are not exempt
• Being deliberate is not the same as being slow, and fast is not always better

Nurse Leader HQ opens for enrollment at the end of June. It's a high-touch program with a small cohort, biweekly group meetings, monthly 1:1 calls with me, weekly async check-ins, and daily Slack access for real-time leadership issues. It's only open to Changemaker Essentials graduates who are leading people or projects.

If you're earlier in this journey and haven't taken CME yet, Map Your Impact is the right starting point. It's the mini course that gets you thinking in systems and approaching your workday more strategically.

• Pick one idea sitting on your plate right now and put it through the three-question diagnostic
• Share this episode with a nurse leader who you know is drowning in commitments
• DM me on Instagram and tell me where action bias is showing up in your leadership
• If you're a CME grad, get on the Nurse Leader HQ waitlist
• If you haven't taken CME, check out Map Your Impact as your first step

• Map Your Impact (mini course)
• Changemaker Essentials
• Nurse Leader HQ (waitlist)

In this episode, I’m breaking down a trap I see all the time and one that most nurses don’t realize they’ve fallen into. We’re talking about the difference between seeing a systems problem and actually knowing how to work within it. Because those are not the same skill and confusing them can do more harm than good.

• The difference between “level one” and “level two” systems thinking
• Why recognizing patterns isn’t the same as understanding root causes
• How action bias in healthcare leads to ineffective system changes
• The iceberg model and how to use it in real-world scenarios
• Why your position in the system matters just as much as your idea

• Seeing a problem is not the same as understanding it
• Systems problems are always multi-factorial—there is never just one cause
• Action bias feels productive but often leads to shallow solutions
• Influence depends on your position, not just your insight
• Slowing down is not weakness—it’s strategy

As you listen, think about a current problem in your workplace. Notice where you might be operating at the “event level” versus digging into deeper patterns and root causes.

If you want to go deeper into this kind of thinking and actually apply it to your career, Map Your Impact is designed exactly for this. It walks you through how to understand your position in a system and build a strategic plan from there. Don't forget about the discount code, "MYI10OFF" to get $10 dollars off!

• Map Your Impact (mini course) - 'MYI10OFF' saves you $10!
• Instagram: @nursing.the.system