Heather Watkins and Roxann Nammour

00:04 Good afternoon.

00:05 Hey.

00:06 Hey. I'm Roxie Namor. It is October 18, and we have been blessed with beautiful fall weather. We are recording this afternoon from Providence infusion in eastern Washington. And Heather and I have worked together for the last year and a half in the same building. I'm one of the mission managers. Heather, I'm going to toss the baton to you.

00:37 Thank you. Thanks, Roxie My name is Heather Watkins, and I am the clinical nutrition manager with Providence Infusion and pharmacy in eastern Washington, as well as Oregon. And Roxie mentioned the dates and our location. I'm 41 when we do this recording, and Roxie as she mentioned, is a colleague, but she's also a friend. And I'm very honored that you are willing to join me today for this.

01:17 Thanks, Heather. I would love to know how you came to Providence. What interested you in nutrition? Give us your story.

01:32 Sure. Yeah. I mean, I certainly didn't take a straight path to healthcare, to nutrition, to Providence. And so, yeah, in fact, my first degree is not in anything healthcare related. So when I went to college, as I think a lot of 18 or 19 year olds do, not really knowing exactly what I wanted to pursue. My mom had been a lifetime naval officer and then had gone into, once she retired after 20 years, had gone into recruiting for the local university in town. So within their office of admissions, and my dad was a pastor, and those were really the two ish career options that were, you know, we chatted about at home, and neither of those were really something I was personally passionate about. But at the time, I didn't really have a passion per se. I didn't know what it was anyway, so I went to Purdue and pursued organizational leadership. So it seemed like a good option for someone who just needed a degree to essentially, you know, enter the workforce after graduation. And I loved the coursework, loved the applied leadership skills that we learned throughout, you know, that degree. And then for about eight years, I worked various positions, you know, in the finance and business management realm. So I started out with a Fortune 500 company as a financial controller and then moved, actually went to work for Purdue University in various roles as. And my last was as a business manager. So really focused on budgets and HR and things where definitely managing things behind the scene, but not necessarily feeling as though I'm really doing the work of the organization I'm working for. The last role that I had before I pivoted from a career perspective was as the risk manager for a local health system in the town that I lived in in Indiana. And I wasn't super connected to the work itself that I was doing, but I really had not been exposed to healthcare before that. And I was really touched and inspired by the work that the healthcare system that I worked at. We called our employees healers. So I was really touched by the work that the healers were doing every day with people they'd never met and caring for them in such a loving and compassionate way. And, you know, it's interesting because there are moments in your life where you find yourself at a crossroads, and, you know, sometimes that's not because you've necessarily put yourself there, but that position. I was actually downsized. So my job was eliminated, and I found myself, you know, in a position where I had to think about what it was I wanted to do moving forward, and just knowing how I felt about where I had been in my career path. You know, I had always led teams since my very first position. Loved leadership, but never really thought found myself connecting to the work in a way that kept me inspired or engaged. So at the time, you know, I had a very young family, so I think our oldest was maybe four, and our youngest was 16 months. We had just bought a house. It wasn't really a great time to be thinking about not being dual income, but, you know, my husband and I chatted and just felt like it was the right time, you know, with Purdue still there in our hometown, to pursue other opportunities that potentially would be more fulfilling, but also just a better pathway for our family in general down the line. So I was very blessed at the time to have received a very generous severance package from the health system that I had worked for, and so really gave me an opportunity to have some time to discern my pathway. And I think that was October of 2009, and in January of 2010, I went back to Purdue to start a brand new degree program in some pathway towards a field in healthcare. I still didn't have it narrowed down as to what I wanted to do, but I started in pre pharmacy because the curriculum was so rigorous that if, you know, if I could get through that, I could discern later what pathway I really wanted to take. So went back to school with two little girls at home and with students who were a decade younger than myself. And I definitely felt like a fish out of water for a bit, but really found myself more engaged in college level coursework than I certainly had been the first time around, thank goodness. And, you know, pharmacy didn't end up being my pathway. I really hadn't even heard of dietetics, which seems so ridiculous at this point, when I think about that. But I'd never heard of a dietitian. Didn't know what they did. But I had some friends who had transferred out of pre pharmacy into dietetics, and I started talking to them and got more interested. And then I went to speak with the counselor within the nutrition science department and made the decision that that was the pathway I was going to take. And I absolutely fell in love with it. There's, you know, when you think about a dietitian, I think most people think about, you know, providing nutrition counseling for individuals who are struggling with some sort of, you know, disease or chronic condition like diabetes or, you know, heart disease. And while that's a super important pathway and definitely very necessary, it's not. I found that that was not what filled my bucket. But when I learned about alternative nutrition support and tube feeding and iv nutrition, which is TPN, and really how nutrition can be such an important part of individuals who aren't able to eat by mouth, really, you know, making. Providing those patients with better outcomes, particularly in the acute care setting. I was totally. I was totally sold. I was lucky enough to be accepted to Purdue's internship program, which was great, because the idea of having to move for a year to do an internship in another location with my family still in Indiana was not something I was really wanting to do, but completed that. And one of my first positions was in actually the same healthcare system that I had been the risk manager in before, and so was able to kind of come full circle, and I was the dietitian for the ICU there. So, again, you know, that's your population where you, you know, they don't eat by mouth because many of them are vented and sedated. And I just really, really loved that population and that work. Fast forward about a year and a half, and my parents, who I essentially have always lived in the same town with my parents, you know, again, we had a couple of little girls who loved being, you know, in the same town as their grandparents, and they moved to Spokane, which came as a little bit of a surprise, especially since family is so important to all of us. But my mom had gotten a job as the director of admissions at Eastern Washington University, and so, great opportunity for her. Totally supportive, you know. But after them being gone for about a year, it really became obvious that no matter how many friends we had in that area from all the years that we lived there, it didn't feel like home anymore because our family was gone. So we started looking for opportunities to move out to Spokane, which was ironic in and of itself, because for years, my husband Trent had suggested that we move west. You know, he and my father are avid fly fishermen, and pretty much every year, they would take an annual trip out to Yellowstone to fly fish. And every time he came back, you know, it was always the same. It was like, we really need to move out this way. And I was like, absolutely not. Like, I will never live west of the Mississippi. And I, you know, the last. Last words, right? So he sent me a job posting with a health system called Providence, and it was for a clinical nutrition supervisor with infusion and pharmacy. And I loved the sound of it. But truthfully, home infusion is such a different. It's so different than managing patients in the acute care setting. And I really did not know much about home infusion. And so, you know, I sort of said, yeah, I don't think I'm really qualified for the role. Sounds interesting. And I know it's all nutrition support, which is really exciting, and I would be able to lead a team, which I also love, but I don't think anything will happen with it, so. And he was like, well, it may not, but it certainly won't happen if you don't apply, right? So just go for it. So I did. I applied, and the next day, I got a ding letter from the HR system saying that, you know, they appreciated my application, but that they were going to go in another direction. And so I said to Trent, I was like, see? You know, like, I told you that I wasn't qualified for this position. And he was like, yeah, that's okay. Like, something will come along. So a month and a half later. So that had been March of 2016, May, beginning of May, I was sitting in my car waiting for my daughter, who was at club soccer tryouts, and I got a random phone call from a Seattle number. And I don't usually answer phone calls from numbers that I don't know. But I did answer this one, and it was a recruiter named Catalina who I had the privilege of working with for years after this phone call. And she was incredible. But I answered, and she introduced herself, and she said, you know, I have a couple of questions for you. She says, I see on your resume that you live in Indiana, and I know that you had applied for the clinical nutrition supervisor position with us. Do you know that this job is in Spokane, Washington? And I said, yes, I know it's in Spokane. We're actually trying to move that way. And she said, well, that's great, because I have another question for you. I don't know why that's making me emotional, but we've reposted the position, and we want to know if you would apply for it. Sorry. And it really was one of those, like, God things at that point, you know, we hadn't really found anything else that seemed like it was going to work for us. And so we had sort of resigned ourselves to the fact that, you know, we would. We would be staying in Indiana. So for the next hour, I had this amazing conversation with her, and I went home after that. And by the way, Claire made that soccer team, which she never played. I went home and applied, and the next week, I had a phone call with Jason, who was the director then and is still my director. And it went really well. And although I think it's incredibly unorthodox, offered me the position the next day without ever meeting me face to face. And, I mean, honestly, the rest is history. I moved out here with my family and started something that I knew nothing about, but I've honestly grown to love. So.

17:31 Yeah, but, like, as you're just talking, I just hear so many things about your personality that I know to be true. You were such a go getter. So when you talk about going back to school, it's not like you were thinking, oh, I'm just gonna take the easy route. You were like, no, I'm gonna do pre pharmacy, because I know it's the hardest one. It just. It just speaks to exactly who you are and how you've continued to just. I'm going to take that. I'm going to go as far as I can go. I'm going to challenge myself in every way possible to expose myself to everything, and then you bring that back to your team. Right. Like, that's just exactly who you are. And so you came to Spokane.

18:31 Yeah.

18:32 But at that time, there was not a Portland. There was not other places in Washington.

18:40 True.

18:41 How many people were. Was your team at that point?

18:45 Yeah.

18:45 Tell me how you grew it to where it is right now.

18:50 Yeah, it looked very different then. So at that time, the role truly was a nutrition supervisor. So I was leading the team, but also had a responsibility for a patient caseload of my own, which I appreciated because it really helped me understand and learn home infusion. Right. And I think it has been. The thing that has likely contributed to our growth over the years is because when I was able to develop a vision for what it could be based on what it was, and at the time, when I started, I had 1.8 dietitians, plus myself, plus one full time nutrition coordinator. And you're right, our team was located in Spokane, and that was it. And I think we had a patient census at that time of, oh, gosh, like 212. And today, obviously, we, I still have responsibilities in eastern Washington, but we've added a satellite location as part of that in the tri cities. So we do have a small office in Richland, Washington. I have four dieticians and one coordinator just there alone, managing all of, you know, southeastern Washington and northeastern Oregon. And then up here in Spokane, I believe we have eleven dietitians and soon to be four coordinators. And we're really covering essentially all of northeastern Washington, northern Idaho, and in parts of Montana. So it's grown a lot. The Oregon piece got added a couple of years ago as we looked to transition our nutrition services out from our HME business line into infusion and pharmacy so that we could align with where nutrition resides in the rest of our regions. And, you know, Jason, who is my director here in eastern Washington, is also the director in Oregon. And so I was asked by him and Christopher, our chief, if I would be willing to sort of take on that initiative as well. And so at this point, we have four dieticians and two nutrition coordinators. They're really working to build that business and relationships and, you know, grow the number of patients that we get to see every day there. So today in eastern Washington, I didn't mention this, but I think our patient census is around 1600 patients just for nutrition alone. Most of them are tube feeders. And, you know, I think when I started, our reputation wasn't great here in Spokane, to be quite frank with you. We couldn't even get our own Providence hospitals to refer to us. And so a lot of that first year was me really not only learning the business and taking care of my patients and taking care of my caregivers, but also really going out regularly to meet with other providers in the area to rebuild some relationships that, you know, had, yeah, fizzled over the years for various reasons. You know, I think even within, you know, infusion and pharmacy at the time, our team culture was very different, and we've been very intentional over the years about really driving a more positive, you know, team culture and really continuing to add caregivers, you know, when I. They're needed for growth purposes that are great humans. And I think we've done a really good job of that. And that's how you change a culture. That's how you continue to maintain relationships with your providers and the community. That's how you set yourself up for success when it comes to providing the best patient care possible. And it's been a really awesome journey to be on. And, I mean, a big part of why I've been here for over six years at this point, I mean, the title's changed. The number of people that, you know, number of caregivers that report to me has changed. I've had different regions layered on. But what's been amazing is we've been able to get to the point where there really aren't providers anymore that refer their patients anyplace else because they know we do it better and they know their patients are in really good hands. And, you know, my dietitians, the reason why we have so many is because they closely monitored their patients as they're coming on service and getting started with their nutrition therapy and making sure they're tolerating their tooth feeds and making sure they're meeting their caloric needs every day. And if they're not, what can we do to fix that? How can we ensure your success with the therapy that you're on and our for profit competitors? Number one, they don't employ dietitians because they essentially think of us as overhead. And because of that, their patients are always struggling. You know, there's so many patients who will call us and refer themselves to us because they've had really poor experiences and really poor outcomes, you know, just because no one was really, no one was keeping track of them, no one was asking them how they were doing. So what we do within the home infusion world is incredibly unique and special, and it makes me really proud that we take care of patients the way that we do. And it makes me really proud that my caregivers love what they do so much. You know, it's such an important part of when we're interviewing and getting to know them, we ask them questions that ensure we're bringing people on who align well with our mission and our values and that really have a heart for patients.

25:55 So I know you won't brag about yourself, but you are consistently nominated for values in action. And this team across all of homing community care was ranked second to none, which is our highest honor within homing community. But, I mean, a lot of that comes down to your leadership, Heather. And so tell me, tell me how you lead. How do you keep the culture, what it is so that people continue to feel inspired and connected?

26:39 Oh, yeah. I mean, I think. I think the most important piece, and maybe it doesn't even feel like leading, but I think the reason why we've been successful is because we really do get to know our caregivers. And I think we do a good job at trying to create pathways where we connect on a level beyond just, here's the work that we do. I think we're very intentional about, you know, social opportunities. Socializing outside of work after hours, creating opportunities even during the work day, you know, fun little events or food trucks or coffee carts, things like that, that, you know, naturally bring people together. And really, I think sending the message that they're important, that we value them, we care about them, they're our family. I talked earlier about how important interviews are and how important asking the right questions during interviews can be because you really do get an insight into someone's heart, I guess, if that makes sense. And that enables us to bring people on board that we know are going to be a great addition to our family. Right. And I think. I think the thing that, what I hear consistently from my caregivers in particular is that they know that I always have their back. They know that I'm always in their corner. They know that I support their continued development. They know that I know them had people mention before, like, she knows our spouse's names and our kids names and our dogs names. And it is true. But I think you know that I know that information about my friends, I know that information about my family. And I spend more time with my caregivers than I do with most anybody else. So it's just as important to have them be, be and feel seen and know that I love them, because I do. I really, I really do.

29:36 Think that's the thing that connects caregivers to you and, and why you consistently are ranked so highly. So tell me, what, what gives you life? What gives you meaning? What brings you joy in healthcare in these days that are filled with so much transition?

30:06 Yeah, I think, well, I always like a good puzzle, and as you mentioned, I like to take things head on and I like challenges. And there's honestly never been a single day in this role where there hasn't been some sort of puzzle to solve or challenge to meet, whether anybody's actually, you know, given me the challenge or not. I know it's there because I have a vision for where I want us to continue to be. And so I think that's what fills my bucket, that's what helps me lift my head off the pillow every morning. That's what provides me purpose and passion, is knowing that I really am going to be able to make a difference. Every day that I'm here. And the difference I'm making has evolved over these years. Like, I used to lay hands on patients, I used to be part of the actual clinical team, and that really filled my bucket. And every patient has different home circumstances, different support systems available to them, different disease states or conditions that you're contending with. And so you just feel so much number one privilege to be a part of that world, but then also so much joy when you're able to really help someone, you know, you've made a difference. And then now in the way of the role has shifted. I feel like I'm making a difference because, you know, we have a shared vision. We're, you know, I'm able to help bring people in to continue to grow that vision and able to support my caregivers in ways that I really wasn't when I was also taking care of patients. My focus is now pretty much solely on them. And it feels really good when I see how inspired they are and how engaged they are. And that's what makes me feel like I'm making a difference now is because I'm creating a pathway for them to be really fulfilled in the work that they're doing.

32:49 What about outside of these four walls?

32:53 Oh, gosh, yeah. My. My joy is my family. So in the same way that I'm really passionate about my work family, I'm just as, if not more passionate about my, my actual family. So my daughters are everything. So, you know, Sophia is a senior in high school this year. My, our youngest daughter Claire is a freshman this year. So it's this interesting dichotomy because we have all the lasts that we're experiencing, and we have all of the firsts that we're experiencing with a, you know, freshman and sophomore. But, you know, I'm. I'm their biggest fans, biggest supporters. Shopping buddy, you know, volleyball mom, you know, concert goer, all of the things. My husband is amazing, obviously a big supporter of me and my passions and my dreams from, from way back. And I wouldn't be where I am today without his, you know, his sacrifice of being the, you know, solo breadwinner there for many years. I went back to school and being, you know, the guy who had to do a lot of the, you know, traditional mom roles while I was doing, as you mentioned, very challenging coursework. So he really is an incredible, incredible guy. And then my parents, you know, I mentioned we moved to follow them. We didn't moved that far away. They live like half a mile from us at this point. So we spend a lot of time with them. We have lots of family dinners. We go on lots of, you know, combined family vacations together. I mentioned fly fishing, still very much a passion of my dad and my husband. And anytime there is a combined vacation is always going to include fly fishing, for sure. And we love to travel. And, you know, I look back at my famous last words of I will never live west of the Mississippi. And, you know, it's incredible to me what I thought I knew then with what I know now. And the Midwest, of course, has its charm. I know you know that, but.

35:47 You.

35:47 Can'T, you couldn't live in a more beautiful place than where we get to call home. And there's so many amazing places and national parks and Canada and, you know, that are the, just a really easy distance. So I feel really grateful and blessed that this crazy pathway that, I mean, honestly, I shouldn't even be here. There's no reason why with all of these things, you know, that this should have been my path. But I'm so grateful that this is where I, this is where we landed and that I love what I get to do and that I love the health system that I work for and I have a great place to nature's playground to spend time with my family.

36:47 If you had to give advice to someone starting, what would it be?

36:58 I think particularly within the home infusion realm, and it's probably true for any new job, to be honest with you, you have to give yourself grace. I think so many roles within healthcare anymore are really complex. And even if you've had experience someplace else, it's not necessarily going to prepare you well for, you know, a new place. We all tend to have different electronic medical records. We all, we have tend to have different policies and procedures, but particularly within home infusion, it's such a specialized type of medical care. You know, we don't, we don't really get individuals who come in and interview that we hire who ever had experience doing what we do here. And so we always tell individuals that they really need to have a lot of grace with themselves because, you know, to get fully up to speed.

38:10 It.

38:11 Takes about a year and there's lots of points in there where it feels insurmountable, like you're never going to learn all the things that you need to learn, but it does happen. And when it comes together, it's like this amazing, it's this amazing thing because, you know, people have this sense of pride in what they've accomplished and it is a big accomplishment so my number one piece of advice to anyone starting out is be sure that you have, you're prepared to give yourself a lot of grace, because we are going to give a lot of grace, as well.

38:56 How true that is, for sure. Are there things you want to touch on or share before we close?

39:10 No, I don't think so. I think, you know, it's a real privilege to be able to share my story, share my pathway to getting here. And it was a real, like I said before, honor that you were willing to be my conversation partner in this. I'm really grateful for you, Roxie in so many ways. And I just think you are someone who I admire greatly at Providence, for sure, but just as a human in general. And I'm really grateful for this time we've spent together. Thank you.

39:54 Well, thank you. Thanks for being vulnerable and sharing your story and being a courageous leader and being someone I admire and look up to and, yeah, I'm just grateful for this time.