Dr Nhi Nguyen holds many roles in the fields of Intensive Care and Clinical Leadership. Nhi is the Clinical Director of Intensive Care NSW Agency for Clinical Innovation, a Board Member for CICM, and the Clinical Lead for Redevelopment at Nepean Blue Mountains Local Health District, where she has recently supported the delivery of a $1 billion redevelopment of this Healthcare system!
Why did you choose a career in intensive care?
I thought I wanted to do intensive care. Then I embarked on an anaesthesia rotation, and got pregnant. A very senior consultant at the time, said to me, “Why would you go back to intensive care Nhi? You’re going to be a young mum. Anaesthesia will give you the life that you want.” And I thought, yeah, he's probably right. But I really missed ICU. I felt that I needed to be part of a profession that valued diversity and experience. And I think intensive care is very much that; we value physician thinking, we value the skill of anaesthesia, we value life experiences, because it helps you to develop your art of intensive care.
I still had this niggling interest in anaesthetics. But the bit that I enjoyed in anaesthesia was supporting the patients at induction, the bit in between was not what drove me. I realised, we see just such a small part of a patient's life in anaesthesia, where intensive care gives you a really rich tapestry.
Intensive care provides an opportunity for clarity. We're able to really harness information that is important for decision making and cut out noise. We have an ability to very quickly do that.
It's important to note, in describing why I chose Intensive Care, I didn't once mention ECMO or fancy machines. I did not talk about saving lives in a resuscitation world. That is exciting initially. But that's not what drives you. It’s not what sustains you.
You began your career as an Intensivist, and have since broadened your scope to managerial and leadership roles where you’ve overseen a $1 billion hospital redevelopment! How did you approach such a massive transition?
When I'm at my best, I'm a better listener than I am a talker. What this transition really taught me is that curiosity, and the acknowledgement that we cannot know it all, is so paramount. It's easy for me to say to an engineer “Look, actually, I don't understand that.” In medicine, we really struggle with saying we don't know. As trainees, it feels like a mark on you. In taking on these new roles, I had no problems doing that. It taught me to ask questions in a way that didn't put me on the defensive, and that didn't belittle my role or my value. I have become more confident of where I sit in the bigger picture.
You've worn many hats; from Intensivist to being a member of the CICM board and local health district, to the censor for the college. In what position do you feel you've done the most good and why?
My contribution in these roles is always anchored on my purpose. I did a Women in Leadership Course a few years ago, where we each wrote a purpose statement. That has really carried me and given me a framework about the work I do. My purpose statement is around the creation of environments - all my jobs or roles link back to being able to create an environment that can provide the best care for the community that we serve.
The components that provide the best care are actually how we look after our staff, how we make human connections and how we support each other. So that sort of ticks off my intensive care NSW Clinical Director role. I'm connecting everybody and making sure that the staff are well cared for. And to provide the best care, I'm also helping develop guidelines to standardise care and make sure it is delivered in a safe way.
The college role provides me an opportunity to ensure that there are training structures in place, so that we're able to train the best doctors in the most equitable way. They then contribute to the environment where we serve the community.
My role on the board of the hospital and my clinical redevelopment role are in the provision of a building structure that staff can work in and patients can be cared for.
In each of the roles I hold, I try to link it back to ‘how does this really contribute?’ It's going back to that sense of clarity, because you get pulled in so many different directions. You need to be able to go, ‘well actually does this fit my purpose?’ Your bucket is only so big.
What advice do you have for women of colour in Intensive Care Medicine?
It's a tough gig. I don't think we should mince words.
There's a piece of advice which I heard recently: no one should cry alone. You need a circle of people who you can pick up the phone at any time. Who acknowledge that how you’re feeling at that moment is legitimate, that it's okay. That it's not you, it's probably the system.
There is so much unconscious bias that exists out there. It's important for minority groups to be brave enough to call it out. It will not always be comfortable, or feel safe. But we need to have more of us talking about it.
Thinking about our language in health, about “fit”. This idea of “Are they going to be a good fit?” You start to unpack that a little bit and go and what does that actually mean? Do you want more of the same? People aren't comfortable with being challenged, but you have to get to a point where you can challenge respectfully.
I'm from a minority group, but I also consider myself to be really privileged. And I'm now really mindful of using that position in ways that empower those who don't have those opportunities, or are not in environments where they're brave enough to call bias out. But how do you empower people to be braver, to give them the words to get a feeling or an opinion forward without making the recipient defensive? Because that's human. If you feel like you've been attacked, you're going to go into defense mode. Most of the time it’s not intended, it does not come from a bad place. But whatever it is, regardless of the intent, that’s how it was felt and received.
We spend way too much time normalising behaviours. We make minority groups fit into the majority structure rather than the other way around. We do not consistently create systems that empower people to be the best they can be.
What has been a career highlight for you?
I think it was a privilege to be part of the COVID response. I think we did make a difference in connecting people and creating a sense of calm amongst it all. It really allowed me to have a lot of clarity about the value that I add to the system.
When we first started hearing about these patients who were coming home from Wuhan, clinicians were saying that they didn't know what to pay attention to, it was such chaos. We needed to connect people, and so intensive care started the first community of practice in NSW. And then the ministry took it on. And we then had 35 communities of practice. We became the conduit, and the interpreter of so much information out there. Again, it's that theme of intensive care and the way we think - that amongst the chaos, we provide clarity.
When I think back to that, my daily frustrations about the health system do not wear me down as much because I think well, actually, all these experiences you have and the information you're gathering will be used in some way in the future, and will influence the way that you approach things.
We still run these meetings, we're up to meeting number 67. Although this was originally for COVID, it has become a community of practice where you dial in if you have time, to know you're not alone, that you have a way to connect. Previously, it depended on who they knew in the “club”. But the Community of Practice allows them to say, “I saw you on the Community of Practice, Do you mind if we have five minutes to talk?”
Is imposter syndrome something you’ve experienced? If so, how do you manage it?
Absolutely, every single day. No matter what you say, all of us have a degree of it, in everything that we do. As a mum at school pick up, as a doctor in a unit. How I deal with it is: I acknowledge it.
As I've gotten older, and my experience is broader, I have less discomfort with saying I don't know. I think we need to give ourselves permission - you shouldn't shy away from not knowing. And maybe the decision is that I'm never going to be an expert in that. I don't have interest in it. Life and your ability to be hold information is so brief in so many ways that to develop angst about something you're never going to have interest in or never use, then why?
To me, imposter syndrome is being put into a position where you feel uncomfortable, because you're pretending to know something or be someone that you're not. I try to minimise the times where that imposter voice becomes too loud. I think you do that by ensuring that you're very clear about what your skill set is, and what your value is, and ensuring there is a close match.
And finally, throughout your career in all of these roles, you've seen quite a few generations of trainees. How do you think trainees have changed over the years? Is it for the better?
I actually don't think trainees are different. I think they're clear about what is needed. Twenty, forty, fifty-years ago, the needs of trainees were the same: they want to be in an environment that values them as individuals, that allows them to be the best clinician they can be, to learn, and to flourish.
From my systems role this is actually the goal. What systems do we have in place that make trainees the best person they can be? To empower them to provide the best care? You don't make well rounded trainees, who thrive to be consultants and have longevity in a career, if you don't provide them a tailored environment for their needs.
Every year we say to the trainees, how do you want to be rostered? And actually, the answer is going to be different for different people. But I'll tell you, it's not seven nights in a row. It's not asking people to work unreasonable, excessive hours and hold it like a badge of honour.
The needs of all trainees are not the same. We can't say we want a high performing team, and then force everyone to do exactly the same thing. We're all different, and we all perform in different ways. And then you have to balance that with equity and equality. That approach takes time and patience. And we all struggle with that in our often, busy lives. But there's a subconscious signal that we send, when this is the roster and you must fit into it.
Interview conducted by Dr Kerrianne Huynh and Dr Georgina Jenkins