Tammy Locke on Care, Calling, and Servant Leadership

Amelia

Welcome to the show. I'm Amelia, I'm here with Tyrone Wigfall, and Tamalia. We wanted to interview Tamalia as a way to celebrate national nurses week. I need you to start with the intro because the first time I heard it, I said, hold on -- one person is doing ALL that?

Tammy

My name is Tami Lock. I am a hospice administrator. I'm somewhat of a unicorn. I am also a hospice chaplain, and I'm also an LVN/LPN. Along with that, I am a licensed assisted living manager, a senior care consultant, and the co-founder of Innovative School of Health.

Tyrone Wigfall

"Somewhat of a unicorn" is doing a lot of work there. That's not a job title, that's like... six lanes of traffic in one human being.

Amelia

Right! Because on paper, that sounds impressive, but it also sounds like a life that got built one very real moment at a time. So when you say hospice administrator, chaplain, LVN, assisted living manager -- what was actually happening way before the titles?

Tammy

Believe it or not, I have been taking care of the sick since I was about 12 years old. I had a brother who was a near-drowning victim, and he lived at home in a semi-coma for six months. He had a feeding tube. He had multiple seizures throughout the day. He had a tracheostomy. And so I learned very early about nursing, and it came naturally. It felt natural, like I was supposed to be there.

Tyrone Wigfall

A feeding tube, seizures, a tracheostomy -- that's not abstract caregiving. That's very technical, very intimate care, and you were what, 12? Thirteen? Did you always want to be a nurse?

Tammy

When people ask me this question, I mean... I think I always knew I wanted to be a nurse. I found a letter I wrote to myself in the third grade, and it said that when I grew up, I wanted to be a teacher and I wanted to help sick people and sing to old people. And I have to say that I've done all those things and will continue to do those things. It still makes me smile.

Amelia

"Help sick people and sing to old people" is maybe the sweetest mission statement I've heard on this show. But also -- third grade. That's not a midlife pivot. That's little-you already naming the work.

Tammy

Yes. And then my aunt was a registered nurse. She owned group homes. So as kids, we would go visit, and we were always around seniors. I grew up watching her administer medication and helping people and even sitting for those that were dying. And it all just felt natural like I was supposed to be there.

Tyrone Wigfall

I want to grab that phrase -- "group homes." Because that matters. You weren't seeing care in theory. You were walking into rooms where seniors actually lived, where medicine got passed, where dying wasn't hidden behind a curtain somewhere.

Tammy

Exactly. And so no matter how many different areas in nursing I've ever worked in, I've always been drawn to working with seniors. I have always had an affinity for seniors, for end of life, for just being there. I don't like saying death and dying like it's something dark. But I have always been drawn to that space.

Amelia

I actually appreciate that correction, because people hear "drawn to end of life" and they can make it weird fast. But what I'm hearing is: you were around the most honest parts of life really early. Illness. Aging. Dependence. Family. Fear. Love. All of it.

Tammy

That's it. People at their most unguarded. Families as well. What happens when plans meet people. What happens when somebody is scared. What happens when somebody is trying to hold on. That's where a lot of truth is.

Tyrone Wigfall

And I think that's why the "unicorn" thing isn't random. The administrator, the chaplain, the nurse, the consultant -- those all make sense if your whole life has been training you to see the person, the family, and the system at the same time.

Amelia

Yeah, because some people stumble into a profession, and then the profession changes them. But for you, it sounds like care had already been shaping you before nursing school ever had a chance to.

Tammy

I would agree with that. Nursing gave language and structure to something that was already there. Service was already there. Presence was already there. And so at this stage of my life, when I look back, I don't feel like I stumbled into it. I feel like I was being prepared for it, which honestly feels a little beautiful to say out loud.

Tyrone Wigfall

What has nursing taught you about people?

Tammy

What has nursing taught me about people? People are predictably unpredictable. That's what nursing has taught me. You can have all the plans, all the care plans, all the meetings, and people will still be people. Families will respond in ways you didn't expect. Patients will surprise you. Staff will surprise you. And so you have to leave room for humanity in the middle of the process.

Amelia

That is such a clean drag of all of us, honestly. Like, you can spreadsheet life all you want and then somebody's grief, ego, fear, denial, love -- whatever -- walks in and says, no, we're doing this MY way today.

Tammy

Exactly. People are not projects. And so I believe in servant leadership. That means that I'm going to serve no matter what. I don't care what race, creed, color, religion -- be nice to me, mean to me, do what you must -- but I'm going to serve and I'm going to do my best to care for you.

Tyrone Wigfall

See, that's where I want to push a little, because "servant leadership" gets turned into corporate wallpaper real quick. People throw it on a website, print it on a mug, and then underpay staff and ignore patients. So when you say it, what keeps it from becoming that kind of empty slogan?

Tammy

Presence. Consistency. Doing it when it's inconvenient. Doing it when nobody is clapping for you. Doing it with the patient who is sweet and doing it with the patient or family member who is angry. Doing it with your staff when they're tired and frustrated. I have been there and done that, so when I say servant leadership, I mean I am willing to serve from the trenches, not just talk about service.

Amelia

That "be nice to me, mean to me" part is what hit me. Because that's not romantic. That's boundaries plus commitment. That's you saying, I'm not here because this is easy or because everybody behaves well. I'm here because care is still the assignment.

Tammy

Yes. And a good nurse understands that, but a good nurse also knows they don't know everything. What does a good nurse look like to me? They look just like me. No, I'm just kidding. But a good nurse is someone that is eager to learn. A good nurse listens. A good nurse sharpens their observatory skills. A good nurse challenges him or herself. A good nurse does not think they're right all the time. A good nurse advocates for their patients as well as advocate for themselves sometimes.

Tyrone Wigfall

I want to grab "observatory skills" because that's a phrase people might glide past. You're talking about noticing the blanket grip, the pause before an answer, the family member who says "we're fine" and is absolutely NOT fine.

Tammy

That's right. Observation. Listening. What is being said and what is not being said. How does the room feel? Who is carrying the fear? Who has the questions but won't ask them? Nursing is not just tasks. It's an assessment, yes, but it is also human observation.

Amelia

And I love that you included "advocate for themselves sometimes," because people love the selfless-nurse fantasy until the nurse says, actually, this staffing is unsafe, this wage is unfair, this environment is not okay.

Tammy

That's just the facts. We all want more money. And people want to be valued and appreciated. A good nurse cannot pour from an empty place forever. And so yes, advocate for the patient, absolutely. But you also have to advocate for yourself.

Tyrone Wigfall

There's steel in that. Because the old lie is that caring people should accept anything. Like if you're truly called, you'll tolerate bad systems in silence. And I don't hear that from you at all.

Tammy

No. Service does not mean silence. It means responsibility. It means accountability. It means I'm going to care for people, and I'm also going to say when something is broken. Those things go together.

Amelia

Okay, let's go straight into hospice, because I think a lot of people hear that word and their whole body tightens up. They think it means giving up. They think it means a dark hallway and a whispered voice. So what do you wish people understood -- specifically -- about hospice?

Tammy

What I wish people understood about hospice is that it is not scary. Hospice is that support, that holistic support that we want to give that is available to those who need it, who are terminally ill. Some hospices will minimize it as if, you know, it's just, you know, you just get extra supplies. And no. You do get support. You get supplies. You get nurse visits. You get a hospice aide to come out and a whole gamut of services. However, this is end-of-life care. And so that means the person has a diagnosis that says this person is terminally ill. It is a noble profession. It is an honor to take care of people in this final stage. And you're not just taking care of them. You're taking care of their families as well.

Tyrone Wigfall

I want to sit on "whole gamut of services." Because "extra supplies" sounds like a delivery list. But what you just described is a coordinated support system -- nurse visits, hospice aides, family support, and medical oversight all tied together.

Tammy

Exactly. It is not one thing. It is coordinated care. It is education. It is symptom support. It is emotional support. It is practical support. It is the family calling because they are scared and they see changes in their loved one and they don't know what to do. And you're able to sit with them and talk them through. That's part of it.

Amelia

And that "the family calls because they are scared" piece matters, because sometimes people act like hospice is only about the patient in the bed. But the family is in it too. They're watching breathing change. They're second-guessing every decision. They're exhausted. They're grieving before the loss even happens.

Tammy

Yes. Families as well. That is why I say holistic support. This is not just a medication issue. This is not just a diagnosis issue. This is people walking through one of the hardest stages of life.

Tyrone Wigfall

And while people see the bedside moments, they don't necessarily see the labor under the hood. You said admissions are hard. Case management is tough. Regulatory standards don't disappear because the work is compassionate.

Tammy

They do not disappear. And so I'm not technically a hospice nurse. I mean, I guess I am, but I'm going to advocate for my hospice registered nurses. Those nurses work tirelessly. Admissions are hard. They take a lot of time. Case management is tough. Because we have to meet the regulatory standards, I see them work long hours just to make sure that all of the orders are in and all the medications are there and reconciling medications and coordinating with the medical director. So I'm going to advocate for them in that space.

Amelia

"Reconciling medications and coordinating with the medical director" -- that right there is the invisible work. The family may remember the kindness at the bedside, but behind that kindness is paperwork, orders, calls, checking, re-checking, making sure nothing gets missed.

Tammy

That's right. And families never realize all nurses do behind the scenes. We cry. We get frustrated. We so desperately want to help them and sometimes they don't realize to what extent. How tired we are. How we go home and sometimes while we're asleep we're dreaming about them. How we want to improve the working conditions so that they can get better care.

Tyrone Wigfall

Dreaming about them -- that's the line. Because that's the piece no chart captures. A chart can show a visit. It cannot show the nurse lying in bed replaying whether every medication, every order, every change got handled right.

Amelia

And that's why when people reduce hospice to "they came by with supplies," it almost insults the scale of what is being held. It's like saying a bridge is just some bolts. No, babe -- there is an entire structure keeping this thing from collapsing.

Tammy

That's what I'm going to say. There is an entire structure. And the rewarding part, at least I think, is just knowing that we're giving them dignity and a quality of life in that final stage. When the family says thank you, not that you're expecting it because that's what we do, but to know that you were part of that final memory for them... that matters.

Tyrone Wigfall

You have these huge values -- learning, presence, advocacy. But values usually get forged in moments. Not slogans, moments. Was there a moment where the way you practiced nursing changed permanently?

Tammy

There have been a couple. One of them was when I was a much newer nurse and my assessment skills were not as sharp. I had a patient that was declining. He was a senior. He was very confused. Back in those days, we restrained patients. We definitely overmedicated them. That was the practice back in the 90s. He was falling out of bed, and so we restrained him. He ended up coding. We coded him. He didn't make it.

Amelia

And you're new in this. So it's not just a loss -- it's a loss you're going to replay.

Tammy

Yes. I had to call the son and I told the son what had happened. The son came to the hospital and he grabbed me and he hugged me so tight and he said, "I know you did all you could." And that affected me deeply because as a new nurse, I asked myself, did you do all you could?

Tyrone Wigfall

That sentence -- "did you do all you could?" -- that's a brutal internal audit. Especially after the son's hug. Because externally he gave grace, but internally you're still doing the math.

Tammy

Exactly. And so from that point on, I really set myself on learning in a very meaningful way. I didn't have to go back to college to be forced to learn. Back in those days, we didn't have the Internet. So I subscribed to every journal I could possibly subscribe to. I never wanted to be that person who did not have information.

Amelia

"Every journal I could possibly subscribe to." That is not casual professional development. That's somebody making a promise to herself after a death she could not shake.

Tammy

It was a promise. And so when people ask what advice would I give a new nurse, I can give you a long synopsis, but I'm going to just say one word that was shared with me: learn. Learn all you can, just learn.

Tyrone Wigfall

I'm never going to forget that -- no Internet, every journal you could get your hands on. That's commitment with friction. You had to WANT it.

Tammy

I wanted it. I never wanted to be without information. And then another moment was back when AIDS was still something that people were afraid of. There was a particular patient that was dying. He had no family. He had sores all over him and everything. And I sat there with him as he passed and I held his hand. Those were some moments that changed me forever.

Amelia

No family. Just you holding his hand. That's the kind of moment that strips all performance out of care. There is no audience for that. No applause. Just whether somebody dies alone or not.

Tammy

That's right. And that is why, when we're talking about hospice or comfort, I say the gift of presence. You don't have to know the answers as to why they're dying. But are you there? Holding their hand, talking to them, just in that moment. I think that's the gift, is being present, listening to them.

Tyrone Wigfall

Let me try to say that back. You're not saying information doesn't matter, because clearly it matters -- every journal, every lesson, all of that. You're saying knowledge and presence are not enemies. The best care is both: know what you need to know, and then actually STAY with the human being.

Tammy

Yes. That is exactly it. Learn all you can. Know your craft. Sharpen your observation. But at the bedside, or in the home, or with the family, be there. The gift of presence matters. Sometimes more than having a perfect sentence.

Amelia

And I think that's what makes your voice feel so grounded. You're not talking about compassion like a soft aesthetic. You're talking about a practiced thing. A hard-earned thing. Sometimes built out of regret, and sometimes built out of sitting next to somebody the world already looked away from.

Tammy

Yes. And those moments stay with you. They should stay with you.

Amelia

So if those moments stay with you -- the losses, the families, the invisible labor, the dreaming about patients -- then we have to talk about burnout honestly. Not the cute social media version. The real one. What do you say to nurses who feel used up?

Tammy

Look, you got to take breaks. You got to go on vacation. Look, I know we got bills. I know we have life that's lifing us. But we have to take care of ourselves. Yes, we feel guilty when we're short-staffed. You know, there's the incentive bonuses. But none of that does any good if we make a mistake and hurt a patient, or we project how we're feeling on our families. Take a break. Just stop. And sometimes that just may not be the position for you anymore. And that's okay too. But you got to take care of yourself.

Tyrone Wigfall

I want to pause on "that just may not be the position for you anymore." Because some people hear that as failure, when really it sounds like discernment. Like, maybe the problem isn't that you're weak. Maybe the role has become unhealthy.

Tammy

Exactly. That is not failure. That's wisdom. At this point, if something is costing you your health, your peace, your family, your safety -- we have to be honest about that. I have a great support system. I have a wonderful family. My faith keeps me grounded. Prayer, my faith, remembering my why -- that's what keeps me going on hard days. Well... and maybe a little wine every once in a while. I'm just kidding, but I'm not kidding.

Amelia

Thank you for the HONEST answer, because sometimes people jump straight to "self-care" and skip the part where you're still human and tired. But the bigger thing I hear is you circling back to your why, and also not romanticizing suffering.

Tammy

No, not at all. Suffering does not make you more noble. It just makes you tired. And so appreciation matters. What does being appreciated as a nurse mean to me? It means that I'm being listened to. I'm being taken serious. I'm being heard. That my employer -- or me being the employer -- that I'm listening to my staff, that I'm providing a safe environment for them to work, for them to be successful. Paying a fair wage. We all want more money. That's just the facts. But people want to be valued and appreciated. People value honesty. What I have found out here is that we're not as honest as we could be, and if we were, we'd probably get some better outcomes.

Tyrone Wigfall

"It means I'm being listened to" is the part that should not be radical, but somehow still is. Not pizza. Not a balloon arch. Not a cute email blast. Listened to. Safe environment. Fair wage. Honesty.

Tammy

It means more than pizza. What Nurses Week means to me is a time for us to recognize and appreciate our nurses, to advocate for our nurses. But these are things we should be doing ongoing. Are we paying attention? Do you know your staff? Do you know their favorite color? Do you know things about their personal life when they talk to you? Just listening. Just letting them know that they really do matter.

Amelia

That "favorite color" line gets me because it's so specific. You're saying appreciation isn't generic. It's not "thanks, team." It's knowing the actual humans carrying the work. Who just lost somebody. Who's caring for a parent. Who drinks coffee, not tea. So, Tammy what do you prefer, coffee or tea?

Tammy

Coffee. Anyone knows me, it's going to be coffee. But I do like ginger tea. And music helps too. Listening to music and having me a cup of coffee, that's perfect. Right now I'm into the Bridgerton playlist. But again, that's small things. The larger thing is people want to be seen.

Tyrone Wigfall

And when you talk about nurses being seen, you don't only mean the glamorous units people love to celebrate.

Tammy

No. If I could say one thing to all nurses this week, what would it be? Thank you sincerely. Thank you for the tears, the time, the effort, the work. It is not easy. A lot of times we sit there and we celebrate the ones at the highest tier, those who are working in neuro ICU and CCU and all those. But I want to take an opportunity and thank those in med surg and thank those in the emergency department and thank those in long-term care and skilled and LTAC. That is hard work. I have been there and done that. Travel nurses, when you're going into environments that you're not even familiar with -- and believe it or not, nurses aren't always welcoming of the extra help that's coming -- so I want to thank all of you for your labor of love. Yes, we want to get paid what we're worth, but there's more that's driving us to do the work.

Amelia

Med surg. ER. Long-term care. Skilled. LTAC. Travel nurses walking into unfamiliar buildings. That's the list I want people to hear twice, because those are not side characters in healthcare. That's the infrastructure.

Amelia

So, Tammy what would you like to say about your team?

Tammy

I am so thankful. I am just so thankful to work with such a cohesive team. We're all a teachable group. We are all eager to learn. We don't do groupthink at the table. People can come with their ideas and bring their experience and their backgrounds, and it just makes us stronger.

Amelia

That is such a good note to land on because it sounds simple, but it isn't. A teachable group. No groupthink. Different backgrounds make the work stronger. That's not just good culture -- that's safer care.

Tammy

It is safer care. And so I am thankful. Very thankful. I'm almost done with this legacy. I'm going to leave as a nurse. That's what I'm going to say.

Tyrone Wigfall

And maybe that's the question hanging over all of this: if the work is a labor of love, if the people doing it are carrying tears, time, effort, regulation, family fear, all of it -- are we honoring them in a way that matches the weight they carry?

Amelia

Mm. Tammy, thank you sincerely for coming through and talking the way you talk -- real, grounded, no glitter where glitter doesn't belong.

Tammy

Thank you for inviting me to this interview. It means a lot, and I hope everyone enjoys it. Thank you.

Tyrone Wigfall

And to everybody listening... check on the people doing the caring. We'll leave it there.