National Nurses Week 2023: Education and Experience are Keys to Good Leadership, Chief Nursing Officer Kathleen Sanford Says

A 5-part series celebrating nurse leaders who have claimed their place as a strategic partner in their organization's leadership.

Editor’s note: Hospitals and health systems have seen a steady evolution of chief nursing officers taking a seat at the executive strategy table, guiding and participating in operations and policies. HealthLeaders is featuring five of those nurse executives during this special week to discuss their experience as a strategic partner in their organization’s leadership.

Part 1 of a 5-part series.

Learning has been a way of life for Kathleen Sanford, DBA, RN, FAAN, FACHE, executive vice president and chief nursing officer of CommonSpirit, one of the nation’s largest nonprofit healthcare systems with more than 1,000 care sites and 140 hospitals in 21 states.

Sanford, a contributor to the CNO Exchange Community*, built and honed her leadership skills with education—formal, informal, and continuing—and continues to learn something new nearly each day.

Sanford spoke to HealthLeaders about how a curious, innovative spirit helps prepare good leaders.

This transcript has been lightly edited for brevity and clarity.

Kathleen Sanford, DBA, RN, FAAN, FACHE, executive vice president and chief nursing officer, CommonSpirit. Photo courtesy of CommonSpirit.

HealthLeaders: When did you first become part of a health system’s operational leadership and what was that experience like for you?

Kathleen Sanford: I was selected as the chief nursing officer for Catholic Health Initiatives in late 2006 and I felt pretty prepared for the job. I'd had a variety of other leadership positions. I'd been in hospitals, I'd been in other settings and like most experienced CNOs, I’d been responsible for both the practice of nursing and operations, managing everything—inpatient nursing, home health, urgent care, admitting, registration, pharmacy—so the complexity in the system was not a big challenge to me.

I've heard people say it's a big challenge, but it really wasn't. I felt prepared for the things that you need to know as a system chief nurse, which are working through other people, partnering, teamwork, and understanding organizational politics. Those didn't bother me.

What I missed, and I didn't realize how much I would miss it when I moved to the system, was my community and state involvement with people like United Way, the YWCA, and local businesses. I still miss those sometimes, because there's an intimacy in a smaller system or in an individual university or community that you just don't have at a large national system.

The only thing that was new was the travel. I've been active in national organizations—AONE [now AONL], the Tri-Council,  AAN—so I was used to travel, but I wasn't used to the extensive travel necessary in such a large system. We are in nearly half the states.

HL: Nursing schools are adapting their curriculum to prepare nurse leaders to lead organizationally, but it hasn’t always been that way. How did you accumulate the skills to step into an operational leadership role?

Sanford: I love the word “accumulate,” because it really is true; we do accumulate so many variants, and educations all along our career, and I’m still accumulating from brilliant people and colleagues, and I'm always learning something new. But the way you accumulate them is pretty similar to everyone else and that’s in three different ways: formal education, continuing education, and of course, experience.

My formal education started at the Walter Reed Army Institute of Nursing, so I was fortunate to be, from the minute I entered college, in training to become an officer in the military. Leadership and management were just something that we learned about, so that was the beginning of my accumulation. But when I graduated as a new officer, I realized I hadn't accumulated enough because I was managing people who were older and more experienced than I was, so I went back and got a master's degree in human resources management.

When I left active duty, I thought I had the right education, but I realized that healthcare in the civilian world was more of a business than in the military world, so I went back and got an MBA. I talked to the CFO about the needs of nursing and decided that I wanted to back that up with an understanding of research, so I went back and got a doctorate so I would be able to speak the research language.

Nurses have a lot of initials after their names and that's often because we believe in formal education, but we also believe in continuing education. I've continued to learn from experienced managers, I’ve been active in organizations where you can learn a lot, such as AONL, Tri-Council for Nursing, ANA, and AAN, where you can get continuing education and keep up with what's happening in healthcare.

The biggest learning of all comes from experience. I discovered that even the things you learned in school don't always exactly work the way you’ve been told, so I have made mistakes along the way, and I try to learn from those mistakes. I try doing different things. For example, I took two years away from nursing leadership and worked for strategy, so that I could learn about that. I did project management for building a new clinic and a new hospital at one time. I served as a journal editor, and it’s amazing how much you learn when you’re an editor because as you read other people's articles you learn about what's going on in their organizations.

I discovered that you can learn more when you yourself are a writer. I accepted positions with HFMA [Healthcare Financial Management Association] and with The Business of Caring, which was a nursing journal, at the same time.  I wrote a column for HFMA to help finance leaders understand nursing and I wrote the column for the nursing journal to help the nurses understand finance.

So, there are a variety of things we can do to help us accumulate what we need to move into any leadership job. I’ve said several times that management is a specialty just as much as any other specialty, and those of us who practice  it need to accumulate that specialized knowledge, education, and experience and learn from them so that we can support everybody else.

HL: What do you, as CNO, uniquely bring to your organization’s leadership team?

Sanford: Nursing leadership is built on experiences and growth from one job after another.  We start close to the patients—the people that we serve. I think my experiences are similar to every nurse leader. I started as a staff nurse, then became a charge nurse, head nurse, nurse supervisor, CNO of a hospital, CNO of a small system, and now CNO of a large system. Each position offers a different way of looking at things at every single level in an organization.

You know what it feels like on the front lines, you know what it feels like at the executive table, and what it feels like in the middle. Those are not experiences that every executive has. I’ve had the experience of managing people who weren’t nurses; I've managed every type of clinician including physicians, and what that has taught me is that different professions can look at the exact same problem differently. This has taught me to be more open about trying to understand alternative viewpoints. I think it has made me more able to learn from others and to appreciate the different skill sets and experiences that can help us when we get to the executive table.

HL: Nurses tend to be creative and innovative. How has this served you as an operational leader?

Sanford: Because I am a nurse I have learned how to be part of innovative teams. It’s helped me understand and be willing to listen to others who may have ideas that seem a little far out. Having worked with other nurses and having to do “work arounds” in order to provide good care, I am able to understand that even when you don’t fully understand what someone else is talking about, you should listen because their innovations may be what we need. Our own experiences makes us—nurse leaders—open to listening to other people’s innovations and also enables us to think about doing things differently. It serves all of us well to be open to new ideas, to propose new things. At CommonSpirit, we’re doing virtual nursing and at one point I had something called a Private Practice Unit where I let nurses hire their own colleagues. You need to try different things to see what works best for your employees, your patients, your organizations and your communities.

Being creative helps in change management, too. If you’re innovative, you’re a little better at helping people adapt to change.

Innovation has also helped me personally. Years ago, a young pharmacist came to me and said, “Kathy, I really think that nursing and pharmacy should work together, and I want to do an outpatient infusion program with you.” We didn't have one in our community. He explained it to me, I said OK. Then we put a dyad together—a nurse and a pharmacist—and started the program.

Many years later, I went into that clinic as their patient to get a shot for osteoporosis. Nobody knew who I was. Nobody knew that I'd had the fun of starting the clinic, but I got the benefit of it as a patient. So, see? Innovation is not just what we're doing for other people; it helps us, too.

HL: How does CommonSpirit prepare its CNOs to be strategic partners within their own organization’s leadership team?

Sanford: I don’t believe that you should start teaching strategy at the chief nurse level. To help leaders  think strategically, you need to help them be strategic thinkers at every level of their career. We’re starting with our new grads. We have a one-year residency program and part of that program is to spend time helping those new nurses learn how to be innovative and how to think strategically. In addition, we have a number of classes on those subjects for experienced staff nurses.

Because of COVID, we have not had the formal education programs that we had previously. We’re currently planning to get back into more leadership education. We are considering how to educate all of our leaders together because leadership isn’t just about nursing. All managers need to be educated in the specialty of management. Everybody should know about how to  think strategically and understand strategy, whether they want to be the chief nurse or a top executive

The business is better off when we're all thinking of the organization’s mission and how it can best be fulfilled.

* The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at https://www.linkedin.com/company/healthleaders-exchange/. To inquire about attending a HealthLeaders Exchange, email us at exchange@healthleadersmedia.com.