The chief nurse executive for Emory Healthcare and 2023 recipient of AONL's prestigious Lifetime Achievement Award shares the strategies behind nursing leadership.
Editor's note: This conversation is a transcript from an episode of the HealthLeaders Podcast. Audio of the full interview can be found here and below.
Sharon Pappas, PhD, RN, NEA-BC, FAAN, is the chief nurse executive at Emory Healthcare in Atlanta, and the 2023 recipient of the prestigious Lifetime Achievement Award given by the American Organization for Nursing Leadership (AONL).
The award honors an AONL member recognized by the nursing community as a significant leader in the nursing profession and has served AONL in a significant leadership capacity. Pappas, who leads the nursing workforce of more than 8,000 nurses across Emory's 11 hospitals and more than 250 clinic locations, is a significant leader, indeed.
She serves as a faculty member for Emory’s Nell Hodgson Woodruff School of Nursing, has authored multiple publications on subjects such as improving patient safety, nurse engagement, building leaders, and enhancing nurse influence, and she is a fellow of the American Academy of Nursing and past chair of its Expert Panel on Building Health System Excellence.
In a recent podcast interview, Pappas shares how chief nurses are finally becoming full strategic and influential partners in their organizations after decades of not being recognized as part of a hospital’s executive organizational team.
This transcript has been edited for clarity and brevity.
HealthLeaders: Chief nurses are finally becoming full strategic partners in their organizations after decades of not being recognized as part of a hospital’s executive organizational team. How did this evolve?
Sharon Pappas: When I first became a chief nurse, I would think, 'you are the only person at this executive table that's a nurse' and 'you're the only one who knows nursing broad and deep and you will have that as part of your responsibility.' Healthcare is a business of patients, and nurses are the largest part of a healthcare systems workforce and who the patient sees more than any other individual. I see nursing as an important element in my organization's success.
I want my organization to be successful because of nursing. In other words, I want nursing to contribute to the success of the organization, not be something that was difficult for the organization. To do that, you have to understand there's interactive elements to achieve success – a nurse engagement element, a financial element, a safety element, a consumer experience element, and a quality element. When you think about nursing in that way, you realize that for all of those outcomes, they're very important foundational elements that create those outcomes. [For] example, things like relational leading, low nursing turnover, a highly educated nursing workforce, a highly credentialed nursing workforce, a nursing workforce who absolutely loves nursing, those were all the pieces that I felt a strong accountability for as being part of that organization success. [This] made me a strategic partner that was able to contribute at that table because I was a nurse and my accountabilities were focused around the organization and how nursing practice contributes in order to achieve all the other outcomes.
HL: You first became a CNO in 1997; how would you compare the general experience of being a nurse executive leader then to being a nurse executive leader now, in terms of organizational influence?
Pappas: Maybe this is a biased response, but I think things were easier to figure out in 1997. Some people might disagree with that, but there's always been a nursing shortage and a staffing crisis across my entire career. We always kind of accepted it as cyclical and knew that there would be certain political or cultural situations that would occur that would either take nurses out of hospitals or bring them back to hospitals.
I think the situation we're in being a nurse executive leader now is very different. We have fewer solutions, and because of that, more organizational leaders are realizing that, 'wow, this is not going to be something that's easy to figure out. I really need to lean on my nurse executives on the team in order to be the person who has the broadest knowledge about what might work and what might set us on a different course.' And so, I think that's where a lot of that influence comes [from].
I've always used that executive platform to help other people view a nursing contribution, and that when you begin to talk in financial and quality terms in the same sentences—I think our value based reimbursement has teed up our ability to do that in a stronger way—it really does raise your ability to influence, because people around the table don't just think of nursing in terms of great patient experience and high quality, because those two things also impact your net revenue by avoiding costs associated with poor quality. All of those things have to occur together, and I think that raised our ability to talk about how we influence.
HL: What nonclinical skills do chief nurses need to be strategic, influential partners within their own organization’s leadership team?
Pappas: One of the strategic elements is our relational leader skills. The reason that I say that is, if you think about our healthcare world today and its level of complexity, it is not something that can be managed as we [did] back in the industrial age: where you had a few decision makers at the top who made all the decisions, and then handed them to people to implement. Problems that call for changes in attitudes, behaviors, beliefs, requires new learning, innovation, and patterns of behavior. That's complex and that's where we are today. Enter your relational leader skills. That is really about creating platforms as a leader where you can interact and learn from the people on the front line, which then tells you what your strategic direction should be. In that way, you have the ability to enable knowledge, you're able to develop people, you're able to help them be more adaptable, and how to innovate.
HL: Are there ways that health systems and hospitals can prepare for their CNOs to be strategic influential partners, as well as nurses on the leadership team lower down?
Pappas: The good news about relational leader skills is that you recognize them as authentic leadership, servant leadership; all of those kinds of monikers are all relational leader skills. The additional good news is all of those skills can be developed. We have done a few things here at Emory Healthcare [where we] placed that content in our frontline leader development program helping people know how to be relational leaders. In addition to that, CNOs, themselves have developed those skills.
There's a lot of thinking out there that to be a chief executive, you have to go to business school. Well, that's fine, if that's what you want to do. But I would always ask yourself, why do you want to go to business school? If it's to gain leadership ability, fine, but if it's to understand the budget, that's the wrong reason. The financial skills can be acquired within your job using the systems that the organization uses. But those relational leadership skills are the ones that I find are most important strategically, in order to be able to move an organization forward and have it filled with people who love what they do.
HL: You have expanded your influence so much during your career that you’ve been honored with the Lifetime Achievement Award by the American Organization of Nurse Leaders. How would you advise other nurse executives to expand their influence?
Pappas: I would say that they can lean in to those executive tables and always be there with the understanding of what happens at the place where the service of the hospital is delivered. That information and knowledge is so critical to how an organization might move forward.
I would also say, remember how important that leadership is throughout the organization, and to think about the fact that there are many people who are looking to you to figure out how to be a leader. Always leave yourself open to the relationships that present themselves along the way. Make sure staff can contact you by email, make sure you're visible, make sure that you have system professional practice councils that you regularly attend, so that you can understand what matters to the nurses who are caring for patients.
The final thing I would say is always be able to articulate nursing value as one of your contributions. Don't just accept the fact that your staff may want to tell you about the changes they've made on some of their quality measures at the unit level, make sure they also tell you the financial impact that those quality changes have made, because that's where you really begin to understand that nurses are a critical element of any healthcare system's performance. They're the surveillance system of a hospital, they're the care coordination role of any kind. All of these roles are just so important and the CNO and other leaders at other levels should be able to articulate that.
HL: What has been your experience leading as a woman nurse leader and do you have advice for others who aspire to follow in your footsteps?
Pappas: It's really important, as a leader, to always be yourself. Be trustworthy. Be humble. As a nurse, you're leading the most ethical and trusted profession. You really should think about that. The other thing is to always remember that when you get stuck as a leader, and maybe you think, 'Oh, I'm the leader, I'm supposed to know what to do.,' that's not necessarily true in a complex organization, because you are not the source of the answer. Always remember that at the point where care is delivered, and at the point where you find patients and clinicians and nurses and doctors, that's where you get your answers. Don't ever hesitate or be afraid to go out there to look for them. It really plays a very important role in clearing your mind and setting the course of things that need to happen next.
Melanie Blackman and Carol Davis are contributing editors for HealthLeaders, an HCPro brand.