Nurses' natural ability to look at challenges as puzzles to be solved benefits the broader healthcare team.
When nurse executives take a seat at a hospital or health system’s executive strategy table, they bring the whole of their training with them, or as nurse leader Maureen Sintich says, “There's a component of our nursing background that never goes away.”
HealthLeaders talked with Sintich, chief nurse executive (CNE) and executive vice president of Inova Healthcare System, and other nurse leaders about how the innate nursing traits of creativity and innovation have served them as an operational leader.
Their comments have been lightly edited for brevity and clarity.
Nurses are creative and innovative, and we often look at challenges as, in some cases, puzzles to be solved. Think about the delivery of care during the pandemic and the fact that nurses were changing their model of care almost on a daily basis as we were learning and trying different things.
Those same challenges apply to leadership, when we expand beyond nursing to think about the broader healthcare team and beyond the technical components of the care delivery model to thinking about, “How do we not only take care of patients and families but support each other and not lose sight of meaning and purpose?”
This goes back to my team and them managing me. I am only as good as my team. I don't have all the answers. I tap into that creativity, that innovation, because with the younger generation, they can think more out of the box than I can, and they can think of ways that can make a process more efficient in ways that I'm not able to.
So, I really depend on my new nurses and my other nurses, too, to look at things from a different viewpoint. I've been nursing for so long, and with someone new coming in, they have a fresh set of eyes and they can see from a different point of view.
I’ve learned from my younger nurses of ways to communicate differently on what works for them in their learning style or in their leadership style. I try to connect with the younger nurses to stay abreast of what is coming up. For example, for Nurses Week, we were thinking of doing the regular, basic stuff, but one of the new nurses said, “How about a TikTok video?”
Well, TikTok is in the news now and I don’t know how safe that is, but I suggested that I do a Facebook video or something to that nature. So, doing certain things with different ways of communication helps to get our message out to the younger generation.
Executive vice president and chief nursing officer, CommonSpirit, Chicago
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 make 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.
Nurses have to deal with complex and challenging situations and often the buck stops with us and to do that, we always have to be creative in finding solutions. You can always count on a nurse and nurse leader to figure it out and make it happen because there's nobody for them to turn to. Consequently, in my position, I avoid saying we can't do things, but always focus on how we can do it.
And so, I often like to, “go outside of the box” and look at new and creative solutions and to do that, sometimes I say to myself and to my leaders, “Let's start with a blank piece of paper, and design what we think is the best and a new and innovative approach.” This helps me and others avoid assuming that everything must start with where we are and helps us eliminate, “Doing things the way we've always done them.”
There are times when we need to transform and do things more efficiently, and that blank piece of paper, I think, is a great approach.
Well, I've got to hit you with some kindness now [Booker began The Kindness Initiative at Northside Forsyth, which has changed the health system’s culture]. That started as just a heartfelt desire—and it still is—to change culture within an organization and I have been given a phenomenal amount of support. I shared with you in our last conversation that this initiative around kindness started as a grassroots effort here at the Northside Forsythe campus. However, it is now infused throughout our system.
I am on a kindness-through-communications committee, and we do these 30-minute power meetings weekly, where we talk about implementing all sorts of ideas to make kindness the norm within the organization, and I have to tell you about something that happened just yesterday.
I was talking to the chief operating officer (COO), and she had just spoken at our auxiliary volunteer Appreciation Week luncheon. After the meeting, as she was preparing to leave, she was stopped by one of the volunteers who was a new volunteer with us and wanted to share some of her story.
Her husband had been a patient in our critical care unit about 15 years ago where he had lived for 12 days, and she shared some of her experiences during that time. Then she asked, “Tell me, who started the initiative around kindness?” and the COO shared our journey with the Kindness Initiative.
She told the COO that she had recently been a patient in the hospital and had also come back as an outpatient for several other levels of treatment and she felt that the culture within the organization had changed dramatically. And she could see how the imperative around being kind had just changed, for her, everything and as a result of that, she decided to become a volunteer to be able to share in that.
I was just blown away. That just happened yesterday. So, to me, creativity and innovation are sometimes those things that are tangible—that you can touch and feel—and sometimes they are the things that are just life-changing, but that you can't touch and feel. They're the intangibles.
Sanford’s Nursing Expansion Grant is one of 25 totaling more than $78 million that the labor department awarded this week to nursing programs in 17 states to address critical staffing challenges and to strengthen and diversify the workforce.
“We are honored that the U.S. Department of Labor has awarded Sanford Health nearly $3 million in funding to help strengthen our nursing workforce in the rural upper Midwest, where nursing shortages are more acute,” DeBoer says. “As the largest rural health system in the country, we are well positioned to carry out a nursing workforce expansion project that will benefit rural nurses and the patients we have the privilege of serving.”
The grant officially begins June 1 and will allow Sanford to improve first-year retention for new nurses and increase the number of nurses in the RN career pathway in North Dakota, South Dakota, Minnesota, and Iowa by expanding paid internship programs, according to DeBoer.
“New nurses face the highest work-related stress during the first three months of practice and approximately 30% to 70% of new nurses either quit their jobs or transfer to another unit within one year of practice,” she says. “These internship experiences will expand the clinical skills and knowledge of nursing students to better prepare them to join the nursing workforce.”
The grant will allow Sanford Health to fund faculty positions to jumpstart an accelerated BSN second degree program in partnership with North Dakota State University, with an emphasis on improving recruitment and experience in rural areas.
It also will increase the quality of nurse orientation and the quantity of preceptors in all care settings by updating Sanford’s advanced preceptor curriculum, to include individualized tools, resources, and improved access for long-term care, acute care, and ambulatory nurses serving in rural areas, DeBoer says.
“By improving recruitment, retention and engagement in RN training programs and career pathways, offering financial support, performing continuous quality improvements to programs, and evaluating strategies for efficacy,” she says, “we will be able to reduce barriers in rural areas and create a more sustainable nursing workforce for generations to come.”
As nurses are well aware, and research shows, adequate staffing is important to outcomes for nurses and patients and is essential to maintaining and improving the nation’s healthcare system.
For those reasons, the labor department’s Employment and Training Administration awarded the grants to 25 public-private partnerships in Alabama, Alaska, Arizona, California, Connecticut, Florida, Kentucky, Massachusetts, Montana, New Hampshire, New Jersey, New York, North Dakota, Ohio, South Dakota, Texas, and Wisconsin.
The grants will support innovative partnerships and strategies that expand and diversify the pipeline of qualified nursing professionals, specifically by increasing the number of nursing instructors and educators, and by creating opportunities for frontline healthcare professionals to advance on a career pathway, according to the labor department.
They also will help grant recipients improve diversity in the healthcare workforce and address the health equity gap in underserved communities by embedding diversity, equity, inclusion, and accessibility strategies into their programs. By doing so, the programs will ensure people from historically marginalized and underrepresented communities have pathways to good jobs and careers in nursing.
“The grants … recognize the burden so many nurses have shouldered for too long by supporting programs to expand and diversify the workforce,” said Brent Parton, acting assistant secretary for employment and training. “These investments will also help to ensure the nation’s well-being and continue to strengthen our care economy using proven practices and strategies.”
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 to discuss their experience as a strategic partner in their organization’s leadership.
But that was a long time ago, and Sintich, who serves as Virginia-based Inova's chief nurse executive and executive vice president, is part of an administration that carefully prepares CNOs to be strategic partners within their own organization’s leadership team.
Sintich spoke to HealthLeaders about how leadership development has changed dramatically since she first became a nurse leader.
This transcript has been lightly edited for brevity and clarity.
Maureen Sintich, CNE and executive vice president, Inova / Photo courtesy of Inova
HealthLeaders: When did you first become part of a health system’s operational leadership team and what was that experience like for you?
Maureen Sintich: It was many years ago and I was still practicing as a clinician. It was a dual role where I spent part of my time in program development and leadership and was integrated into the broader healthcare operations team, and part of my time was providing clinical services to the patients within our program.
From a leadership perspective, there were many days where I am certain I felt like a fish out of water. One of the benefits though, is that nurses bring to the table every day our practice of nursing. Whether it be thinking about leadership from a relationship perspective, or to be able to listen with empathy, or to be able to make an impact with our teams, there's a component of our nursing background that never goes away.
I also believe that all nurses are leaders, and you don't have to be in a formal leadership role to lead. Having said that, though, there were many days where I felt like I was flying by the seat of my pants, just hoping that I could get through the day, asking questions when I was uncertain and hoping that my leaders and my team would be supportive because I was truly learning along the way.
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?
Sintich: I'm a nurse practitioner by training, so my graduate degree in nursing was very clinically based. There were administrative tracks that had come along later, as you referenced, for nursing administration and very different types of roles, but that's not what I learned in graduate school. I didn't have those skills, so I realized that I needed to go back to school, and I obtained a master's in business administration.
It's probably one of the most difficult things I've ever done, because my background was so clinically based and I had to learn a whole different way of doing things. I had to learn a new language. But I had amazing colleagues in school who came from all different backgrounds—some came from business backgrounds, healthcare, engineers, scientists. It was truly an interprofessional group of adult students where we were all learning together.
But one of the most important components of my personal leadership development journey, and I'm forever grateful, was my organization who supported me while I went through that process.
HL: What do you, as CNO, uniquely bring to your organization’s leadership team?
Sintich: Nurses are the largest group of healthcare professionals in the nation, and the representation of the nurse and the work that we do is critically important to the broader leadership of any health system.
Having said that, when we come to the table as leaders within our organization, while we are expected to have our professional roles and our expertise that is specific to our primary role, we are also seen as leaders of the health system. As a member of my CEO’s cabinet along with my colleagues from the health system—whether it be the chief of our clinical enterprise operations or our CFO or chief people officer—we are expected to be able to contribute for and on behalf of the greater good of the health system, which I find personally very rewarding.
HL: Nurses tend to be creative and innovative. How has this served you as an operational leader?
Sintich: Nurses are creative and innovative, and we often look at challenges as, in some cases, puzzles to be solved. Think about the delivery of care during the pandemic and the fact that nurses were changing their model of care almost on a daily basis as we were learning and trying different things.
Those same challenges apply to leadership, when we expand beyond nursing to think about the broader healthcare team and beyond the technical components of the care delivery model to thinking about, “How do we not only take care of patients and families but support each other and not lose sight of meaning and purpose?”
HL: How does your health system prepare CNOs to be strategic partners within their own organization’s leadership team?
Sintich: We have an amazing operating model and it’s a triad structure where we partner nurse leaders with administrative leaders and physician leaders. Whether it’s at the service line level or at the site of care, chief nursing officers, chief medical officers, and hospital presidents work together in teams, and it elevates everybody's role.
When new leaders are identified, first and foremost we want to make sure that they have a mentor that they can work with. We also want to ensure that they are supported through our leadership development programs, but also as a member of the overarching guiding coalition of Innova leaders who contribute to our Innova strategy. Whether it be focusing on purpose and joy, or diversity, equity, and inclusion, or patient safety, we have components of all of those that are integrally a part and parcel of our culture, so that’s how we support our teams and our leaders.
And it doesn't start with the chief nursing officer. We start with frontline leaders so that we are developing people along the way to be ready to step into that next CNO role. It’s important to know that leadership development doesn't start with somebody who's ready to be a vice president; it starts at the unit level.
We start it with our shared governance structures where we partner frontline nurses with their clinical leaders to make decisions that impact their work. So, it’s not about a specific curriculum or program—while we have those—it's about how to integrate the work to achieve the outcomes that we would all expect for our people as well as our patients and communities.
Most nurses blame staffing shortages for poor mental health.
Only one-third of nurses surveyed plan to remain in the profession for the foreseeable future and about one-fourth plan to leave in one or two years from now, a new report warns.
The survey was conducted earlier this year with nearly 1,500 nursing professionals and students at healthcare and hospital facilities across the country and was outlined in the report, The Future of Nursing: At the Breaking Point.
Nurses reported experiencing symptoms of anxiety (46%), insomnia (35%), and depression (32%) and the leading cause for poor mental health was staffing shortages (71%), followed by a lack of support resources (55%). Yet, most employed nurses (83%) do not use mental health or well-being counseling, despite employers offering such services, according to the survey.
In contrast, 47% of nursing students use the mental health offerings from their school and 53% find them useful, the survey says, with 61% saying their school offers mental health and well-being resources, including student assistance programs, gyms and fitness resources, counseling, food and nutrition services, and a mental health and well-being hotline.
Asked if they were satisfied with their decision to become a nurse, 93% of student nurses said they are.
Working nurses’ experience with the COVID-19 pandemic has added to feelings of discontent, and nearly two in five employed nurses indicating it dramatically increased their desire to leave the profession.
“We had hoped that at this point past the pandemic, we would see improvement in the sentiment of our nurses, but that’s simply not the case,” said John A. Martins, Cross Country’s president and CEO. “The profession has reached a breaking point, and it is well past time that industry leaders come together to create reform to revitalize this essential profession.”
Methods might include:
Create new opportunities for education: Identify new pathways at the high school, undergraduate, and postgraduate levels to expedite the supply of nurses; recruit more nursing faculty to educate and train the next generation of nurses.
Offer flexibility and awareness of growth opportunities: Open every door to expedite the transition from the university to the hospital floor and offer more fluid career paths that match individual skills and ambitions to evolve and grow with the person.
Invest in retention strategies and well-being initiatives that matter: Focus on enriching current and future nurses’ working conditions and well-being to ensure long-term satisfaction and subsequent retention.
Embrace technological innovation: Use technology to understand better equitable workforce distribution, workflow management, employee satisfaction and well-being, and patient safety.
Explore innovative staffing models: Explore innovative and flexible staffing models, including travel and per-diem nurses, to provide agility and continuity of quality patient care.
“Despite the many challenges and stressors that have contributed to burnout and nurses being on the brink of a breaking point in their professional careers, nurses and nursing students remain overwhelming satisfied with their career choice,” said Safiya George, PhD, FAANP, the nursing school’s dean and professor.
“Nurses have endured and thrived over the years,” she said. “The profession as a whole will need a lot more investment of human capital as well as fiscal and other supportive resources moving forward. This national survey has helped to identify innovative ways to improve quality of work and life for current and the next generation of nurses.”
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 to discuss their experience as an operational leader.
In fact, McGrue, also director of outcomes for the Baptist Health System, seeks them out for their “fresh” set of eyes. McGrue spoke with HealthLeaders about this, and her other management styles.
This transcript has been lightly edited for brevity and clarity.
Van McGrue, CNO, Princeton Baptist Medical Center / Photo courtesy of Princeton Baptist Medical Center
HealthLeaders: What part of being an operational leader has most resonated with you?
Van McGrue: I was a director of operations for large dialysis companies for more than 20 years, but I didn’t get into operations with Baptist Health until 2010.
That has been a learning experience for me, especially since we just went through the pandemic. I’ve gone through pandemics before, especially when AIDS first came onto the scene, but when this COVID pandemic happened, it was truly different because patients of my age were dying. That has turned my entire nursing career around on how I see things.
Now that we’re coming out of that era, I see new nurses who are eager to learn and who were not deterred from the nursing field, even though they did not have a lot of hands-on experience during that time and were, instead, doing a lot of simulation in classes.
That behavior—the readiness to learn—is still there amongst the new grads and so that is the most rewarding thing throughout my nursing career. I love to give back to the younger generation, so I’m trying to mentor and take the young nurses—specifically a couple of them in the intensive care unit—under my wing.
And I must say, it’s very fulfilling to go home at the end of the day to know that you made a difference in someone's life.
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?
McGrue: I acquired this really through my military school and because in nursing we didn’t deal a lot with the business side when I first started in nursing school back in the 1980s. But now I see where the nursing curriculum has changed, where they are dealing with more finance and critical thinking, and that's going to lead to a better leader role.
I learned a lot from my military background and I've learned a lot through trial and error, too. When I first started, I had my BSN. Later, I was able to get my graduate degree and then my DNP, and I noticed that the curriculum has been revamped compared to when I started more than 30 years ago. It's more focused on relationship building, what we can bring to the table, and cost savings, but not to cut quality.
Healthcare in general has evolved into more of a profitable business. We still have several hospitals out there that are not-for-profit, but the healthcare industry is really becoming a business.
So, I’ve seen a lot of nurses go back to get their MBA to increase their knowledge of the business portion, but I accumulated a lot of my operational leadership from on-the-job training.
HL:What do you, as CNO, uniquely bring to your organization’s leadership team?
McGrue: I’m an out-of-the-box thinker; I'm not just your traditional leader. I have several different leadership styles: I can be very bureaucratic, I can be a servant leader, I can be a transformational leader, a transactional leader, and I've learned to adapt to what would bring more to the table. I always look at the big picture, instead of just looking all into the weeds, to see what we are trying to achieve as a team.
I believe in relationship building, regardless of who is on the team. I want a diversity of people on the team. The one thing that is truly unique with me is I want to be considered as one of those frontline workers and the way I do that is I meet with every new-hire nurse and have one-on-ones with them.
I have charge-nurse breakfasts with all the charge nurses within the hospital because I want them to see myself as part of the team and not just a hands-down leader. More or less, I want them to manage me, so that's what I bring to the table.
HL: Nurses tend to be creative and innovative. How has this served you as an operational leader?
McGrue: This goes back to my team and them managing me. I am only as good as my team. I don't have all the answers. I tap into that creativity, that innovation, because with the younger generation, they can think more out of the box than I can and they can think of ways that can make a process more efficient in ways that I'm not able to.
So, I really depend on my new nurses and my other nurses, too, to look at things from a different viewpoint. I've been nursing for so long, and with someone new coming in, they have a fresh set of eyes and they can see from a different point of view.
I’ve learned from my younger nurses of ways to communicate differently on what works for them in their learning style or in their leadership style. I try to connect with the younger nurses to stay abreast of what is coming up. For example, for Nurses Week, we were thinking of doing the regular, basic stuff, but one of the new nurses said, “How about a TikTok video?”
Well, TikTok is in the news now and I don’t know how safe that is, but I suggested that I do a Facebook video or something to that nature. So, doing certain things with different ways of communication helps to get our message out to the younger generation.
HL: How does your health system recognize CNOs as strategic partners within their own organization’s leadership team?
McGrue: They really promote growth and participation. They want us to have that seat at the table. When we all are talking about earnings and we have more MBAs in the room compared to nurses, they want us to always put patients first, the clinical aspects first.
Baptist encourages nurse leaders to think outside the box and continue to learn. As a nurse, from an operational standpoint, we need to always be willing to learn new things and be open-minded, and Baptist really promotes that.
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 to discuss their experience as a strategic partner in their organization’s leadership.
Part 3 of a 5-part series
Lanie Ward, MBA, BSN, RN, chief nursing officer of Massachusetts-based Cambridge Health Alliance (CHA), credits good mentors with helping her build a strong career of more than 30 years where she has served in senior roles in organizations across the country.
Now, Ward passes along the advice and help she received to nurses also seeking to one day take a seat at the leadership table. Ward spoke to HealthLeaders about what it takes to get there.
This transcript has been lightly edited for brevity and clarity.
Lanie Ward, chief nursing officer, Cambridge Health Alliance / Photo courtesy of Cambridge Health Alliance
HealthLeaders: When did you first become part of the health system’s operational leadership and what was that experience like for you?
Lanie Ward: I came to CHA in July of 2020, and it was a unique and unusual experience for two reasons. I came to this organization as an interim CNO and during the height of the pandemic, and even though I was an experienced CNO with many, many years of experience, I'd never been an interim. I remember asking one of my peers who had been an interim how to best do it and she said, “Just think of yourself as the permanent CNO,” and that was great advice.
And obviously, it was very different coming to a new system, not knowing anyone and them not knowing me, during the pandemic. Instead of meeting in person, I met them via Google Meet from my office, so it was strange being in an organization and not having that personal face-to-face interaction.
However, even with these two challenges, it was so enjoyable. I enjoyed being part of the team during this really challenging time and being a major player in the Incident Command Center. I was truly moved by our healthcare workers, and extremely proud of the nurses and nurse leaders in the entire team, because everyone pulled together during this crisis and it was truly rewarding.
HL: When you first became an operational leader earlier in your career, what was that experience like?
Ward: I started out as a staff nurse and gradually got new projects, new experiences, and increasing responsibilities. When I became chief nursing officer and chief operating officer, I’d been groomed for that. I did some very good things and I still made mistakes and learned from them. But I was a novice CNO at first and so I sought the advice of others, and I was fortunate that I had great mentors.
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?
Ward: That goes back to what I was saying about how I was fortunate to have those great leaders and mentors who allowed me to take on new projects and increasing responsibilities. They encouraged me to get my MBA, which I did, and they wanted me to attend local and national conferences, so I had a broader look, and they suggested I become a member of nursing organizations, and those were extremely helpful.
I would say that my leaders and mentors celebrated my success, but just as importantly, they allow me to fail and learn from it and get up again. I really, truly mean it when I say I've learned from every leader I've worked with. I’ve learned as much from great leaders as from not-so-great ones. I've also learned a great deal from informal leaders—staff who don't have a position or title, but they certainly are leaders in their area.
I've learned some pearls of what to do and some pearls of what not to do, but as a leader, you never stop acquiring skills and learning. It's a lifelong journey.
HL: What do you as a CNO uniquely bring to your organization's leadership team?
Ward: It’s not unique, but I bring the voice of the nurse to the leadership team and to the decision-making table. But as far as unique things, I have the ability to simplify complex things and bring focus and continued disciplined focus on strategic priorities and initiatives and actions and results. I don't have the tendency to get lost and in putting out all the daily fires, of which there are many.
As importantly, I also bring focus on recognizing and celebrating improvements and successes with the leaders and the frontline staff. That's important because that keeps their motivation and pride going. And I like to think I bring a good bit of fun and humor to our team as well, which is important to me.
HL: Nurses tend to be creative and innovative. How has this served you as an operational leader?
Ward: Nurses have to deal with complex and challenging situations and often the buck stops with us and to do that, we always have to be creative in finding solutions. You can always count on a nurse and nurse leader to figure it out and make it happen because there's nobody for them to turn to. Consequently, in my position, I avoid saying we can't do things, but always focus on how we can do it.
And so, I often like to, “go outside of the box” and look at new and creative solutions and to do that, sometimes I say to myself and to my leaders, “Let's start with a blank piece of paper, and design what we think is the best and a new and innovative approach.” This helps me and others avoid assuming that everything must start with where we are and helps us eliminate, “Doing things the way we've always done them.”
There are times when we need to transform and do things more efficiently, and that blank piece of paper, I think, is a great approach.
HL: How does your health system prepare CNOs to be strategic partners within their own organization’s leadership team?
Ward: Other members of the senior leadership team and I develop the strategic plan for the next few years, and we meet regularly to discuss it and the results and actions. We are strategic partners and recognize that we can't work in silos to achieve our goals, as far as grooming new leaders to move into CNO positions.
We’re very focused on our ACNOs and our nurse managers, finding out their career goals and encouraging them to do some of the same things I did. Certainly, they need to be degree-ready, but they also need to attend national conferences and be members and leaders of local and national nursing organizations.
If I have an ACNO that’s in a specialty area and doesn’t want to be pigeon-holed there and is looking at new projects and increasing responsibilities in other areas—which is what happened to me—we keep advising them and suggesting and encouraging them to do the things that will help them become a CNO, if that's what they want to do.
UL Lafayette is one of the largest producers of healthcare professionals in Louisiana.
A new accelerated bachelor of science in nursing (BSN) degree program will help address the urgent need for RNs in Louisiana’s Acadiana region in the south and southwest part of the state.
The new program, created through a partnership between the University of Louisiana at Lafayette and Ochsner Lafayette General Medical Center, will enable students who hold a bachelor’s degree in any field to earn a bachelor’s degree in nursing in less time, resulting in more qualified and skilled nurses entering a workforce that is facing a severe shortage.
More than 1.1 million new nurses will be needed in the United States by 2030, according to the U.S. Bureau of Labor.
“The UL Lafayette · Ochsner Accelerated BSN Program answers a nationwide challenge that’s certainly being felt in our region,” said Lisa Broussard, DNS, RN, CNE, interim dean of the university’s College of Nursing & Health Sciences.
“For more than 70 years, our college has been the primary creator of Acadiana’s healthcare workforce, and our graduates can be found in clinics, doctors’ offices, and in major hospital systems throughout the area and beyond,” she said. “Partnerships such as this one with Ochsner Lafayette General strengthen the strategic commitment the university has made to ensure that patients who turn to our region’s medical providers in times of need receive high-quality care from exceptionally skilled, deeply compassionate health professionals.”
UL Lafayette is one of the largest producers of healthcare professionals in Louisiana; indeed, nearly one-fourth of its students enter a healthcare or social assistance field after graduation and 75% of alumni remain in the state five years after completing a bachelor's degree, said Joseph Savoie, university president.
“This accelerated BSN program helps us produce more nurses who are overwhelmingly likely to remain in the state,” Savoie said. “As a result, the university is enhancing the commitment we share with Ochsner to create a healthier Louisiana.”
In this partnership, Ochsner Lafayette General will offer nursing students critical training with clinical faculty and clinical placements—eliminating a barrier commonly found by nursing programs seeking experience for their students.
Ochsner Lafayette General also will invest $2.8 million in the accelerated BSN program for operational expenses and faculty and staff support. The investment also covers student tuition for nursing courses, though students will cover costs for prerequisites. In exchange, program students must commit to work for Ochsner Lafayette General for three years after graduation.
“It’s an honor to partner with the University of Louisiana at Lafayette and build on our legacy of excellence in training the healthcare workforce of the future,” said Leonardo Seoane, MD, FACP, Executive Vice President and Chief Academic Officer for Ochsner Health. “Investing and growing our workforce is vital to our long-term success, and it’s also critical to meeting the needs of our communities.”
'The pipeline into nursing must be protected,' AACN president says.
For the first time in 20 years, enrollment in entry-level baccalaureate nursing programs decreased by 1.4%, and declines continue to occur in master’s and PhD programs, according to new data from the American Association of Colleges of Nursing (AACN).
On top of that nursing schools nationwide turned away more than 78,000 qualified applications—not applicants— in 2022 largely because of shortages of clinical placement sites, faculty, preceptors, and classroom space, as well as budget cuts, according to AACN.
More than 10,000 of those applications were turned away from graduate programs, which threatens to further limit the number of potential nurse educators, the data revealed.
Reduction in nursing students and its effect on staffing is a top concern of hospital and health system leaders across settings, said Dr. Deborah Trautman, AACN president and CEO.
“The pipeline into nursing must be protected and supported by all stakeholders with an interest in ensuring access to quality healthcare,” Trautman said.
Though a single-year decline doesn’t necessarily signal a trend, any decrease in these critical programs raises concerns and merits further investigation, noted the AACN, which conducted this latest annual survey, titled 2022-2023 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, in fall 2022. The survey contains data reported by 974 schools of nursing.
Enrollment in PhD nursing programs declined by 4.1% from 2021 to 2022, continuing a downward trend that began in 2013. Indeed, since 2013, enrollments have decreased by 14.8%, creating deep concern among academic nursing leaders.
In its report on the Future of Nursing: 2020-2030, the National Academy of Medicine, Science, and Engineering said the declining enrollment in nursing PhD candidates is “a major concern for the profession and for the nation.”
Students in master’s-level programs, which prepare individuals for roles in research, informatics, direct patient care, administration, and teaching, decreased by 9.4% since 2021, marking the second year of enrollment decline.
AACN’s research and data team is continuing to examine survey findings to determine some of the factors affecting enrollment declines.
“With enrollments trending downward, academic and practice leaders should work together to ensure that schools are able to accommodate all qualified applicants to meet the growing demand for nurses to provide care and serve as faculty, researchers, and leaders,” Trautman said.
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 to discuss their experience as a strategic partner in their organization’s leadership.
Part 2 of a 5-part series.
Carolyn Booker, DNP, RN, NEA-BC, chief nursing officer of Northside Hospital Forsyth, in Cumming, Georgia, created a culture change within the Northside Hospital system when she developed The Kindness Initiative, which has reached into all of Northside’s campuses.
Booker hasn’t always wielded such influence. She became a nurse leader more than two decades ago, at about the same time nurse leaders were first getting invited to the executive table. For those pioneering nurse leaders, the learning curve was steep.
Booker spoke to HealthLeaders about her journey to the C-suite.
This transcript has been lightly edited for brevity and clarity.
HealthLeaders: When did you first become part of a hospital's operational leadership team, and what was that experience like for you?
Carolyn Booker: I’ve been a nurse 42 years this year, with 34 of them in nursing leadership, and 21 of those years with Northside Hospital Forsyth. Before Northside, I was with another healthcare system and that was in more of the earlier days of nursing leaders being a part of operations. When I graduated from nursing school, nurse leaders were more clinically inclined and by the time I became a nurse leader, it was just at the beginning of nurse leaders being incorporated into the operational aspect. And for me at that time, it was trial by fire.
I was basically promoted to become a nurse manager based on my clinical acumen because I did not have formalized leadership training. I did not know what I did not know, and therefore I had a tremendous number of very painful experiences that took me from being an individual who did not know to one who “got it,” but typically in those years, the experiences were ones that you were dipped into the pool of fire, and you learned through your mistakes.
When I became a leader with Northside, that was absolutely a much better experience. By that time, I’d had formalized leadership training by returning to school and getting more education and got to be part of an organization that is very forward thinking. That experience has been phenomenal.
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?
Booker: Northside provides a level of education prior to our budgeting processes, prior to any type of innovative computer systems—any of the systems that we add, we are all receiving education on those at the local level. You also gain a level of perspective and knowledge through networking with colleagues.
And then, Northside has been a huge part of my formalized education because the organization offers, as a part of our benefit, tuition reimbursement so, since I've been a part of this organization, I've returned to the university setting to achieve a master's degree and a doctorate in executive nursing administration. I'm also certified as a nurse executive as well. There’s been a phenomenal level of investment that organizations—definitely Northside—have put into nurse leaders to ensure that we are all able to operate at the top of our ability.
HL: What do you as a CNO uniquely bring to your organization's leadership team?
Booker: I try to bring the concept of experience and serve as a champion for that as it relates to the patients’ experience, but also to the staff’s experience here at the hospital. Every hospital has bricks and mortar, but what differentiates an organization, really and truly, is the people.
So, from the perspective of being a nurse, and coming from that caring component, I definitely bring to the C-suite that focus on ensuring that we keep our fingers on the pulse of how people experience working in our organization, and then how our patients and families experienced the receipt of care.
HL:Nurses tend to be creative and innovative. How has this served you as an operational leader?
Booker: Well, I've got to hit you with some kindness now. That started as just a heartfelt desire—and it still is—to change culture within an organization and I have been given a phenomenal amount of support. I shared with you in our last conversation that this initiative around kindness started as a grassroots effort here at the Northside Forsyth campus. However, it is now infused throughout our system.
I am on a kindness-through-communications committee, and we do these 30-minute power meetings weekly, where we talk about implementing all sorts of ideas to make kindness the norm within the organization, and I have to tell you about something that happened just yesterday.
I was talking to the chief operating officer (COO) and she had just spoken at our auxiliary volunteer Appreciation Week luncheon. After the meeting, as she was preparing to leave, she was stopped by one of the volunteers who was a new volunteer with us and wanted to share some of her story.
Her husband had been a patient in our critical care unit about 15 years ago where he had lived for 12 days, and she shared some of her experiences during that time. Then she asked, “Tell me, who started the initiative around kindness?” and the COO shared our journey with the Kindness Initiative.
She told the COO that she had recently been a patient in the hospital and had also come back as an outpatient for several other levels of treatment and she felt that the culture within the organization had changed dramatically. And she could see how the imperative around being kind had just changed, for her, everything and as a result of that, she decided to become a volunteer to be able to share in that.
I was just blown away. That just happened yesterday. So, to me, creativity and innovation are sometimes those things that are tangible—that you can touch and feel—and sometimes they are the things that are just life-changing, but that you can't touch and feel. They're the intangibles.
HL: How does your health system prepare CNOs to be strategic partners within their own organization’s leadership team?
Booker: Northside does succession planning, so they are always looking for the next nursing leaders in our hospitals—folks who really want to make a difference. There’s the promotion of academic completion in going back to school and taking courses that can assist leaders in honing that leadership muscle.
We also have formalized leadership training to help us to grow in our knowledge and skills. These leadership training programs are based on structured education. We also have assigned preceptors and mentors. One of the things that works across our system is that we are truly interdisciplinary. There's a phenomenal amount of collaboration, and then there's also a level of inclusiveness that is very, very refreshing.
For five years, Cole has led the ANA Enterprise, which is the family of organizations composed of the American Nurses Association (ANA), American Nurses Credentialing Center (ANCC), and American Nurses Foundation (the Foundation). She joined the ANA Enterprise in 2016 as chief officer and executive vice president of the American Nurses Credentialing Center.
During Cole’s tenure as CEO, she started ANA's Racial Reckoning Journey, strengthened the organization’s finances, and championed burnout prevention strategies for nurses. Indeed, a prevention program that reduced burnout in more than 52% of pilot program participants is now available as a permanent benefit to the entire ANA membership.
“Recent data finds 84% of registered nurses are experiencing burnout and only 42% of nurses feel their employer values their mental health,” she said when the Burnout Prevention Program was rolled out. “ANA wants to help our members by making a great resource easily available.”
“Dr. Cole will be valued and remembered for her professional commitment and elevating the voices of and advocating on behalf of our nation's 4.4 million registered nurses,” said Jennifer Mensik Kennedy, PhD, RN, NEA-BC, FAAN, president of ANA.
“The ANA board of directors is grateful for all that Dr. Cole has done to advance the vision and mission of the ANA Enterprise. She will be greatly missed,” Mensik Kennedy said.
Serving as ANA Enterprise CEO has been the “pinnacle” of her nursing career, Cole said.
“I have been honored to lead a world-class team, which includes the dedicated staff at the ANA Enterprise and hundreds of nurse volunteers, who are completely dedicated to improving the professional lives of our nation’s registered nurses and fulfilling ANA’s vision of ‘a healthy world through the power of nursing,’” she said.
“Every day, I am inspired by the resolve of this team to listen and respond to the priority issues of nursing, then execute on strategic initiatives that address these issues to make a positive and sustaining difference for our nation’s largest and most trusted healthcare sector—nurses,” she said.
Cole previously held chief nursing officer and chief operating officer positions within the Hospital Corporation of America’s (HCA) Capital Division. While chief nursing officer at LewisGale Montgomery Hospital, she led the hospital to attain ANCC Magnet® recognition.
In accordance with ANA’s succession plan, the ANA board of directors has created a search committee and selected search firm WittKieffer to manage the search process.
