DiversityNursing Blog

In the wake of the 2016 election and a changing context for healthcare decision-making, health systems that expand the scope of board dialogue will have a strategic advantage.

Into what was already a rapidly if not chaotically changing healthcare marketplace, there may be major changes from a new presidential administration. There is no better time to get all the right players at the table. Care providers facing the many changes and uncertainties associated with healthcare during Donald Trump’s administration will need diverse board-level input and timely feedback from their core employee sector, nursing, and its insider’s perspective on the patient experience. 

We view this as an optimal time for health systems to add a nurse leader to their boards because the profession’s caregiving expertise and awareness of patient perspectives is needed for sound strategic decision-making. Drawing on our many years of work together as a former health system CEO and as a nurse executive board member, here’s our short list of ways a nurse with high-level business expertise can help a health system board strengthen profitability and patient outcomes.

Balanced board focus

A nurse who has a strong business background and substantial healthcare experience can offer practical, useful input to improve a health system’s board governance. When Kathy first joined the Alegent board, she urged the board to balance its time equally between finance and quality outcomes, patient safety and quality care.

Rick: Kathy first and foremost earned the respect and trust of the board as a very strong business leader and colleague with substantial healthcare experience. She could stand toe-to-toe with any board member on any topic. She also brought nursing experience and the unique dimension of clinical care, an array of experiences and perspectives our board didn’t have before.

Kathy: Nurses understand what it is to deliver human services and generally find themselves in the role of patient advocate and touchpoint for all activities in a hospital. My perspective was broader because I was a senior vice president of a Fortune 500 healthcare company. In addition to my passion for the mission, my experience was corporate and profit-oriented. My focus was on making sure you deliver care as efficiently and cost-effectively for the best outcomes.  

Return on investment 

To improve quality outcomes, resource utilization and financial metrics, it’s critical that nursing leadership and front-line nurses, executives and board governance are all in partnership. Without that, change is simply not possible. Across the board, Alegent’s measures improved dramatically after it dedicated resources to improving outcomes for direct hands-on care of patients. This core business is affected directly by nursing across the enterprise. At Alegent, we could link a clear set of statistics and graphs for a variety of outcomes to the impact of Kathy’s input and expectations.

Kathy: When I joined the board, we had no board committees working on quality. It was easy to make the case that the board ultimately has responsibility for quality outcomes. A lot of people think having better quality may cost more money. Actually, you get a return on investment if you deliver higher quality, and you can easily reduce your costs.

Rick: We took Kathy’s recommendation to focus on quality patient care very seriously and found the resources to make this happen. We ended up with a strong team of quality experts, physicians, nurses and colleagues with analytical skills—some of whom we hired and some of whom we moved into leadership roles. We became national leaders in quality outcomes. Our company’s quality scores were on par with Johns Hopkins (Health System) and Cleveland Clinic and were ahead of the Mayo Clinic.

Blind spot protection

A board without diverse perspectives risks overlooking uncomfortable yet important issues.

Rick: Kathy could challenge management and the board in ways nobody else could because of her experience and knowledge. She pressed management on quality outcomes when they began to be published publicly. I will never forget the day we reported wonderful quality outcomes scores for our metropolitan hospitals. Our rural hospitals weren’t reporting the same scores. Kathy said,“Our company’s name is on those buildings too. Why aren’t we delivering the same care there?” There was dead silence. That type of feedback—pointing to conversations our board needed to have—was exactly what I needed as president and later CEO. Thanks to Kathy’s input, we put resources and focus on quality outcomes in our rural hospitals and brought them quickly into the top decile nationally with comparable care.

Kathy: We achieved these quality improvements because our hospital administrative leadership team took on this challenge; they creatively led changes in our culture and processes, and committed resources to make it happen.

Pivot to the future

The nursing profession has dedicated itself to empowering people with comparable stature and skills as other board members to share nursing’s valuable perspective on the front-line business. That’s why we joined the American Nurses Foundation’s effort to increase the number of nurses on boards, building on its impact as a founding member of the national Nurses on Boards Coalition.

There is a ready cohort of nurse leaders with the governance and healthcare expertise to be excellent board members. All the board has to do is get them oriented to the organization. This next-generation cadre of nurse leaders is ready for an important task. Their input on behalf of the critical issues and the bigger picture will be essential to protecting and reinforcing the nation’s vital healthcare sector in the coming era.

If you have any questions feel free to ask one of our Nurse Leaders who are always here to help!

I’m a Magnet® nurse. I’m proud to say that my entire nursing career thus far has been nurtured within Magnet-recognized hospitals, first in Idaho and now in Missoula. The American Nurses Credentialing Center currently recognizes 448 hospitals as Magnet hospitals – only 6 percent of all U.S. hospitals. This recognition has become something of a gold standard in nursing.

In the early 1980s, a nursing shortage prompted the American Academy of Nursing to establish a task force to study workplace satisfaction within U.S. hospitals. In the course of that work, the researchers noted that a handful of institutions were particularly adept at retaining talented nurses and fostering a positive experience for patients.

The team directed their attention to those hospitals in order to learn what factors produced the effect of keeping skilled nurses employed within an organization. They identified 14 traits, termed the “Forces of Magnetism,” and formed a culture that evolved into the Magnet Model. The culture described by these forces became the standard of excellence, the Magnet recognition program, which hospitals can strive to attain. Those traits, while varied, center on two things: improving patient outcomes and empowering nurses within the health care system.

So what does it mean to be in a Magnet hospital? Magnet hospitals must outperform other hospitals nationwide for clinical outcomes, patient satisfaction and nursing satisfaction by focusing on best practices in patient care. Nurses are encouraged to develop strong working relationships with patients, physicians, social workers, and other health care disciplines to create a high-quality experience for the people they serve. The hospital can apply for recognition through the ANCC Magnet Recognition Program and must reapply every four years.

This past October I attended the national Magnet Conference in Orlando, Florida. It was incredibly inspiring to be surrounded by nearly 10,000 passionate, engaged and motivated nurses from across the country, linked by a similar purpose. These nurses do not shy away from tough situations or unwanted outcomes in health care, but work to improve their chosen profession and empower those around them to do the same. They are nurses who are committed to being leaders, teachers and advocates within the field of nursing. They are the best at what they do.

Since returning home, I’ve tried to keep that inspiration with me daily as I care for patients. Magnet hospitals aren’t perfect, yet they strive toward excellence and continued improvements through the shared theme: empowering nurses to transform health care. We are committed.

It was cold but the sun was shining when my father looked out the window and said he wanted to die.

He was lying in a hospital bed, tubes tying him to machines and drips. He was 65, wasn’t a smoker but, like a lot of firefighters, had inhaled things that embedded in his lungs, slowly strangling them. His skin was ashen, his eyes wet and hauntingly sad.

When he said he wanted to die, my immediate reaction was to reassure him, to hold his hand, to tell him that my mother, my brother, my sister, and I didn’t want him to go, that we loved him too much to let him go, that he couldn’t go just yet.

That was 29 years ago, and it took me many years to realize that my reaction to my father’s plaintive, death-bed declaration was selfish, that it was rooted in what I thought was best, what I wanted, not what he thought was best, not what he wanted.

My father lingered for several weeks after he told me he wanted to die, suffering greatly. I have no idea if he would have opted to end his life earlier, to end his suffering earlier, but I wish he had the option.

It would be helpful to know whether a majority of Massachusetts legislators think others should have that option, too, but for the last eight years they have punted on the Death with Dignity Act, bottling it up in committee so that it dies without the dignity of a full and fulsome hearing.

Five years ago, a referendum that would make it legal for physicians to prescribe medications that terminally ill people could use to end their lives was narrowly defeated. But, like all social change, like all civil rights, the right to die with dignity is moving forward, inexorably.

Last month, the Massachusetts Medical Society commissioned a survey of its members’ attitudes toward what they called “medical aid in dying.” For a group that has historically opposed what some call physician-assisted suicide, the mere act of seeking its members’ opinions acknowledges the shift, much of it generational, in thinking.

In October, Dr. Roger Kligler, a retired Falmouth physician with prostate cancer, filed a lawsuit asserting he has a right to obtain a lethal dose of medication from a doctor willing to prescribe it if he becomes terminally ill and chooses to avoid more suffering. 

Dr. Kligler rightly believes he’ll get a quicker answer from a court than the Great and General Court. As it has with other highly contentious matters, including same-sex marriage and the legalization of marijuana, the Legislature has been more than happy to let the courts or the public do the heavy lifting.

But even if a court agrees with Dr. Kligler’s argument, the decision could be narrowly tailored to only his case. And as the messy rollout of marijuana legalization has shown, legislating complex matters by referendum often leads to convoluted results. 

The Legislature needs to take on Death with Dignity, in all its complexity.

Nine years ago, State Representative Lou Kafka sat down with one of his constituents, a guy from Stoughton named Al Lipkind, who was dying of stomach cancer. Lipkind asked Kafka to file a bill that would make it legal for doctors to write prescriptions for terminally ill people who wanted to avoid needless suffering. Kafka refiles the bill every session. The initial dozen co-sponsors have grown to 40.

“Al was able to make me see it through his eyes,” Kafka told me. “Unless and until it becomes personalized, it’s an issue you don’t necessarily think about.”

Not long after Al Lipkind died in 2009, Kafka watched helplessly as the same disease that slowly and torturously killed my dad did the same to his father.

“I watched him gasp for breath,” Kafka said.

Like me, Lou Kafka doesn’t know if his father would have chosen to end his life before enduring months of agony. Like me, he wishes his dad had the option.

“Love is the reason I do what I do, even though at times it’s painful when you have a loss.” — Tommy Covington, hematology-oncology nurse at Children’s Hospital Los Angeles.

Thank you, Tommy, for the last 50 remarkable years you’ve given us.

From Vietnam and all those severely wounded soldiers and Marines you cared for during your four years as an Army nurse. How many beds did you say were filled in your hospital ward in Guam during one stretch of heavy fighting — 92?

You knew it was just a matter of days, even hours, before you’d be sitting by the bedside of many of these men as they were given their last rites. You felt the pain and the loss, but where was the love?

You came home and enrolled in the RN program at Los Angeles Trade Tech College, leaving your friends wondering why you would want to work in a “female profession.”

You didn’t see it that way. You had just left a war full of male nurses. Gender had nothing to do with saving lives. You landed a job in the hematology-oncology unit at Children’s Hospital Los Angeles in 1970 where your patients now were babies and kids fighting another enemy — cancer.

That’s where you say you found it. In pediatrics. The love. 

You cared for these kids and cradled them in your arms for 46 years, giving their emotionally drained parents a chance to catch a few hours of precious sleep. You’d sit at your nurse’s station at 3 a.m. on the night shift and turn on soft music to calm the babies down.

“You cuddle them and make eye contact, and when they smile back at you, well, it’s just a wonderful thing,” you told me. Yeah, I bet it is, Tommy.

But with the love, came the pain. Always. You knew many of these babies and young children would not see another birthday. You had to block that out and just do your job.

“Many of my patients have succumbed to their disease,” you say. “How do you learn to deal with it? It’s part of life. It’s been my way of life for 50 years.”

The people at CHLA tell me you’re a legend at the hospital, one of its most beloved employees. You’re still getting mail and phone calls from parents who can’t shake you from their minds, even years after their babies have died.

If it hadn’t been for you, the heartache they went through would have been so much worse. You helped get them through the lowest point in their lives, and they still feel a need to thank you for that all these years later.

One young mother of a 22-month-old daughter, Jessica, who spent a month in the oncology unit recently, described your gift perfectly.

“It was about 10 o’clock at night and she just kept crying,” Brittany Thornton says. “Tommy came to the door and asked if he could help. He picked Jessica up and it was like magic — she stopped crying immediately and laid on his shoulder.

“He took her for about two hours and let me sleep. He’s the only one who can make Jessica stop what she’s doing and smile.” What a gift you have, Tommy.

And now, it’s time to say goodbye to this hospital you’ve served for almost half a century and go fishing. To throw your line in the water and find that peace you can’t find anywhere else.

Your 71-year-old knees are killing you, and there’s a lot of walking on this job. You don’t want to cheat your patients.

“If I can’t function at 100 percent for them, it’s time for me to go,” you say. I can see that. The smart ones always know when it’s time.

But there’s a hurt in your voice you can’t hide, Tommy. It’s not going to be easy walking away from a job you love, even with all the pain and loss attached to it. You’re going to miss these kids and the rookie nurses you’ve helped train to one day take your place.

They were a large part of why you worked the 7 p.m.- to -7 a.m. shift three nights a week all these years. You joked the hours made the commute from your home in Valencia to L.A. easier with less traffic, but that wasn’t the real reason.

The night shift gave you more independence, a chance to spend extra time looking into the eyes of the crying babies in your arms. Feeling their love.

This morning you’re going into work one last time to clean out your locker and sign some retirement papers before driving home to your wife, Laurie, who also works at CHLA as a staffing coordinator, as does your son, Joe.

Next week, you’ll be on a fishing boat out of Ventura Harbor, throwing your line in the water and just relaxing. It all sounds perfect, but you admit your heart won’t be out there on that boat with you. Not for a while.

It’ll still be at work with all those beautiful babies and children who gave you so much love and pain throughout your remarkable career.

Thank you, Tommy Covington, for the last 50 years. You’re a hell of a man.

I've discovered that nurses are a) seriously overworked and b) absolutely the best!

They do things that other people would shun. Really think about that. They are also underappreciated, which is a real shame because there aren't many professions in the world more awesome than nursing. We need to shower nurses with appreciation for their work because the things that nurses do for their patients are among the most noble on the planet.

In case you have any doubt about how cool nurses are, check out my five reasons that nurses totally rock...

1. They Are Patient Advocates

If you or a loved one is in the hospital, make sure you are as kind as possible to the nurses. There is no one you can trust more in the hospital than the nursing staff. They are true patient advocate. Rushed doctors can sometimes not be as thoughtful about patient care as they could be, which is why it is so cool that nurses are always willing to fight with the doctors to get their patients the best care possible.

Always remember to do everything you can to support the nurses in their efforts as your patient advocate. If the nurses are urging you to talk with the doctor about a certain aspect of your care, do it. Nurses always have their patients' best interests at heart, and they deserve the highest of fives for the level of advocacy they demonstrate daily.

2. Nurses Are the Ultimate Lovers of Humanity

One of the most admirable attributes that nurses demonstrate is their ability to provide stellar care to every person who walks through their doors. Whoever a person is, whether they are good or bad, they will be treated equally by nurses.

Nurses ensure that every patient gets the level of care they deserve as a member of the human race. It takes an amazing kind of soul to treat every segment of society equally. The fact that it is just par for the course for nurses shows precisely why they are so awesome.

3. Their Bravery Is Remarkable

Because nurses treat every member of society equally, they are exposed to the best and the worst it has to offer. While interacting with the bottom rungs of society, they can be insulted, shouted at and even attacked. It takes an incredible type of person to bravely face a work environment where you will be exposed to some of the dregs of society. Nurses walk through the doors of the hospital every day knowing that they may face a mentally ill or criminally desperate person who could make their work dangerous.

4. They Cover Some Serious Distance

If a nurse ever challenges you to a walking contest, you better make sure you are in shape. The average American walks 2.5 to 3 miles per day. On the other hand, nurses average four or five miles just during their workdays on a 12-hour shift. The kind of endurance nurses need to respond to many patients simultaneously while being on their feet all day makes them true heroes.

With that in mind, you might want to think about how long the nurses have been on their feet during their shift when you interact with them. They work so hard and in such a grueling manner that they deserve to be treated with respect. When you think about getting upset in the hospital, keep in mind that nurses are doing everything they can to make your stay as pleasant as possible.

5. They Have the Best Stories

Because they are so caring and see people at their best and worst, you will find that most nurses are treasure troves of stories. Their stories range from the heroic to the tragic to the hilarious, and you can bet that every nurse has several of the most incredible stories you will ever hear in your life. If you want to make a friend who is caring and full of great stories, there is no better friend than someone who wears nursing scrubs.

It is indisputable. Nurses totally rock. They do the hard work of taking care of people when they need it the most. We should always do everything we can to show love and support to the hard-working members of the nursing world.

Nurses bring a wealth of clinical understanding to the chief executive role, but they have to master business skills and a wider focus if they want to succeed.

When Leah A. Carpenter, RN, MPA, went into nursing 30 years ago, she did not intend to follow a career path to administration. In fact, early in her career, she was pretty skeptical about the folks in the C-suite.

"I had no desire to be a suit whatsoever," says Carpenter, who is now Administrator and Chief Executive Officer at Memorial Hospital West in Pembroke Pines, FL.

"There was a very big disconnect between the C-suite—and even middle management—and the rank-and-file staff. I really didn't have a great deal of respect for or want anything to do with a leadership at that time."

Then a bit of what she calls "divine intervention" nudged her into the administrative realm. "I lost my hearing progressively over the last past 20 years, so I'm virtually deaf in one ear," she says.

"I had to make a decision whether I wanted to go into management or education, because that's pretty much the two paths that a nurse can take if she's not going to be at the bedside."

Despite that unconventional beginning, Carpenter has risen to the top as a CEO. Now she has some insights and advice for RNs who are considering a CEO role.

Q. What talents, skills, and insights can a nurse bring to the CEO role?

A. Besides the obvious, which is the clinical background and really understanding what it takes to give safe, quality care that is service-oriented, I think I understand the struggle and what the staff needs to be able to deliver that.

That allows me to garner a certain level of respect from the team because they know I've been where they are.

Q. Do you think nurses who become CEOs face unique challenges?

A. Yes, in some respect. It's been easier for me personally in terms of mastering the role because I have the advantage of understanding the intricacies of the clinical world. I think it has been difficult—I've accomplished it but it's taken a while—to garner the respect as a businesswoman as well as a clinician.

Not every nurse leader or CNO can transition from the clinical world into the administrative world.

Q. Do you think there's a major difference between CNO thinking and CEO thinking?

A. Absolutely. You have to still have the understanding and the insight of the CNO, but there's a completely different skill set that you have to master in order to be a CEO.

You have to learn that balance. You can't look at it from just the eyes of a nurse. You're everyone's voice and you represent everyone—the clinical side, the dietary side, the environmental side, the construction side, the legal side.

There's a whole scope of skills and negotiation abilities that you need to have to balance all of that.

Q. What advice do you have for nurses interested in becoming CEOs?

A. It shouldn't be about the title or about the money. It needs to be about the impact: What do you hope to achieve and deliver? What's the end product?

For me, the end product was having an impact on safety, quality, and service, but at a table where I could really make a difference by having the experience as well as learning the business end of it.

I would steer [prospective nurse CEOs] away from a graduate degree in nursing. I think it limits your scope. They have to look at a business or administration type master's degree.

Also, mentors are key. You have to find people who are really good at this, attach yourself to their hip, and learn everything you can from them.

Not everybody's not going to be a great leader, but you can still learn from bad leaders. You can learn what not to do, and you can develop yourself into the kind of leader you want to be, knowing the things that don't work.

Interested in learning more about this or maybe have a general question? Ask one of our Nurse Leaders today.

Here’s an alarming statistic: Around one in four nurses has been physically attacked at work in the last year. Patients often kick, scratch, and grab them; in rare cases even kill them. In fact, there are nearly as many violent injuries in the healthcare industry as there are in all other industries combined. Healthcare workers make up 9 percent of the workforce.

There are currently no federal rules mandating that hospitals attempt to protect nurses from violence in the workplace, though some states have passed them on their own. State-specific measures include requirements that hospitals develop violence-prevention programs, such as teaching de-escalation techniques, and increased penalties for people convicted of assaulting healthcare workers. In October, California passed the toughest guidelines in the country, obligating healthcare employers to develop tailored violence-prevention plans for each workplace with employees’ input. But the problem has gotten so bad that the U.S. Department of Labor is considering setting nationwide workplace-safety standards for hospitals in order to prevent this kind of abuse.

Patients with dementia or Alzheimer’s and patients on drugs were the most likely to hurt nurses, according to one research study published last year in the Journal of Emergency Nursing. The study surveyed more than 700 registered nurses at a private hospital system in Virginia, and 76 percent said they had experienced physical or verbal abuse from patients and visitors in the previous 12 months. About 30 percent said they had been physically assaulted.

Working directly with patients in emotional and physical pain has always put healthcare workers at risk of violence. But  in the past decade or so, there has been a 110 percent spike in the rate of violent incidents reported against healthcare workers. The intensifying abuse has a lot to do with money: During the Great Recession, public and private hospitals began slashing budgets at the same time people were losing jobs—and their health insurance. That meant fewer nurses and security guards available to help when patients got out of control, and more people turning to hospitals instead of private practice for medical care since they couldn’t be turned away due to lack of insurance. States also cut billions of dollars in funding for preventative mental-health services, which likely had a significant effect on the frequency of violence against doctors and nurses. Psychiatric patients are increasingly seeking treatment in hospital emergency rooms, where staff are often unprepared to deal with violent outbursts. “This is creating volatile, unpredictable situations,” says Bonnie Castillo, a registered nurse and director of health and safety for National Nurses United, a labor group representing more than 160,000 nurses across the country. Her organization has been pushing states to pass laws to protect workers in the healthcare industry.

"A delirious patient kicked her so hard in the pelvis that she slammed into a glass wall and fell to the ground. She was two months pregnant."