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.

A strong connection with an anesthesiologist at the mechanic shop he worked in inspired Chris Graham to pursue nursing school, but little did he know that years later, he would inspire his son to do the same thing.

Graham, a 48-year-old resident of Baton Rouge, walked across the stage to graduate from Our Lady of the Lake College in 1999, and a few weeks ago, his second son, Stefin, accomplished the same feat when he received his diploma from the newly dubbed Franciscan Missionaries of Our Lady University.

Chris serves as the director of Nursing at Jefferson Oaks Behavioral Health, and Stefin has been hired to work in the intensive care unit at Our Lady of the Lake Hospital.

In 1995, Chris was working at BMW of North America as a mechanic, married to a schoolteacher and the proud father of two sons, but he knew that eventually he wanted to pursue another career path.

Although he didn’t know exactly which field he would pursue, Chris began taking prerequisite courses at night while working a 40-plus hour workweek at the mechanic shop.

It wasn’t until he struck up a relationship with a local anesthesiologist who became a regular at the shop that he decided to turn toward the medical field.

“I said, ‘Doc, I can’t go to nursing school with these kids,’ and he said, ‘Aw, yeah you can. Just put your mind to it.’ Long story short, I ended up registering at Our Lady of the Lake College, and in 1996, I took my first nursing class,” Chris said.

Being accepted into the program was only the first of many hurdles he had to overcome on the long road to graduation.

“Once I got accepted into nursing school, we had two more children,” said Chris. “My wife, Jeri, was a full-time teacher, and I quit working for BMW North America and put all my efforts into nursing school. At that point, I became a stay-at-home dad, and we went from having my six-digit salary to living on a teacher’s salary, which was tough with four kids and a house. Somehow, we got through it, though, and I love what I do.”

Chris’ hard work did not go unnoticed, since he was the first person to receive the Dr. John Beven Award for graduates who exemplify the art and science of nursing, and years later his second son, Stefin, chose to pursue the same career path.

Stefin said, “I was maybe 8 or 9 years old when my dad graduated from nursing school, and I didn’t realize what a big feat that was until I was older. He didn’t just have me, he was also taking care of my two younger brothers and my older brother, so he graduated nursing school with four kids.”

Although watching his dad was inspiring, for Stefin, the decision to pursue nursing was solidified while doing service hours as a high school senior.

Stefin said, “When I was in high school, I had to do service hours, and my dad helped me get those by bringing me with him to work. He worked in a surgery center, and I would go with him to see the patients. I loved seeing what he did as a nurse, and I felt like that was the type of trade I could enjoy and pursue.”

Growing up, Stefin always felt drawn toward caretaking roles, so the unit he chose to work on was a natural fit for him.

Stefin said, “I feel like I was always called to be a caregiver to other people, and my faith teaches me that in serving others we are served. About halfway through school, we did our ICU rotations, and I really fell in love with it. You get to take care of the most vulnerable patients who often can’t speak for themselves.”

The nursing legacy of the Graham family will be continued when the fourth Graham son, 18-year-old Austin, starts classes in the fall at Franciscan Missionaries of Our Lady University.

For Chris, seeing his sons follow in his footsteps is an honor unmatched by little else.

Chris said, “It makes you wonder: Did they mimic and learn from me, and did I help to encourage this somehow? I teach my children to go after their own aspirations, not what other people tell them to do, so it’s been humbling to see them pursue nursing.”

A grant from the National Science Foundation has led engineering and nursing students at Duke University to create a robotic “nurse” to assist human nurses, according to an article published in the News & Observer. The robots are being tested as “alternatives to human contact to diminish risks for providers,” who are caring for patients with infectious diseases.

The first-generation robot called “Trina” (Tele-Robotic Intelligent Nursing Assistant) can perform tasks, albeit clumsily at present, such as delivering a cup, a bowl, pills and a stethoscope to a patient. Its face is a computer screen on which an actual nurse’s face appears.

In the fall, students conducted a simulation with a fake patient using the remote-controlled robot, which has a price tag of $85,000.

Plans for the next generation of Trina include giving her a “more friendly and human-like appearance” and enabling her to collect and test fluids, the article stated.

“We need to establish a better interface with the human and the robot to make them work together and be more comfortable,” Jianqiao Li, engineering student, said in the article.

A Business Wire article stated that by 2021 robots will be a growing presence in the healthcare system, surpassing 10,000 units annually.

“More than 200 companies are already active in various aspects of the healthcare robotics market,” said principal analyst Wendell Chun, in the article. “These industry players are creating highly specialized devices for a wide range of applications, and the use cases will continue to expand as costs decline and healthcare providers recognize the early successes of robots in supporting high-quality care and a range of ancillary services.”

MIT has been teaching robots to assist nurses with scheduling. A robot can observe humans working on a labor and delivery floor and then formulate an efficient schedule for staff, according to the July 2016 MIT News article.

Nurses’ positive comments about the robot included that it would “allow for a more even dispersion of workload” and that it would be helpful to new nurses who are acclimating to their roles.

“A great potential of this technology is that good solutions can be spread more quickly to many hospitals and workplaces,” Dana Kulic, an associate professor of computer engineering at the University of Waterloo, said in the article. “For example, innovative improvements can be distributed rapidly from research hospitals to regional health centers.”

Another robot project funded by the NSF is developing robots to help nurses lift patients and heavy objects.

“The proposed Adaptive Robotic Nurse Assistants will navigate cluttered hospitals, while equipped with multimodal skin sensors that can anticipate nurse intent, automate mundane low-level tasks, but keep nurses in the decision loop,” according to an award abstract. “Modular and strong hardware will be deployed in reconfigurable platforms specially designed for nurse physical assistance.”

Related Article: A Robot Delivers Meds at Dana-Farber