On December 2nd, Dr. Donald M. Berwick will step down as administrator for the Centers for Medicare and Medicaid Services (CMS). Replacing Dr. Berwick will be Marilyn Tavenner, who served as Berwick’s deputy principal administrator since April 2010. The first article I read about this development was last week on Reuters.com. Toward the end of the article, I read “Tavenner is a former Virginia health secretary and hospital chief executive. A nurse by training, she has been with CMS since February 2010, first as acting administrator and currently as principal deputy administrator." A nurse to head CMS? Yes!

Since last week, I’ve read more about the sequence of events leading to Dr. Berwick’s resignation as well as more about Marilyn Tavenner’s background and experience. In this blog post from the Washington Post, Tavenner’s path from ICU nurse to this nomination is chronicled in detail with comments from former colleagues describing her as respectful, quick-thinking, decisive, and hard-working. In an article on HealthLeaders Media, more former colleagues share their thoughts and feelings of Tavenner’s pragmatism, leadership experience, and decision-making skills. 

The American Nurses Association (ANA) has released a statement commending the White House for its decision to nominate Marilyn Tavenner, MHA, BSN, RN, to head CMS.  I’d like to join in on the commendation. Seeing a nurse take on such a prominent leadership role makes me feel proud – how about you?

There are certain words and phrases that are used frequently in nursing and medicine – sometimes so frequently that we lose our understanding of their true meaning. Or sometimes, we may not have really understood them at all.

For me, “shared governance” was one such phrase. In the past, if someone had asked me what shared governance meant, I would have had some difficulty explaining it in great detail. Sure, I would have answered that it’s a model for nurses to work together and manage themselves, but beyond that, I’d have been at a loss.

That is, until, I did some reading. Now I feel better prepared to discuss shared governance and its role in nursing. Here’s what I’d say now:

Shared governance is collaboration, whether in scheduling staff, educating new staff, or implementing evidence-based practice. It involves teamwork, problem-solving, and accountability, with the goals of improved staff satisfaction, productivity, and patient outcomes. It is working together to make decisions that affect nursing practice and patient care. It is working with other disciplines for the good of the patient. It is collaborating to improve nursing practice. 

Allow me to share the following excerpt which I found very enlightening:

The structure is shared governance; the process is professional nursing practice; the outcomes are positive productivity data.¹

Is a shared governance structure in place where you work? Have you been involved with implementing shared governance? I'd love to learn more; it sounds like the ideal working environment, but I'm wondering - does it truly exist?

1. Church, J.A., Baker, P., Berry, D.M. (2008). Shared governance: A journey with continual mile markers. Nursing Management, 39 (8).

What does it mean to be a leader? In the past, I would think of a nurse leader as any nurse in a management position or an advanced practice nurse. After reading Finding the Leader Within: Thoughts on Leadership in Nursing, my perspective has changed. Let me share the following words of the authors to help you understand why we all can be, and should be, nurse leaders:

…real leadership is less about a title or institutionally granted power, and more about how we “show up” in the myriad of moments that make up our days.

…leadership is an “in the moment experience”

…being a leader is basically about constantly trying to be a better person.

The authors’ work has focused on helping individuals find the “leader within” and developing behaviors to share their leadership with others. To do this, they identified five “skill-cepts”, that is, skills derived from leadership concepts:

1. Know your stuff - have the knowledge and be confident in it
2. Have a goal - know where you are going
3. Stay “in role” - focus on your goals and how to achieve them; avoid taking things personally (you really must read this part of the article in its entirety!)
4. Love the fight - recognize resistance as a sign that you are making an impact
5. Cultivate gratitude - remember there is always something positive to gain, even when you are faced with challenges

I hope you find this article as inspiring as I did. You can read it free online until 7/1/11 as it is from our current featured journal. Let me know what you think!

Reference: Gordin, P.C. & Trey, B. (2011). Finding the Leader Within. Journal of Perinatal and Neonatal Nursing, 25(2), pp. 115-118.