1. Adams, Jeffrey M. PhD, RN


This department highlights nursing leaders who have demonstrated a commitment to patient care leadership and innovation in practice, policy, research, education, and theory. This interview profiles Karen Hill, DNP, RN, NEA-BC, FACHE, FAAN, chief operating officer and chief nursing officer of Baptist Health in Lexington, Kentucky, and editor-in-chief of the Journal of Nursing Administration.


Article Content

Adams: Dr Hill I appreciate you speaking with me today. You are the chief operating officer and chief nursing officer (COO/CNO) at Baptist Health in Lexington, Kentucky, and you are the editor-in-chief (EIC) of JONA, among other commitments. Can you speak a little about your leadership career trajectory?

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Hill: Jeff, thank you for this opportunity to share. I think about my career as evolving simply because I love patient care. I really didn't go into nursing thinking that I was going to do anything besides be a great bedside nurse. However, through networking, I became aware of other opportunities in nursing. I recognized other roles that I would enjoy and further contribute to patient care.


Adams: Correct me if I'm wrong, but you started your career in the same hospital where you're currently the chief operating officer/chief nursing officer (COO/CNO). That is unique. What do you think best prepared you for your leadership roles?


Hill: That is correct. I volunteered in the junior auxiliary during high school. I admired the nurses so much that I decided that I wanted to be a nurse. I've lived in the same town most of my life and worked at this hospital all but 4 years of my 36-year career. I've performed different roles here over the years from cleaning test tubes for my 1st job to bedside nursing, nursing education, nursing administration, and now my current role as COO/CNO. My early colleagues had a great impact on me. I think one of those leadership lessons I've learned is you never know who is watching and how you're going to inspire people. I hope I've been able to, in turn, be a good example for other nurses. I am certainly a good example that you don't have to move around to have a great career. You do have to take advantage of strategic opportunities, prepare yourself, and find people who will help support you and open doors.


When I started my current role as COO/CNO, I was concerned that I wasn't ready. However, I also knew that I would work hard and seek learning opportunities. I was inspired by Diana Weaver, DNSc, RN, FAAN, AONE, past president, who at the time was CNO of a hospital here in Lexington. I shadowed her during my master's program and immediately knew that I wanted a career like hers. My current role provides gratification not only because I help lead and contribute to optimal patient care, but I get to help nurses and other staff realize the potential of their careers, similar to what others have done for me.


Adams: Dr Hill, your accomplishments, experiences, and credentials suggest you are very driven. You are credentialed as a nurse executive through American Nurses Credentialing Center, a fellow in the American College of Health Executives, a Robert Wood Johnson Foundation (RWJF) nurse executive alum, and a fellow in the American Academy of Nursing. What drives you? And secondly, what's next?


Hill: In a nursing executive role, you are the role model for your staff and for people in your community and beyond, representing nursing. As far as the credentialing and the certifications that I've achieved, I've done those things to set the bar for my staff and to help them realize that they can accomplish those things. I feel it is a professional obligation as a nurse leader to pursue personal excellence. In an executive role, you have to be your own coach. You have to be realistic about your time, opportunities, skill deficiencies, and your abilities. I think strategizing, being goal-driven, and trying to make a meaningful difference have been drivers for me. As far as what's next? I am in a good place, love my work, and feel that I am making a difference for others. To be able to continue that is my future goal.


Adams: On the topic of JONA, can you speak to your development as a writer and role as the EIC?


Hill: Early in my career as a CNO, I recognized that I desired to develop a well-rounded portfolio of competencies including credentialing, certifications, publications, and presentations. Professional publications were a real interest during this time, and as with any skill, you must practice to gain expertise.


My first publications were collaborations with a friend creating small department columns in Nursing Management. It was fulfilling to see our work in print. It felt like somebody was listening to our voice, the voice of people in practice settings. In 2003, I submitted an article to JONA based on my RWJF Nurse Executive Fellowship project. I became acquainted with the then JONA EIC, the late Dr Suzanne Smith. Soon thereafter, Suzanne sent out an e-mail to JONA authors soliciting ideas for a new column. I answered quickly and gave her an idea for what is today Inspiration Point. We forged wonderful relationship, and I counted on her as a mentor and friend. I expressed my interest in becoming an editor. I published more than 60 articles during those years, and with her mentorship and encouragement, upon her retirement in 2011, I was named the EIC.


Adams: Throughout our discussion today, you've spoken quite a bit about mentorship.


Hill: I've had people in my career who have been generous in their knowledge, and it is wonderful when people are secure and nonthreatened in their mentorship. I think that is such an admirable characteristic in a leader. It really helps others and it helps you. I have that level of support now from my CEO who has been my boss for over 22 years.


Adams: Building on that, how might someone in school, a midlevel manager, or a junior researcher get more involved in writing for JONA?


Hill: I tell novice authors that writing for JONA is an attainable goal, but a lot of work goes into the writing and revision of a JONA manuscript. Read the "Guidelines for Authors,"1 tap into an experienced writer, and have them review/critique your work. School papers and internal reports don't translate well into journal manuscripts. At JONA, we receive around 350 manuscripts a year. I publish 11 editions a year with about 12 articles (full manuscripts and department columns) a month. An annual Magnet(R) supplement in October is the 12th edition. We publish about 25% of the submissions either initially or through the revision process, and our initial acceptance rate is 15%. JONA's impact factor in 2013 was 1.373. A recent article rated JONA as the most frequently cited nursing journal in the last decade.2 I take my responsibility for JONA very seriously, and I want to continue to maintain the respect that JONA has among the readers and authors across the world. Because busy nurse administrator readers use their valuable time to read this journal, the articles have to be timely, concise, and well-written and inspire others to act.


Adams: Aside from the successes of JONA, in your professional role what brings you the greatest sense of accomplishment?


Hill: Professionally, there are a many things that have been a source of satisfaction. One is when Baptist Health Lexington achieved Magnet accreditation for the 1st time in 2004. Supporting that vision with my staff was a great sense of accomplishment because we did it together and were recognized for achieving excellence. Personally, being inducted into the American Academy of Nursing as a service-oriented nurse leader was particularly rewarding because those of us in administrative and practice roles can and do have sustained impact to nursing but are often not recognized. A personal and professional source of pride stems from being a working mom and raising fun, successful children. I've been working continually, returning to school, and engaged in demanding jobs, and my now adult children are amazing. Through this, my kids are very proud of the fact that I was a working mom. I also have a supportive husband who has been my partner and friend since we met at age 14! Together we make family and work shared priorities.


Adams: What do you feel are the most pressing issues for nursing leaders to know about?


Hill: We need to see evidence-based projects demonstrating the value of nursing in healthcare reform models. We will experience pressure to change the model of acute care and take it beyond the hospital walls across the continuum. I would like to see nurse leaders and nurse researchers developing projects to test roles to quantify and highlight the value of nursing.


Adams: Are you seeing these pressures in your role?


Hill: Yes. I'm seeing the boundaries of where acute care starts and stop fade. Our hospital has nurses, hospital employees, calling patients up to 30 days after they leave to make sure that they're still taking their medication(s) and that they have an appointment scheduled with their nurse practitioner or physician. We have nurse navigators who have formed long-term relationships with their patients over time to support them. The boundaries and expectations have changed, and new interventions and resources have to be substantiated.


Adams: What is an example of an innovation you're implementing at Baptist Health Lexington?


Hill: In May, my staff published an article developing and testing a new high-risk-falls assessment tool.3 This was a challenge because we developed it based on data and evidence from the literature and tested it across 5 facilities. We are continuing to trial care innovations. The new tool takes 1 minute to complete, which is good for nursing and effective for the patient. We must decrease waste in our systems and maximize nursing resources including time.


Adams: Are there things that you think that we didn't touch on that you wanted to speak about?


Hill: I'd like JONA readers to know that I am a nurse who has a very interesting career impacting others beyond traditional boundaries because I prepared myself and set goals. I want readers of JONA to know that you need to be strategic about your career; look for those who will support you and take risks.


Adams: Dr Hill, thank you for taking the time to speak with us. Baptist Health Lexington and JONA are fortunate to have you guiding the ship.


Hill: Jeff, thank you; it has been a real pleasure.




1. Guidelines for authors. Accessed August 12, 2014. [Context Link]


2. Lee Y, Chen S, Kuo J, & Chou H. The status of nursing leadership studies: its invisible network of knowledge. Int J Model Optim. 2014; 4( 2): 157-162. [Context Link]


3. Corley D, Brockopp D, & McCowan D The Baptist Health high risk falls assessment: a methodological study. 2014; 44( 5): 263-269. [Context Link]