1. Reid-Ponte, Patricia DNSc, RN, FAAN, NEA-BC


In this column, Dr Reid-Ponte interviews Dr Karen Cox, current president of the American Academy of Nursing and chief operating officer for Children's Mercy Hospital in Kansas City. Dr Cox discusses her leadership trajectory and lessons learned.


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Dr Reid-Ponte: You have had a successful career. Many times nurses look at longevity in an organization or a position as an impediment to career advancement. How many years have you been in your current organization and role?

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Dr Cox: I've been working at Children's Mercy Hospital in Kansas City (CMKHC) for 30 years except for working at Children's Hospital of Philadelphia from 1988 to 1989. I was recruited back at CMHKC to open the hematology/oncology unit and became the service line director. After my appointment as chief nursing officer (CNO), the hospital achieved the prestigious Magnet(R) designation in 2003, which we maintain today. I currently serve as chief operating officer (COO). The growth of our organization has been amazing. Initially, we had 1500 employees, and now we have more than 8000. Throughout my time, I have consistently taken the time to show respect for everyone I encountered, and I am proud to say I have a trusting relationship with the staff. I have been fortunate for the past 25 years to work with a forward-thinking chief executive officer (CEO), who has helped the organization thrive. He has recognized the value of my academic and professional work, which, in addition to supporting me, has helped expand the organization's academic standing.


Dr Reid-Ponte: Could you share how you work with the CNO of your organization while being a nurse in the COO role?


Dr Cox: The senior vice president of patient care services/CNO reports to me, and we think of ourselves as peers, working collaboratively to meet the organization's priorities. Often, nurses in executive roles outside a nursing department overaccommodate for being a nurse. When you have a nursing perspective, you use it in everything you do. We should always be proud of our profession and the value that our perspective brings to the situation just as someone with an MBA sees the world through that lens. These different world views are important for the executive team, and we all need to be open to each other's viewpoint. I must mention here that I'm bothered by COOs and CEOs who are nurses and drop the RN credential. I think it's critical to have the internal and external stakeholders know your clinical discipline if you have one. I've never seen an MD who is a CEO or COO drop his/her clinical credential.


Dr Reid-Ponte: How have you used this stability and longevity in your organization to your and the organization's advantage? How has it been instrumental to the success of your organization?


Dr Cox: I go back to trust, respect for all, and humility. It is important not to let knowledge and respect for the past slow you down as you innovate for the future. Please don't use examples from the 1980s or 1990s; it makes you look old and irrelevant. Longevity in any organization means you can't just focus inward. You must have leaders who are true lifelong learners in the healthcare industry as well as in their role and area of practice because if you aren't moving forward, you're moving backward. Additionally, being a longstanding member of the Kansas City community is helpful. I have served as chair of both the Kansas University Research Institute and the Health Care Foundation of Greater Kansas City, both great opportunities for me and the organization. When you are new, it takes time to build your political capital and find your passion.


Dr Reid-Ponte: What are some key lessons you have learned in your career?


Dr Cox: I started my career as a licensed practical nurse. In that role, it was obvious which RNs thought of me as a colleague and which saw me as a 2nd-class citizen. That experience has made an impact on both how I practice and lead. I have a deep respect for everyone in the healthcare setting, from our environmental services staff to our clinical teams. You may say everyone is important, but people know if you mean it. Being humble is so critical to effective leadership. We need to keep our egos in check. I also keep in mind that I'm always representing the organization wherever I am. Finally, I work hard and love my time off. Do I work on weekends? Absolutely, but I make time for rest and recharging. It's important to role model self-care and not expect everyone to accomplish their work in the same way you do.


Dr Reid-Ponte: What do you see as the biggest challenges for nurse leaders in the next decade?


Dr Cox: Healthcare is constantly changing. It's a given that there will be fewer dollars in the future for healthcare. Moving to value-based payment requires changes to many care processes. We currently have approximately 20% of our net revenue tied to some form of risk sharing. Having owned a Medicaid HMO and Integrated Care Solutions, we are familiar with these arrangements, but we still have work to do. Value-based care requires us to think differently about children's and families' health. Only 20% of a person's health is related to healthcare; the rest is attributable to genetics, behavior, and the social determinants. Another disruptor relates to consumers wanting immediate access and a positive experience. With mergers of health insurers and drug store chains that own clinics, it's easy to see how traditional hospital and ambulatory clinic business models could be marginalized. To be successful, we must be innovative and aggressive in developing our own more convenient, cost-effective options. Nurse leaders have an opportunity to show the value of nurses in these new pay models. Nurse leaders will also need to be creative in deploying nurses, and it is important we consider and address the nursing shortage. For example, public health and ambulatory become even more critical.


Dr Reid-Ponte: What advice do you have for nurses who want to be involved in policy, professional association work, and so on, at the state, national, or global level?


Dr Cox: Policy skills are important as a nurse leader and a citizen. Policy work is often slow paced and requires a different skill set and mind-set. We need to find an organization whose mission we are passionate about. Too often, people think they can join an association and immediately be considered for a board seat. It's important to 1st do some of the less glamorous work and do it well. People notice that, and it increases your name recognition. When I became a fellow, I knew I wanted to be involved (but not necessarily president!). Prior to being president-elect/president, I served as cochair of an expert panel, member of conference planning, chair of nominating committee, and board secretary. You shouldn't run for office if you aren't prepared to lose.


Dr Reid-Ponte: As the president of the American Academy of Nursing (AAN), what are your priorities?


Dr Cox: I am honored to lead the AAN. AAN is not an inward-facing group focusing on 1 aspect or specialty. Rather, it is outward facing and focused on improving the health of the public through promoting bipartisan policy based on the best evidence available. The board has identified 5 priorities that guide our work: (1) violence prevention, (2) reproductive rights, (3) environmental health, (4) toxic stress in children, and (5) opioid crisis. We are committed to making sure our fellow selection process is as applicable to outstanding leaders in service as it is to those in the academic setting. We need a strong representation across sectors.


Dr Red-Ponte: Thank you, Dr Cox, for what you have done for CMKHC and for AAN. Nurses across the globe can learn a lot from your career path.