1. Massella, Joan RN, BSN, MEd, MBA

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In today's complex and continually changing healthcare arena, it is the visionary leadership of St. Clair Hospital's Chief Nursing Officer Joan Massella that has helped the organization remain an independent, fiscally sound institution that provides high-quality patient care. While much in the nursing news reflects negativity and reactivity, Joan's vision and optimistic view toward the profession of nursing enables her to lead St. Clair Hospital nurses forward-illustrating the creative possibilities of nursing for today and the future. Joan's own enthusiasm is a driving force in spreading her vision to others throughout the organization and energizing others to reach their fullest potential.

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As stated in Nursing Management 's award criteria, "the visionary nurse leader views nursing as both an art and a science by promoting caring and competence as the link between science and humanity." McLaughlin (2001) identifies the following qualities of the visionary leader, personal characteristics at the heart of Joan's leadership that she lives daily:


[white diamond suit] devotion to the profession of nursing


[white diamond suit] strong commitment to the values of nursing


[white diamond suit] personal integrity


[white diamond suit] value of positive relationships as key factors for effective visionary leadership


[white diamond suit] approachable; listens to others to gain insight and knowledge


[white diamond suit] sees opportunities, not problems


[white diamond suit] strives for win/win solutions that promote growth and learning


[white diamond suit] presents an unmistakable vision of possibilities


[white diamond suit] puts vision into action, both personally and through discerning and mobilizing skills and gifts in others


[white diamond suit] takes risks


[white diamond suit] exhibits confidence in those working with her. 1



Nursing Management 's Visionary Leader award criteria outlines six objectives that define the visionary leader, challenging those who would seek this award to limit discussion to just one area. And while there would be much to share about Joan for each of the objectives, we chose the category of development. Joan is passionate about the personal and professional growth and development of her nurses and of the nursing profession.


Joan received her bachelor of science in nursing from Edinboro University of Pennsylvania, and her first position was at St. Vincent Health Center, Erie, Pa. Of her first position, Joan recalls her positive precepting experience, which helped her forge her own strong belief in the vital need to support nurses not only through orientation, but also throughout their careers. Joining St. Clair Hospital as a staff nurse on the behavioral health unit, advancing to nurse manager, and then to clinical director, Joan has steadily risen through the ranks, progressively adding more responsibilities. In 1997, Joan was appointed administrative vice president and chief nursing officer.


"Joan has been an ultimate leader for nursing. Through her insight and continual desire for exceptional nursing care, she has given all nurses at St. Clair Hospital the opportunity to utilize their individual talents. In doing so, we now have the ability to put our personal signature on the future of nursing. She is genuine. She is the real deal and has been able to reach individual nurses in a way that I have never seen in my 31 years of nursing experience. It is an honor to be a part of our nursing department with Joan at the helm."


Alice Oakes, RN, staff nurse, outpatient surgical unit


Joan models commitment to professional growth. She received her MEd in counseling and education in 1987 from Duquesne University, furthering her skills in caring for patients with mental illness. In 2002 Joan received an MBA from West Virginia University, where she honed the administrative skills needed for her advancing positions of responsibility.


Actively seeks professional growth opportunities, supports professional certification


Beyond modeling professional growth, Joan seeks to make professional growth possible, workable, and attainable. She was instrumental in developing a professional advancement ladder program for the nurses of the organization, encouraging a group of nursing staff and managers to develop a program that would provide maximum benefit. Her vision was that the nursing staff members would utilize this program to maximize their own professional growth. The program includes an "educational account" for nurses-monies they may utilize for professional growth opportunities. Her commitment to the nursing staff generated the enthusiasm to carry this program through its development and implementation. As a result, approximately one-third of the eligible nurses at St. Clair applied for the program.


Joan was also instrumental in seeing that a strong, internal educational resource was brought back to the organization, by way of a clinical and professional development department. Through Joan's commitment to professional development, additional full-time equivalents were developed to ensure that nurses have the support for their professional growth.


Joan encourages membership and participation in professional organizations at local and state levels. Staff nurses and members of the nursing leadership group participate in a number of professional organizations, and many maintain advanced credentials. Joan models this participation through her work on the family hospice and palliative care board of directors, of which she currently serves as vice-chairperson, and through her work as a member of its newly created foundation board. A longtime member of the Pennsylvania Organization of Nurse Leaders, Joan was appointed to the board of its southwestern Pennsylvania chapter in 2003.


Joan initiated the development and implementation of St. Clair's professional practice council, which promotes nurse autonomy by giving nurses a voice in decisions that affect their practice. Based on the belief that the profession can only advance by embracing the collective knowledge of all professional nurses regardless of position within the organization, Joan has modeled nursing in the new world. Under Joan's guidance, the professional practice council enjoys remarkable progress as an integral voice in institution-wide decisions regarding optimum patient care and support of best practices.


Joan was pivotal in the promotion of a new nurse preceptor program, developed out of a need verbalized by new hires within the organization. Joan's initiative to recognize and support preceptors in this role with a 5% pay differential was implemented to underscore the preceptor's importance in the orientation process.


Demonstrates excellence in recruitment and retention


Additional activities Joan has pursued to promote the profession of nursing include:


[white diamond suit] collaboration with human resources to provide full scholarships for 10 nursing students at an area school for nursing


[white diamond suit] creation of a transitions program for senior nursing students, in which the nursing student's last semester is paid through a grant from the St. Clair Hospital Foundation


[white diamond suit] initiation of a tuition-free LPN to RN program in conjunction with the local community college. Twenty St. Clair LPNs started the program in 2002, with 15 graduating.


[white diamond suit] development of an on-site training program for certified nursing assistants and development of a clinical scholarship program


[white diamond suit] reimbursement of tuition to nurses who obtain national nursing certifications.



Her excellence in nursing recruitment and retention is clearly evident in the following outcomes:


[white diamond suit] RN turnover rate of 5.7% compared to national average of 15%


[white diamond suit] RN vacancy rate of 2.7% compared to East Coast rate of 8.2% (Source:VHA East Coast Vacancy and Turnover Report 2004)Fosters technologic environments to enhance the continuum of care and patient safety culture"The current environment for nursing recruitment and retention is difficult, at best. Joan's commitment to workforce initiatives has enabled St. Clair Hospital to achieve amazing things in the face of a national nursing shortage. As the vice president of human resources, I am fortunate to work with someone of Joan's caliber, someone who strives to maintain a culture of nursing excellence and someone who recognizes the fundamental importance of human resource issues."Andrea Kalina, vice president of human resources


[white diamond suit] 100 Best Places to Work in Pennsylvania award winner for 2 consecutive years.



To achieve such outcomes, Joan has implemented and/or fostered the following:


[white diamond suit] annual fall nursing seminar, a full-day conference offered to St. Clair and other area nurses, which hosts nationally known inspirational and motivational speakers


[white diamond suit] recruitment dinners at local restaurants and job fairs


[white diamond suit] "Just Ask Me" committee; Joan meets with staff nurses in a forum to share questions, thoughts, and ideas.


[white diamond suit] salary restructures for veteran nurses


[white diamond suit] preceptor workshop and orientation speaking sessions


[white diamond suit] lunches for senior nursing students


[white diamond suit] Cameos of Caring, a recognition program sponsored by the University of Pittsburgh School of Nursing for nurses who provide outstanding, compassionate bedside care. Each unit Cameo winner is Joan's guest at a restaurant.


[white diamond suit] referral program, offering cash incentives to St. Clair nurses who successfully refer other nurses


[white diamond suit] restructured in-house educational opportunities to meet the requests of staff nurses


[white diamond suit] CRNA recruitment through relationship building


[white diamond suit] nurse-physician liaison committee to improve communications and foster collegiality.



Recognizing the benefits of automation, Joan assembled a group of professional nurses to enhance the facility's current documentation system. This group attained a 33% reduction in time spent on documentation. Although a considerable improvement, Joan realized that true success could only occur by focusing efforts on the integration of all disciplines. Her vision included an automated clinical documentation system that would enhance professional collaboration, develop and strengthen trust between the disciplines, improve communication, and reduce duplication. This focused effort has brought St. Clair Hospital to the brink of a new era with upcoming use of clinical practice guidelines supported by interdisciplinary councils. Her commitment to this process is clearly evident as staff nurses have been directly involved in the design and implementation process of this product.


"Joan has a remarkably clear vision of where healthcare should be. Her goal is to develop a healthcare delivery system which embodies quality, ethics, and caring for each individual who is served."


Alan Yeasted, MD, vice president of medical affairs


"Implementing technology and leading change often go hand in hand. The key to success in both is having the trust of those individuals who are impacted by the change. Joan has earned this trust by showing compassion for everyone in the organization. Nurses believe that Joan will make decisions that are in everyone's best interest, even if that decision involves a new innovation or a leading edge technology. To stay competitive, to increase productivity, and to improve patient safety, technology has to play a role. Joan has a keen sense of knowing when technology is the answer and then she pursues it without hesitation, having the confidence to take risks and know that the organization will follow her lead and make the project a success. Joan has been a visionary in the early adoption of many technologies: handheld and tablet technologies to provide information at the bedside, five rights bar code systems to reduce medical errors, wireless technologies for nursing mobility, evidence-based interdisciplinary documentation for better collaborative outcomes, Web-based educational scheduling for nursing development, electronic forms to reduce paper, and upcoming RFID technology for secure timesaving log-ons, just to name a few."


Rich Schaeffer, vice president and chief information officer


Joan supports an initiative that permits staff nurses to use innovative technology to help solve existing patient safety concerns. She has been the driving force for the adoption of handheld technology that utilizes bar codes to ensure the five rights of medication administration. Joan has provided numerous opportunities for staff nurses to be involved in the development, design, and implementation of this new technology.


The PeriOptimum Program for revamping operative services highlights Joan's commitment to innovative technology. Revisions include a better EHS system and an interface with the OR system to determine the correct cost per case; Intersign (Electronic Signature), made available to the surgeons for the signing of the Nursing Intraoperative Report; and an automated charging system. These and other related changes in surgical processes resulted in an 8% increase in surgical volume, and a maintained utilization of 70% and above.


Recognizing communication as a key element in patient safety, Joan uses technology to enhance communications. She ensured that each staff nurse has access to e-mail and developed a policy that each nurse must check e-mail each workday. Additional initiatives Joan has fostered include:


[white diamond suit] computer training classes, including e-mail usage; e-mail refreshers; beginner and intermediate Microsoft Word, Excel, and Power Point


[white diamond suit] computer kiosks on the units


[white diamond suit] Inter/intranet access from home


[white diamond suit] nursing home page and nursing portal site with links to all nursing sites and current nursing and medical references


[white diamond suit] research and professional practice home page


[white diamond suit] individual nursing unit Web sites


[white diamond suit] online library resources with literature review links


[white diamond suit] updates to the hospital's intranet pages, including: administrative and nursing policies and procedures, committee meeting minutes, PI and safety updates, online newsletters, committee "want ads," and human resource information on employee benefits


[white diamond suit] online availability of career advancement opportunities and application process


[white diamond suit] online learning and resource center, which offers continuing education and electronic registration.



Joan's future plans include engaging nurse leaders and staff nurses in identifying how technology impacts patient throughput issues, communication with patients and families, and the quality of work for bedside nurses.


Joan has impacted the careers of many nurses within St. Clair Hospital. She inspired the Professional Practice Council to create their mission statement: "We can, we will, and we do make a difference." This could easily be Joan's personal credo.




1. McLaughlin, C.:Visionary Leadership, The Center for Visionary Leadership, 2001; available online: [Context Link]