1. Boerger, Judith MBA, MSN, RN, NEA-BC

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As the Chief Nurse Executive of a 10-hospital system, I often find myself thinking how did I get here? As I talk with my colleagues, it is often an evolution over time as well as being positioned to accept the opportunity when it is presented to you. Certainly, the more recent trends toward mergers and acquisitions have led to more hospital systems being formed. Even so, the position of chief nursing executive is not always considered a necessity. Although nurses play a strategic role in the quality and safety arena, their contributions and opportunities to lead significant change and innovation across organizations and systems is sometimes overlooked.

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I began my career in Perioperative Services, then known as the Operating Room. My area of expertise was cardiac surgery. We had just begun to do coronary artery bypass graft procedures, so it was a challenging time. I had a concern that patients were not well prepared for the procedures, and being a problem solver, I started rounding on and educating patients preoperatively and postoperatively. It was this initiative that drew attention to me and my goal to make things better. At that time, a new hospital with new operating rooms was being built with a central service department that would supply instruments and supplies to the operating room for all procedures-a new idea for the time. I was asked to coordinate the purchase of instruments and supplies and to educate staff and design work flows and processes. This meant stepping away from nursing and into the realm of materials management where I learned a tremendous amount about purchasing, contracting, finance, teamwork, work processes, and statistical process control. Leading a support service gave me a different perspective, and I gained a tremendous respect for the work and engagement of my coworkers. After receiving a promotion and serving as the Director of that area for several years, I was yearning to return to nursing, and because of my experience, I was hired by another organization as the Director of Operating Rooms where they were again building a new hospital addition to include case carts. It was at this hospital that I had the opportunity to grow professionally through the mentoring and encouragement of the Chief Nursing Officer. Having hired in with a nursing diploma, I attained my Bachelor of Arts and Masters in Business Administration. She allowed me a flexible schedule to meet what were traditional classroom demands, an accommodation I am still grateful for today, and when I graduated, she encouraged me to seek opportunity outside our organization. With her strong recommendation, I was hired as a Vice President for Nursing. Her mentorship gave me someone to talk through my approach to problems and issues. She was wise, and I was fortunate to learn every day from her. It is my strong opinion that having a coach or mentor is invaluable for professional development and career advancement. My mentor helped me find my nursing voice.


As the Chief Nurse Executive, I feel that having that unique nursing voice at the executive level is of vital importance to the success of any healthcare system. It has been my privilege to speak for nurses and for the profession in a way that promotes collaboration and teamwork across the clinical setting as well as the community. I have sought to shine a light on the daily contributions that nurses make to continue our health system's mission and vision and to align nursing's strategic goals with that mission and vision. My broader scope across the system is to facilitate and lead collaborative efforts, bringing together constituents across all clinical professions (American Nurses Association, 2016).


Speaking with one voice for nursing requires a cohesiveness and alignment that begins with nursing leadership. Creating a sense of purpose and the challenge to be among the best in the nation where patients receive care and nurses practice has been my true north. Inspiring and illuminating the path to excellence and professional growth while providing practical approaches to removing obstacles in that path is how I see my daily practice as a nursing leader. Encouraging and developing nurses to step out and seek board positions to influence and lead in their communities is another focus and in alignment with the Institute of Medicine 2010 Future of Nursing Report recommendations (Institute of Medicine, 2011, p. 283).


The essence of a successful nursing leadership team is communication. I make an effort to communicate in a variety of ways and in a cadence that has become routine. I have long been a true believer of Porter-O'Grady 's research on the power of shared governance (Porter-O'Grady, 2019). Listening to the voice of the clinical nurse and empowering the nurses in our system to unleash the creativity and ingenuity they possess have been the secret sauce to any success we have achieved and certainly our system Magnet designation. By facilitating the opportunity to meet monthly with nursing leadership as well as our shared governance chairs at our Nursing Coordinating Council to exchange best practice, to seek out each other's wisdom, and to spread that knowledge, I continue to learn. I also have the opportunity to connect in a real, authentic personal way with nurses across the health system.


One of the more difficult challenges in this role is maintaining visibility. The distance to travel and creating the opportunity to meet with nurses makes developing and maintaining relationships with clinical nurses as well as nursing leaders even more important. Furthermore, although we are a system and have a system culture, each hospital has a unique approach that is reflective of the community they serve, and it is important to understand and to be respectful of that uniqueness because it is the glue that bonds the coworkers and community to the hospital.


Finding the strength in this diversity is both the challenge and the opportunity. Building a team and encouraging open communication and a work environment that is a reflection of your leadership and your values is the legacy we all hope to create. Part of this legacy is in the development of those who will follow. We all have a sacred duty as a profession to mentor and grow those who will fill our place. This is the foundation of the legacy we leave behind.




American Nurses Association. (2016). Nursing administration: Scope and standards of practice (2nd ed.). Author. [Context Link]


Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. The National Academies Press. [Context Link]


Porter-O'Grady T. (2019, January). Principles for sustaining shared/professional governance in nursing. Nursing Management, 50(1), 37-41. [Context Link]