1. Hill, Karen S. MSN, RN, NEA-BC, FACHE


This department highlights nursing leaders who have demonstrated the ability to inspire and lead change. This competency is seen in the ability to create, structure, and implement organizational change through strategic vision, risk taking, and effective communication. Each article showcases a project of a nurse leader who demonstrates change in a variety of environments ranging from acute care hospitals to home care and alternative practice settings. Included are several "lessons learned" applicable to multiple settings that provide insight for other nurses in executive practice.


Article Content

Marjorie Splaine Wiggins, RN, BSN, MBA, NEA-BC, the vice president of nursing at Maine Medical Center (MMC), is not a novice nurse executive. Maine Medical Center, located in Portland, Maine, has 606 licensed beds and provides comprehensive inpatient services in all medical specialties including cardiac, oncology, and pediatric services within a teaching environment. Marge is a whirlwind of inspiration and change. Achieving and then sustaining this momentum in executive practice is an "art and talent" and one that is necessary to transform nursing culture and the healthcare environment. O'Grady and Malloch1 reflect that "in current efforts to establish evidence-based clinical processes, success will be limited to the extent that the systems connections between stakeholders are made and the interface of collaborative efforts is established." Marge Wiggins is a "connector" with stakeholders.


Marge received a diploma in nursing from Quincy Hospital, a bachelors degree in nursing from Salem State College, and a master's of business administration from the University of New Hampshire. Currently, she is attending the University of Kentucky to attain a doctorate in nursing practice. Continuing her education is one way Marge keeps challenging herself as a seasoned nurse leader. Marge has held roles in nursing leadership on several levels, including as a director of nursing, clinical operations director, and director of medical-surgical nursing. Within 3 years of becoming a registered nurse, Marge began serving in leadership roles, which included supporting her state nursing organization and most recently functioning as chairperson of the practice subcommittee of the American Academy of Nursing's Task Force on the Implementation of the Clinical Nurse Leader Role.


Innovation at MMC

Research is a focus for the nurses at MMC. Marge has created an environment to support risk taking through research within her organization by creating and supporting the Center for Nursing Research and Quality Outcomes. One component of the mission of the center is to "research new ways to provide care." The center has developed a clinical scholar series that includes 6 full-day workshops to teach nurses at the bedside how to conduct research. More than 400 nurses have attended the series and initiated hundreds of projects to provide new evidence for the hospital and the profession. Many of the research projects presented nationally and internationally have won awards from a variety of organizations and are published in peer reviewed journals.


A love of research, evidence, and scientific inquiry drives Marge to constantly challenge herself, nursing leaders, and staff nurses to try progressive approaches to care delivery. Marge is described by Lindberg et al2 as having a "vision for nursing in the twenty-first century that has emerged from devoted attention to detail, theoretical scholarship, empathy and the infusion of lofty time-honored ideals into a high-tech environment." These beliefs and values have supported Marge to reflect on her own organization as she looks for opportunities to add value to the patient and staff experiences at MMC. Currently, under Marge's leadership, staff nurses are working on developing a new care delivery model that is based on the concept of partnership with patients and families. One key factor to success in this exploration is staying in touch with the staff at the bedside. Marge frequently schedules 2- to 4-hour blocks of time to shadow staff from various units in MMC. In addition, she attends many of the numerous shared governance councils and rotates her hours of rounding to be visible to as many of the more than 1,600 nurses in her workforce as possible. Marge has articulated a vision of leadership that includes creating a shared vision, empowering staff and leaders, creating an environment of passion for nursing, and celebrating achievements.


One innovation in care that Marge is particularly proud of is the development of the clinical nurse leader (CNL) role in MMC. Through serving as the chairperson for the practice committee of the AACN Clinical Nurse Leaders Implementation Task Force, Marge had the opportunity to be an early adopter of the new role and to integrate current hospital needs and the evolution of a new component of care into the delivery model. Marge sees CNLs, who are master's prepared, as having in-depth knowledge about the medical and nursing decisions surrounding their caseload of patients as they act as a "connector" for all care providers. Partnership between the care providers and the patient is key, and the CNL is a facilitator for this collaboration. Marge has 7 CNLs thus far, with 6 more in graduate programs. Successes include a 14% decrease in ventilator days for critically ill patients, decreased utilization of transfusions for total knee replacement patients, and significant improvements in many nurse-sensitive quality indicators. In addition to a caseload, the CNLs also look at high level population improvements like these and have realized more than $1,000,000 of savings for the organization due to these practice changes alone.


Leadership Lessons Learned

Some lessons learned for new and less "seasoned" nurse executives include the following:


* Keep balance in your life. Marge has so much passion for her work that it would be easy to be consumed. She sets aside time for boating on the beautiful Maine coastline as well as extensive travel and spending time with her daughter and 4 grandchildren. Through keeping a balance, the nurse leader can regenerate thoughts, enthusiasm, and energy for the tough day-to-day challenges.


* Support an environment of empowerment. Staff nurses are key to initiating, evaluating, and sustaining change. Marge includes staff nurses in every component of the organization and ensures that they are driving nursing practice and are at every table where decisions are made about patient care.


* Surround yourself with talented people. Marge has worked to cultivate a leadership style in each position that she has had. Marge identifies talent, seeks out leaders who will support innovation and change, and supports these individuals as they go about doing the work to create the vision and thus create leadership capacity within the organization. Marge works collaboratively with other departments and feels that this has been a key to success in many projects and initiatives because nursing is not the only profession that must be involved to change care delivery.


* Continue to challenge yourself to innovate. Marge has found that every experience builds your toolbox of talents and skills. She has gained an appreciation for education and executive talent and incorporates principles of leadership from these disciplines within her role. Marge has found that she enjoys reading and must stay current to challenge herself on developments in leadership and clinical realms.



Marge Wiggins is seasoned! Marge has committed a portion of her career to invigorating herself personally and professionally and, thus, invigorating others. As she so succinctly put it, "I love to see nurses advance to the place they should be, and innovation is the key to getting there."




1. O'Grady T, Malloch K. Quantum Leadership. Sudbury, MA: Jones & Bartlett; 2007. [Context Link]


2. Lindberg C, Nash S, Lindberg C. On the Edge; Nursing in the Age of Complexity. Bordentown, NJ: Plexus Publications; 2008. [Context Link]