Authors

  1. Sanford, Kathleen D. DBA, RN, CENP, FACHE
  2. Editor-in-Chief

Article Content

Interview With a Nurse Board Leader

Some nurse leaders not only leave a legacy for our profession but also contribute to health care and society through additional activities as productive members of socially relevant boards. An example of this type of leader is Geraldine (Polly) Bednash, PhD, RN, FAAN, who recently retired as the CEO of the American Association of Colleges of Nursing (AACN). Polly currently serves on the Catholic Health Initiatives (CHI) system Board of Stewardship Trustees, which is the governing body for a national system with hospitals and continuum of care organizations in 20 states. Nursing Administration Quarterly's (NAQ's) Editor-in-Chief, Kathy Sanford, caught up with Polly just before she received the National League for Nursing President's Award for a lifetime of serving our profession and those who have benefited from nursing care.

 

NAQ:Polly, I know that you have just retired from AACN after 26 years of service there. How did you happen to get into the work of association management?

 

Polly:As a part of my doctoral program, I was fortunate to serve as an intern with AACN's governmental affairs director. When she chose to go back to teaching, I was asked to take her position. I remember walking in on my very first day and looking at this great big desk and thinking, "Now what do I do?" However, I had already realized that nursing has a great story to tell and I was lucky to get a job where I was paid to tell it. It was pretty exciting.I had never intended to do this kind of work, because I love patient care, but 4 years later I was still at AACN, and I became the executive director (and then the CEO) of the organization! Back then, it was a pretty small organization. I started out with only 7 staff people. A lot of the work we got done was through our "dean's club," which was a network of nursing deans working together to improve nursing education.

 

NAQ:Well, I know that you graduated as a nurse in 1965 and have served almost 50 years in our profession. I also know that you were an active duty army nurse who served in Viet Nam. What other memorable jobs did you have as a nurse?

 

Polly:One of my best jobs after Viet Nam was working as a civilian with the army in Ft Belvoir, Virginia. I was a nurse practitioner in a wonderful clinic where there was a waiting list of patients who wanted to be seen there. What made it memorable was that the team of professionals were great colleagues. We had strong partnerships and a good team culture. We delivered exceptional care. It was really hard for me to leave that job when I accepted the work at AACN. In fact, I tried doing part-time nurse practitioner work, and also teaching for a while, after starting at AACN, but the schedule was just impossible. I loved being a nurse practitioner. I loved treating whole families and I loved the teamwork.I will never forget the time when I wanted to quit nursing. I had done a workup and examination on one of our military patients and prescribed a medication for him. Sometime later, I bumped into that patient, and he told me that he had suffered terrible side effects from the drug. I was heartbroken and spent a lot of time second-guessing myself, trying to figure out what I had missed that might have alerted me that this drug would not work well for the patient. It was a physician on the team who took me aside and said, "Polly, we all have a bad or unforeseen outcome as result of the work we do to take care of people. You need to forgive yourself and continue doing the work you do because it does help so many." The patient was also very forgiving and did not hold me responsible. I'm sharing this as memorable, because, as caregivers, we are all in this together, regardless of profession, and we can care about our colleagues, just as we care about our patients.I've had some pretty wonderful mentors, and they are largely responsible for making my career memorable. For example, Virginia Mullen, a faculty member at George Mason, helped me learn to be a teacher myself. When I was a young professional, still in the formation stage, she helped me learn to go through doors that I couldn't even see.It was also memorable to be a Robert Wood Johnson faculty fellow for primary care. Then, when I worked in governmental affairs, I was fortunate to be in Washington, DC at a time when nurses were very involved in health care policy and politics. As I mentioned before, my most powerful tool working with congressional aides was my experience and knowledge as a nurse. It was exciting to see nursing so involved. One of my colleagues who I met at that time was Mary Wakefield (who was later appointed by President Obama to serve as the administrator of the Health Resources and Services Administration). She was serving as a congressional aide to Senator Burdick and was one of several nurses working on the Capitol Hill. Those of us who were involved in policy work used to meet once a month, to talk health care policy. One nonnurse colleague said, he thought of us as the "nurse mafia" because we were such a powerful collective working together that everyone was afraid of us! In spite of the fact that the work was low paying, we were driven to do it because of our passion for changing the world for the better. It was a great time and place to be a nurse.

 

NAQ:Why did you choose nursing as a career in the first place?

 

Polly:I actually became a nurse by accident. It was not a childhood dream. However, on my first day at Texas Woman's University, I was required to declare a major. My high school friend, Betsy Roy, asked me to sign up for nursing with her. She told me that we could always change later, but at least we would be declaring a major. So, we both signed up. The irony is that Betsy ended up becoming a librarian! It was serendipity that led me to nursing, because it has been a wonderful career.The program at Texas Woman's University was a new BSN curriculum developed from what had been a diploma program. We had to take 22 credits a semester and were required to complete 220 credits to graduate. (BSN programs today require 120-124 credits.) At my program, we began clinical care in the very first semester, so I learned to take care of patients and to connect with nursing at Parkland Hospital. I still wasn't sure about nursing, so I went to the college counselor, who had me take a battery of tests. When he reviewed them, he said, "Too bad you're a girl. You would have made a fine engineer, if you were a boy." Things were different then for females, but in spite of that I made a fabulous choice. As I look back at all the people I've met, and all the things I've done, I am grateful for what this profession has given me, including my experience with board governance.

 

NAQ:Speaking of governance, you have been on the CHI Board since June of last year. How did you find yourself on the Board of Trustees of a large system?

 

Polly:Actually, someone I knew, another nurse, who was on the board already called me and asked if I would consider being a candidate for the CHI Board. I was extremely honored to be considered. Some nurses may not know that being a candidate does not mean you are automatically appointed to a board. Boards are looking for particular skills to round out their ranks and want to know that potential trustees are a good fit for the organization's mission. I was very happy to be scheduled for an interview, and when my flight to Chicago was cancelled by the airline, I was disappointed. When I called to tell the board selection committee that I wasn't going to make it, they arranged for the board chairman and 1 additional board member to come to Washington to interview me. I already knew about CHI's great reputation in health care, but the board's willingness to reach out to me made me feel wonderful.

 

NAQ:You already had extensive board experience before CHI, right?

 

Polly:Yes, among other experiences I served on the board of the Friends of the National Library of Medicine and was their treasurer for 5 years. I chaired the Nursing Alliance for Quality Care and have served on many advisory boards over the years. Among those was service on the steering committee for the Brookings Institute. Probably, my most challenging board experience was when I had the opportunity to be the chairman of the board for an insurance corporation. There were some difficulties with management and we ended up letting the CEO go. As the chairman of the board, I then had to oversee the transformation and restructuring of the company. We became a captive insurance corporation, the first of its kind in health care.

 

NAQ:You and I first met when we were serving on the Tri-Council for nursing, which isn't exactly a board. What were some of your early learnings from boards?

 

Polly:I learned early that it was important to get to know the other board members, to understand why they were there, and the individual value that each trustee brings to the organization. It is so important for boards to form synergistic, cohesive groups. Understanding what motivates others is a fun process as is learning to understand the mission and purpose of the organization at a deeper level.I also learned that it's up to the board to hold organizations accountable for staying true to their mission. One of the things that I appreciate most about CHI is that the organization is clear about its mission and its values. This is evident everywhere because both the board and management are committed to doing good and really believe in the values. For example, even when leadership talks about whether or not to add a new organization to the system, there is discussion about whether our values match.

 

NAQ:Why do you think it's important to be on a system board, and where do you think health care systems are going in this country?

 

Polly:We are at a point in history where health care is on the cusp of making changes that will improve care for individuals and communities. Systems can be a model for others to lead the huge amount of change that will ready us for the next era. Health care organizations are consolidating because joined together we can gain economies of scale, efficiencies, and a better reach throughout the country. As systems become more operational (ie, acting as operating companies), there is a stronger focus on partnership, collaboration, interdisciplinary practice, and shared accountability for improved care. We are learning to work better across the continuum of care and among professions.While I'm talking about that, I need to mention that any nurses who are holding on to history, and allowing that to prevent us from being good partners and team players, should remove any chip they find on their shoulders. I am seeing that people from all walks of life are recognizing the importance of nurses and including them on teams, even if that was not always true in the past.Those of us who want to be at the center of change need to pay attention to some things that might not seem important. For example, it concerns me when a professional caregiver calls him or herself a "floor nurse." We take care of people, not floors! I also think it's a problem for individuals and the profession when we exhibit a lack of attention to our physical appearance. Looking crisp, clean, and professional, while exhibiting a firm handshake, and looking others in the eye increase our image as respected partners. This is true whether you are a direct caregiver or a nurse board member.By the way, there is a lot of attention these days for nurses on boards. Individuals need to recognize that they won't be selected for board membership just because they are nurses. They have to bring value to the board. Over the years, I have been asked to recommend nurses for governing bodies and then heard later that they were poor board members. They may have attended the meetings, but they never spoke up. It's important that trustees get information about the organization and its issues, are present in all discussions, and add their expertise to the conversation.

 

NAQ:Have you had any learnings since joining the system board that differ from community boards?

 

Polly:It's been interesting to learn about systems and their evolution from holding companies to operating companies and all that that entails. The complexity in large systems has also added to my knowledge. For example, watching all the work going on around system IT projects has been fascinating, as has been learning more about population health and structures needed to truly transform health care. I've been privileged to serve on 2 of the board committees: the Quality and Safety Committee and the Human Resources Committee. On the Quality and Safety Committee, it's great to see the investment that a system makes on quality care and keeping people safe. I saw that when I worked with the Veterans Administration too and realize it is difficult to decrease variance across a large system and to translate standards for care. A huge amount of the work for quality and safety is nursing.

 

NAQ:So, what benefit do you think a board gets from having nurses included among the trustees?

 

Polly:Nurses are not only about quality, they are critical to the triple aim, which every board should be concerned with. Major goals for improving care, such as practices to prevent CAUTIs (catheter-associated urinary tract infections), emboli, and ulcers are nursing-sensitive indicators. It is helpful to have board members who have been at the point of care and who have lived health care. They can translate what they know into policy. In the past, boards have thought they were getting all of the clinical information they need from physicians. But physicians and nurses have different expertise and experience. There is a growing body of research that shows that uniform boards, that is, less diverse boards, are less likely to come to the best answers in governing. Diversity is central to making the best decisions, and nurses bring a diverse voice from clinical care.

 

NAQ:Why should individual nurses think about becoming board members?

 

Polly:Nurses have a commitment to our social contract with patients. Being on a board is not about making registered nurses important or about elevating an individual. As a profession, we want to do the right thing for families and communities, and boards are a powerful and different forum for helping organizations support this. We could have our own Don Quixote quest for changing the world for the better, but it's better to work with others to help us ensure that organizations do the right thing and serve the people we should be serving.

 

NAQ:What advice would you give to nurses about how to get involved with boards?

 

Polly:First of all, it's important to know more than just nursing. It's essential to understand health care, to learn about the changing environment, and to grow personal knowledge. Nurse who see what they do as just a job will not be successful as board members. It's important to be present and attentive to every circumstance and situation, so you can add value.Many people who get on boards start as volunteers for various nonprofit and charitable organizations. Sometimes, finding a mentor with board experience is helpful. It's important to read, learn, and grow while becoming well-educated.

 

NAQ:Polly, I have met board members who are nurses, who do not use RN after their name, just as I have met nurses who drop the RN after they become a COO or CEO. What do you think about that?

 

Polly:I once knew someone who chewed out another person who introduced her as a nurse. This individual was no longer practicing nursing, per se, and told her colleague that she was never to tell anyone that she had once been a nurse. It is a sad commentary on our profession, but true to an extent, that some other people in our business do seem to see nurses as "sweet little things who are nice people but can't add any value at a business table." However, the truth is most of the people who get to positions of power in organizations after serving as a clinical nurse got there because they were nurses. We need to recognize what the profession has given us.Some of the people who seem to be embarrassed to be identified as nurses appear to not have a sense of the value of their own profession. It's important to be proud of who we are, to remember that we got to our health care leadership jobs because of our nursing roots, and to celebrate all that we learned as direct caregivers.

 

NAQ:It is obvious that you are proud of being a nurse. What's the best thing about being part of this profession?

 

Polly:This is a profession that has unlimited number of potential jobs and roles that an individual can pursue to help make our world a better place. I have been so privileged to meet wonderful people who I never would have met if I hadn't signed up for nursing on my first day of college.

 

NAQ:Polly, I know you have just retired from AACN. I also know that you will stay busy in health care and other health care venues. What is your wish for the future of our profession?

 

Polly:I am confident and hopeful that we will implement solutions for health care in keeping with the recommendations from the Institute of Medicine for the future of nursing. My wish is that we will become an even greater profession through required higher education. It's important that we own our responsibility to be the active voice for the needs and rights of patients. I want us all to be introspective as we evaluate whether or not we are meeting our social contract. It's our responsibility to make the future and not to wish for someone else who will do it for us. In other words, my wish for nursing is that we be everything that we should be and that we realize and use our power to be in service to the world.

 

-Kathleen D. Sanford, DBA, RN, CENP, FACHE

 

Editor-in-Chief

 

Nursing Administration Quarterly