Leading the evolution of nursing care at UNC

How did you get your start as a cardiac nurse?

I started out as a molecular biology major but after my first year I really started thinking about what that meant and what I wanted to do long term. The more I thought about it, the more something in medicine sounded like an interesting career to me. I spent some time shadowing both physicians and nurses, and I decided that the interactions that nurses have with patients and their families was the part that attracted me the most.

After I finished my undergraduate degree at Vanderbilt, my first job was in the pediatric intensive care unit at Vanderbilt Hospital. It was very exciting and very overwhelming.

My “aha!” moment came when I started working with pediatric cardiac surgery patients. I loved working with that group. It was hard sometimes, but also very interesting. Many of the children came back again and again, so I learned a lot about working with families.

I liked the fact that I got to work with both patients and their families, but it was a challenge. Our patients were sick and some of them were very young but it always felt like a place where you could make such a difference for the family – to be the person on the floor that the family could trust, so that, even if they went home for a while someone would be watching that child. To be entrusted with the care of a child is a gift.

I loved doing that. I decided to do more of it, so I packed up all of my things and went to the University of Colorado for my master’s degree. After graduation, I worked with pediatric cardiac surgery at the University of Colorado as an advanced practice nurse.

After 15 years in Colorado, I was hired to be director of the cardiac center at the Children’s Hospital of Philadelphia, and that was a great experience too. Philadelphia is where I started my transition to the administrative side of things.

What led you to Chapel Hill?

After I had been at the Children’s Hospital in Philadelphia for several years I adopted my daughter Grace from China. My family lives in Charlotte and, as a single parent, I decided that it would be nice to be closer to them.

I was very fortunate to have several job opportunities to explore when I decided to look into the area. But I really wanted to be at an academic medical center and UNC was preceded by its reputation in that respect. I was offered a position here as the director of the cardiac program. I came and interviewed, and decided it was a good fit for me, and that was almost 13 years ago.

I really like the town. I like the vision of the hospital. I like the people that I get to interact with here every day. It’s been a great fit for me; it’s been a wonderful fit for my daughter. So I feel really grateful that we ended up here.

She’s 17 now and getting ready to go to off to college at UT Austin. It’s hard to believe she’s not going to school here. She’s going into engineering and UT had a great engineering program, especially for women. But she’s not going to be wearing Carolina blue and that’s a tough one for me [laughs].

How does your clinical experience crossover into what you do now?

People sometimes say to me, even now, do you miss taking care of patients? I always think to myself: I do take care of patients. Somebody I worked with very early in my career said to me “If you keep your eye on the patient you won’t do the wrong thing.” And I still think that’s true. In my current role, taking care of patients means making sure our nursing staff has what they need to provide the best possible care.

I don’t think I would have the same understanding of the challenges that the staff are working with if I hadn’t also had to do many of those same things myself—work extra shifts, do more with less sometimes, juggle responsibilities, deal with difficult situations, deal with difficult people. I think that all of those skills are really the foundation for where I am today. My time as a nurse was a really important part of my career, because those skills translate to what I’m doing now.

As a charge nurse you are always learning: organizational skills, how to make important decisions quickly. All of that is something I’ve built on through the years, and that’s gotten me where I am today. These are all skills I still use.

I feel like I have a fabulous job; I work with bright people—the staff, the managers, the directors—who do the hard work. I’m very fortunate and I know that. I’m grateful to the people who taught me along the way. It’s my hope that we can turn around and provide the same strong foundation of skills for the next generation of nurses that are coming up. Because we need them.

You’ve recently completed you DNP here at UNC, some of which was completed while you held the position of Vice President of nursing; how did you balance your leadership role with that of a student?

I started my doctorate many years ago, when I was up at the Children’s Hospital in Philadelphia, got part way through it and just decided it was not the right fit for me at the time.

When I first came to UNC, I didn’t really think about it because I was getting acclimated to a whole new environment. But as the University started to offer degrees that focused more on clinical integration I started thinking about it again. The doctorate of nursing practice [DNP] allows you to translate research into practice and that really interested me.

And so, with great support and assistance from Mary Tonges, our previous CNO, I went back to school.

It was a real juggle. I think it’s probably true for anybody that’s in school; you look back and think “How did I ever get that done?” And yet, piece by piece, the work gets done.

It was a really great opportunity. Normally, we’re all so busy; we have research we want to keep up with but it’s hard to make the time. When you are in school, you have to make the time. So I think it really helped me understand things like population health and clinically integrated networks that are becoming an increasingly important part of health care. You approach the research literature differently when you have to sit down and write papers about it.

My research project dealt with using our HCAHPs scores in a more precise way. Often, we look at HCAHPs as a number that tells us how we’re doing against other institutions. I drilled down into the data see what the demographic effects were on the HCAHPS survey: were all of the different demographic populations that we serve equally happy and, if not, were there ways to address those differences in satisfaction?

Once you get into the data, there are different drivers of patient satisfaction among the different demographic groups.

For instance, there are different satisfaction drivers for women than the overall answers on the survey. We have a women’s hospital, we have floors where there are a lot of women, we need to look at that and say, “maybe there is something we can do to make this a more satisfying stay for those patients.”

The message really is: don’t assume that the populations that you’re taking care of are all the same, in terms of what they feel like they need to make their hospital stay a good one. This hadn’t really been looked at before. I’ve given a couple of talks about it and I’m going to be submitting an article because I think it’s important.

And it was interesting to find something in the data that I could bring back to my professional position at UNC and say, “we need to look at this differently.”

I didn’t go into this project thinking “boy, I’m going to change the world here at UNC” but I did want to do something that we could use here so it would be a mutual benefit. I was very grateful that I was supported to go back and do this, so I wanted to do something that could potentially have an impact here at our own institution.

How has nursing changed since you’ve been at Chapel Hill and how does that inform your plans for the future?

Over the last 10 years, Dr. Tonges and I have worked with some really wonderful leaders – both in nursing and otherwise – to change the practice environment at this hospital by making it a better place for nurses to work. There’s a lot of research that shows when nurses are satisfied and feel like they are doing a good job that leads to better outcomes for patients. So by making the environment better, we’re also improving outcomes for patients. I don’t think I could ask for anything more important than that.

My favorite part of my job is working directly with the staff and the managers and directors. Dr. Tonges and I worked with nursing leaders to implement shared governance practice here at UNC Hospitals. It’s a way for staff – the people who are doing the work with the patients and families – to tell us better ways of doing the work. It’s really a way of interacting, collaborating, getting feedback that has worked very well and has helped us to transform the way care is delivered.

We do nursing satisfaction surveys and over the past decade our scores have gone from nothing special to scores that now have us among the highest scoring hospitals in the US every time we do them. And that’s because of the great partnerships we’ve been able to develop.

We have to continue to grow. We have to make sure that we see that all of our staff are working to the highest capacity and potential of their skills and their license. I also think that we need to make sure that we are as efficient as we can be. Health care is changing as far as how we’re going to get reimbursed so we really have to use our dollars very wisely.

We have to be smart about how we take care of what we have and we always have to be thinking of better ways to do it. That’s never going to stop. I’m just one in a long line of chief nursing officers that’s here to help the staff realize that potential.

As health care continues to evolve I want to see us continue to do the same great job that we are doing. I want to see us giving the same great care to patients, and know that patients and families are happy with the care that we give. But I think we have to continue to be smarter and faster because that’s where health care is going.

One of the things I like best about our staff here is that they absolutely embrace the fact that they are here to care for the people of North Carolina, but the only way that we can care for them is if we continue to have the resources to do so, so we have to use what we have wisely and we have to be smart about how we do things. I believe that the people of North Carolina can’t get better care anyplace else so I want to be here for those people, so that they can come here and continue to get care for years to come.