His mother told him, “If you don’t like something, change it!” So he did.
Sigma’s treasurer didn’t graduate from high school, but that didn’t keep him from becoming a successful nurse entrepreneur, earning a PhD, and showing effective leadership.
I was in a 1972 beige, secondhand Volkswagen Beetle en route to North Miami Senior High School when the Lady in the Cape said to me, “If you don’t like something, change it!” Thus began my leadership journey. Lesson 1: Don’t complain and do nothing. Do something, and do your best to do the right thing, even though it may not turn out to be the right thing. Action always outdoes inaction.
I decided to change my situation. The Lady in the Cape, a single parent, was working several jobs to make ends meet, which relegated me to attending the local public school. I found my studies less than challenging, which gave me plenty of time to get caught up in activities that were sometimes less than desirable. So, at age 15, I decided to get out of Miami. At a college fair at a nearby high school, I learned about a small liberal arts college in the hills of North Carolina that would accept me at age 16. I dropped out of high school and took my graduate equivalency exam. Yes, the treasurer of Sigma never graduated from high school. Lesson 2: Dropping out of a bad situation is always an option; quitting never is.
I spent a semester and a half in North Carolina. Because I had grown up in the city and was younger than the rest of the freshmen, I didn’t have a lot in common with them and found the isolation challenging. Midway through my second semester, I returned to Miami, took a job, and began taking classes at Miami Dade Community College in hopes of getting into the University of Florida in Gainesville. After several rejections, I was finally admitted. Lesson 3: Failures are inevitable. What you learn from them is what makes you become who you want to be.
Even though I grew up in a big city, I felt overwhelmed at the University of Florida (UF). Despite my mother urging me to pursue medicine—an option many nurses have recommended to their sons—I had no career direction. But I had a passion for helping people. So I left the University of Florida and, while working in the emergency department of UF Health Shands Hospital, trained as a paramedic at Santa Fe Community College in Gainesville. Lesson 4: Other people’s dreams are not always yours, and that’s OK.
When I graduated, not a single paramedic position was available in Gainesville. So, I moved to the southeast coast of Florida and took a fire-rescue position. Because I had worked with burn patients at Shands Hospital, I don’t like fire. Nor do I like heights or closed-in spaces. Lesson 5: To pursue your passion, you have to overcome your fears.
There’s a saying around some fire departments, “You give a guy a white shirt, and he forgets where he came from.” Translation: Managers often forget their roots; leaders do not. Lesson 6: Never forget where you came from.
After several years in the fire department, the urge to grow professionally took hold of me again. My colleagues in the department thought I was crazy to give up one day on and two days off, outstanding benefits, retirement at an early age, a great pension, and my “outstanding man” status. (When we dispatched a fire truck, we also rolled an ambulance. As the paramedic, I sat in the front passenger seat of the ambulance. That meant I was responsible for hooking up the hose to the fire hydrant, waiting for the call to turn on the water, and then walking the length of the hose to check for kinks. After accomplishing those tasks, I would put on my breathing apparatus and head to the fire. This meant I spent most of my time “out standing” in the street.)
Despite all the perks of the fire department, I applied to and was accepted into the nursing program at the University of Central Florida (UCF) in Orlando. Lesson 7: It is OK for other people’s measure of success not to be yours.
At UCF, I joined the National Student Nurses’ Association (NSNA). Initially, I was only marginally active, but I was asked to attend the state convention as an alternate delegate. Before committing, I asked about the duties of an alternate delegate and was told I would just need to sit in the audience and could study. On that basis, I agreed. As it turned out, a delegate failed to show, and I was pressed into service.
On the first day, a controversial issue came before the House of Delegates, and debate continued until the close of that day’s session. I studied the bylaws of the organization that night and presented myself at the microphone with a point-of-order card when debate resumed the next day. After asking the parliamentarian to confirm that, according to the bylaws, promotion of membership was an organizational objective and that no issue—including the one before the house—that was in direct conflict with those bylaws could be debated, I conducted a quick straw poll.
As I expected, no matter which way the vote went, half of the delegates would resign. I then suggested to the parliamentarian that the resolution was in conflict with the bylaws and was, therefore, out of order. After conferring with the board, she agreed, and the resolution before the delegates was removed from the agenda. Little did I know at the time it was a board-sponsored resolution. Lesson 8: Always do your homework before opening your mouth.
One week later, I received a call from a board member of the North Carolina Student Nurses’ Association. The stir I caused in Florida had rippled to North Carolina, and he encouraged me to run for the organization’s national board of directors. When I hung up the phone after a lovely conversation, I laughed about how out of my depth I had felt at the state convention just a week earlier. There was no way I was ready for national office. But the more I thought about it, the more I concluded I should at least discuss the idea with faculty members at UCF School of Nursing.
They were concerned about the clinicals I might miss and expressed their reservations, so I shelved the idea. But the possibility of making an impact kept gnawing at me. Finally, I got up the nerve to ask the dean what she thought. She was supportive and told me that, if I needed to make up clinicals, she would precept me herself. I decided to run for election, and when the time came to head to the national convention, my dean came with me. Lesson 9: When a door opens, believe in yourself, and don’t be afraid to walk through it.
Again, a controversial issue came before the House of Delegates. Three candidates were running for the office of secretary-treasurer, including me, and I had prepared my speech for months. But just like a scene from a movie I once saw, when I got up to the lectern, I folded up my speech, put it in my breast pocket, and addressed the issue at hand from the heart. Lesson 10: Listen to your heart.
For the next two days, I campaigned. I didn’t know my dean was politicking behind the scenes on my behalf with other deans, and I was elected. Afterward, delegates on both sides of the divisive issue came to me and said they had no idea which side of the debate I was on. For that reason, they knew I would do the right thing. Lesson 11: Be genuine.
Advisers to the NSNA board of directors recommended I pursue an MSN/MBA degree when my time came to return to academia. Intending to enroll at the University of Pennsylvania School of Nursing and Wharton School of Business, I moved to Philadelphia. As it turned out, I decided to pursue my dual degree at The University of Texas at Austin. The dean of UCF School of Nursing agreed to write a letter of support. She said she would be in Washington, D.C., for a conference the next week and invited me to drive down. I could join her for lunch, we’d visit the National Zoo together, and she’d give me the letter.
The little voice in my head said to wear business clothes that day, even though jeans would have been more appropriate for a trip to the zoo. I have rarely been happier with a decision. When I walked into lunch, my dean was seated with the executive director of NSNA and the dean of the School of Nursing at The University of Texas at Austin. As the saying goes, “I wasn’t born in Texas, but I got there as fast as I could.” Lesson 12: Quoting the NSNA executive director, “Connections only hurt those people who don’t have them.”
While seeking admission to the University of Pennsylvania, I worked as a staff nurse in the emergency department at Temple University Hospital in north-central Philadelphia. It was the early 1990s, and crack cocaine and carjacking had become popular. On my first day of work—a busy, understaffed Monday morning—I was being oriented to my new surroundings by a preceptor when a man came crashing through the ambulance doors yelling, “You’ve got a gunshot wound coming! It’s going to be about five minutes. He ain’t walking too fast because he’s shot in the chest!”
Five minutes later, I assisted in pulling the patient out of a police paddy wagon and placing him in Trauma Bay 1. Because we were short-staffed, I jumped into action and assisted with cracking the man’s chest. A few minutes later, I saw him off to OR with his aorta cross-clamped. As he rolled out of the bay, the attending physician turned to me and asked, “Who the **** are you?” I replied, “I’m Ken. I started about an hour ago.” The physician responded, “You’re gonna fit in just fine around here.” By the way, the man lived. Lesson 13: Be ready to step into scary situations at a moment’s notice. They aren’t usually life and death, but a leader’s actions can make all the difference in the outcome.
Before moving to Austin, I applied for employment at a trauma center in that city. It was a Level II trauma center at the time, the only one in central Texas. Coming as I did from a Level I trauma center in the inner city, I thought I would be a shoo-in, but my application was rejected. I was disappointed but didn’t let it get to me. Instead, I made a trip to Austin and presented myself to the personnel department at 9 a.m. on a Monday. By 10 a.m., I was in the nurse manager’s office and, by 11 a.m., was completing my pre-employment paperwork. I put a deposit on an old house in Austin and returned to Philadelphia with a new job. Lesson 14: Don’t take rejection lying down.
A few weeks later, I was working the night shift at my new job. I was seated at the nurses’ station, having just organized scraps of paper I had written on for a trauma patient who had just gone to the OR when, behind me, I heard a throat clear. Without looking up, I said, “May I help you?” A voice said, “I need to sit down.” Again, without looking up, I said, “That looks like a chair over there to me; help yourself.” The voice said, “I need to sit by the phone,” and I responded, again without looking up, “I think that black thing over there next to that chair is a phone.” The voice, now disgruntled, asked, “Do you know who I am?” In one motion, I spun around, stood up, ripped my badge off, and nose to nose asked the voice if he knew who I was. He said, “No.” I said, “I don’t know you are, and I don’t really care. Now go sit yourself down over there.” He spun around and left.
The next morning at the end of my shift, I was summoned to the nurse manager’s office. When I walked in, he told me to hold out my hand. I said, “What?” and he said, “Hold out your hand.” I did, and he slapped the back of it. “What was that for?” I asked, and he said, “That was for telling off the chief of staff.” We both had a good laugh. My manager didn’t like him all that much anyway. Lesson 15: Sometimes it’s a good idea to know who you’re talking to.
As I began working toward my joint degree at UT Austin, I was in the School of Business and was talked into attending a meeting of the entrepreneurship club. (I doubt I could spell entrepreneur back then.) When the club’s faculty sponsor encouraged us to drop our résumés off for feedback, I did. Little did I know mine would be on an overhead for public critique at the next meeting. I think he said, “Now, here is a guy who has absolutely no idea of what he wants to do with his life.” I say I think because it was hard to hear from under the desk where I was hiding.
Somehow, I got up the nerve to take this faculty member’s course the next year. It was the most difficult course I took in graduate school but worth every bit of pain I endured. It put many tools in my kit that have contributed to my success as a leader, and that faculty member has since become one of my best mentors. Lesson 16: Always be willing to put yourself out there.
I entered my joint degree program thinking I wanted to be the best director of an emergency department ever. I finished the program as a healthcare information systems consultant. Yes, minds are like parachutes; they only work if they are open.
During my final summer in the master’s program, I worked as an intern for a consulting firm that specialized in assisting hospitals with selecting and implementing electronic medical records. I was introduced to process mapping during that time and used that skill for the duration of my tenure with the firm.
When developing a process map, I would sit down with the leader of a department—say medical records—and ask him or her to tell me, in that example, how a record moved through the hospital. I would then go back to my office and sketch a map of the process described to me. A day or two later, I would return to the person I had interviewed, present my map, and ask if I had correctly represented his or her description. More often than not, the answer was yes.
I would then take my map and visit the people doing day-to-day management of the hospital’s medical records and ask them if my map was a valid representation of their work. More often than not, they told me, “That’s what they think we do.” I would then be told about all the workarounds that had been put in place over the years to adapt to changes in policies and procedures. Lesson 17: Know how your organization really works.
Another thing I learned from using process maps is that organizations have bad processes, not bad people. To evaluate processes, I brought interdisciplinary teams together. This exercise illuminated for many that it was not personnel in another department who made their lives difficult; it was a flawed process that could be mutually redesigned for the good of all. Lesson 18: Shared mental models and processes that are mutually agreed-upon by all have a high probability of being efficient, effective, and adopted.
The beauty of consulting is that you are exposed to many cultures and a wide variety of projects. This exposure gives you the ability to identify good and bad solutions. It also enables you to identify unmet needs in the marketplace.
While working on a large electronic medical record implementation, it struck me that, although we were collecting massive amounts of patient data, we had very little information about the providers taking care of those patients. To optimize outcomes when using the Synergy Model, patient and nurse characteristics are matched. At that time, this goal was nearly impossible to achieve because of limited data available on our nursing staff. To me, the situation screamed, “Opportunity!”
I set to work developing functional specifications for a web-based learning management system that targeted the needs of nursing. This was 1998, and the internet was still in its early adoption stage. Passionate about the project, I worked on it nights and weekends. One day, the CEO of the consulting firm I was working for told me, “I hear you are working on something in the basement.” I said I was, and he directed me to decide whether I wanted to work on that project or work for him. I knew I would have to eventually make that decision but wasn’t planning to make it that soon. I tendered my resignation and struck out on my own. Today, I’m grateful he forced my hand. Lesson 19: Leadership means taking calculated risks.
There was plenty of access to venture capital in Austin because the dotcom boom was in high gear. I pitched my idea to investors well over 20 times. I will always remember my last pitch. Standing in front of five wealthy men whose knowledge of the healthcare industry was extremely limited—I think one of them had been a patient once—I told them about my product, the need for it, and the size of the market. They told me that the U.S. market of more 5,000 hospitals was not large enough for them to get excited about and that I needed a business-to-consumer solution.
So I told them about the fourth extension to our product, a business-to-consumer individual professional portfolio for nurses. They told me I had lost focus. That’s when I informed them that what I had really lost in talking to them was my most valuable resource—time. I proceeded to bootstrap my business and used customers to fund its development. The dot-com bust came and went. The company I founded—Decision Critical Inc.—survived in part because we did not take outside investment, a practice that often alters vision for a company.
Decision Critical was purchased in 2012. One of the primary drivers behind the decision to acquire my company was the professional portfolio product I had pitched more than 10 years before. Lesson 20: Believe in your vision, and work hard at your dreams. Dreams don’t come true on their own; it’s up to you to make them come true. RNL
Kenneth W. Dion, PhD, MSN/MBA, RN, assistant dean for business development and strategic relationships at Johns Hopkins University School of Nursing in Baltimore, Maryland, USA, is treasurer of the board of directors for Sigma Theta Tau International Honor Society of Nursing (Sigma). In addition to founding Decision Critical Inc., Dion is past president of the board of trustees of the Foundation of the National Student Nurses' Association, past chair of the board of directors of Sigma Foundation for Nursing, and founding principal of TurnPath, LLC, a healthcare innovation incubator.