The role I tried to avoid became my passion

By Ruthie L. Robinson | 10/04/2017

Some of my peers thought I had gone to the “dark side.”

Woman walking with stethoscopeShe had no desire to be a nurse administrator, but others saw leadership potential she didn’t see in herself. Now she wants to develop leader attributes in other nurses.

I did not start out wanting to go into nursing administration. As a matter of fact, when I became Magnet program director at a hospital seeking its first Magnet designation, I remember specifically telling the chief nurse that I had no desire to be in administration. She just smiled, and somewhere along the way, I assumed an “interim” director position over the women and children’s area. Later, I noticed I was no longer being referred to as interim!

Ruthie RobinsonWith a strong chief nurse as my mentor, I grew into this position and found I actually liked the administrative role. I also found that my passion to take care of patients could be fulfilled as a nurse leader. Indeed, I found it fulfilled to an even greater extent. Not only could I advocate for patients, I was in a position to advocate for nurses as well. I realized that the chief nurse had seen potential in me that I had not seen in myself, and I learned that the ability to see potential in others is one of the characteristics of a great leader.        

We versus they
In taking a formal leadership role, however, I was surprised by the reaction of some of my peers. We’ve all seen or personally experienced the “we versus they” mentality that staff nurses sometimes have toward nurses who function administratively. It is as if staff nurses feel that, when a colleague assumes a formal leadership role, they have gone to the “dark side.” But who should lead nurses if not other nurses? Nurse administrators set the tone for the entire organization, and their advocacy on behalf of bedside nurses and patients, if performed well, creates a positive work environment. So, we desperately need good nurse leaders.

When the chief nurse took a job at another facility, I became interim chief nurse for six months during the search for her permanent replacement. During that time, our facility successfully underwent six separate accreditation surveys, including our first Magnet redesignation and Joint Commission reaccreditation. In the process, I came to appreciate the role of the chief nurse as a leader not just of nurses, but of organizations. I suddenly realized that nursing administration was my passion!

Your passion is showing
When you have a passion, it shows. Not long afterward, I was hired as the first chief nurse for a new surgical hospital that was still in the planning stages. What an opportunity to take a leadership role in designing a facility from the viewpoint of a nurse and to see my ideas incorporated in the completed structure. The chief executive officer and I had many discussions about the type of culture we wanted to build for our patients, their families, and the hospital’s staff and physicians. We knew exactly what we wanted, and, in conducting interviews, we sought staff members who shared our vision of excellence and patient-centered care.

Serving as chief nurse of that facility was the pinnacle of my career. In the two years I was there, we had outstanding patient and staff satisfaction and the best patient outcomes I have seen anywhere. I truly believe this was because we established a vision, communicated that vision, and held everyone accountable to it. We didn’t need consultants or scripting. We hired the right people and gave them the tools to do the job they were hired to do.

I can, therefore I teach!
After two years, however, the impact of healthcare reform proved too much for this small specialty hospital, and it was acquired by a large health system. Believing we would not be able to maintain in the larger system what we had achieved in the smaller one, I decided to leave and teach what I had come to love so much.

I am now director of the graduate nursing program at Lamar University, where I teach primarily in the nursing administration track. Sharing my experiences with nurses who aspire to be formal nurse leaders is rewarding, and seeing their enthusiasm for nursing and the patients we care for is inspiring. More than ever, we need strong, assertive nurse leaders, and I am proud to contribute to their development.

Functioning as chief nurse was difficult during the acquisition process mentioned above. What I experienced during that time spurred the qualitative research study I will be presenting at the 44th Biennial Convention in Indianapolis. Was my experience unique, or did others who had been through similar circumstances feel the same way?

I spoke to 16 chief nurses from both the acquiring side and the acquired. Some served in small, rural facilities and others in large, academic medical centers. Although the circumstances varied significantly, I found that our experiences were very similar. Many of the nurses said the interviews were cathartic because the transitions they had experienced had impacted them both professionally and personally.

Leading during transition
It was inspiring to hear their stories. With hospital acquisitions and mergers occurring so frequently, nurses who serve in administrative capacities must learn how to lead through these transactions with a minimum of disruption to patients and staff. My findings also suggest that the role of a system chief nurse is needed and can be key to making these transactions smoother.

Nursing leadership is more than creating budgets and schedules or attending meetings. Nursing leadership is caring for patients by ensuring that proper processes and structures are in place. Nursing leadership is providing resources that nurses and ancillary staff need to deliver the best possible care to patients and communities in which they serve. Nursing leadership is advocating for our staff members and communities, making the tough decisions, and being willing to challenge established processes.

Finally, nursing leadership is seeing potential in others that they do not see in themselves—and helping them reach that potential. I witnessed these traits and attributes in the chief nurses I interviewed for my qualitative study. They and so many others make me proud to be a nurse leader! RNL

Editor’s note: Ruthie Robinson will present “Surviving Acquisitions: Perspectives of Chief Nursing Executives,” on Saturday, 28 October, at the 44th Biennial Convention in Indianapolis, Indiana, USA. See the Virginia Henderson Global Nursing e-Repository for additional information.

Ruthie L. Robinson, PhD, RN, CNS, FAEN, CEN, NEA-BC, is associate professor and director, Nursing Graduate Studies, at Lamar University in Beaumont, Texas, USA. 

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