The Path of Leadership: Chief Nursing Officers Respond

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The Path of Leadership: Chief Nursing Officers Respond

California CNOs on their career paths, challenges and advice

By Working Nurse
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­A PORTRAIT OF LEADERSHIP photos left to right, top row: Katherine Bullard, Caroline Esparza, Karen Grimley, Peggy Berwald, Shirley Johnson, Mary Jane Jones; middle row: Shawna Sharp, Patricia Stone, Reanna Thompson, Lori Burnell, Judith Lloyd Storfjell, Margaret Pfeiffer; bottom row: Patrick Reinhard, Mary Dee Hacker, Judy Blair, David Neal, Lynne Whaley-Welty, Linda Burnes Bolton.

What Influenced Your Decision to go into Management?

Linda Burnes Bolton, RN, DPH, FAAN

Vice President and Chief Nursing Officer
Cedars-Sinai Medical Center

I accepted a position in management during a transition in leadership within the organization. My previous roles as a clinical nurse specialist and nurse educator enabled me to build on my staff engagement skills as I started the nursing director role. My experience as a nursing director provided me with broad knowledge of the organization and its nursing services when I was promoted to chief nursing officer.

Katherine Bullard, RN, MS, NEA-BC

Regional Chief Nursing Officer
Providence Health & Services

I never had a formal plan to go into management. It just seemed like the logical thing to do when the first opportunity (head nurse for an ICU) came up just two years after I graduated. Once I experienced the privilege of leading a team, I discovered I enjoyed it tremendously and was good at it.

Shirley Johnson, RN, M.S., MBA

Chief Nursing and Patient Care Services Officer
City of Hope

After being a staff nurse for a year at Barnes Jewish Hospital on a postoperative surgical unit, the nurse manager asked me to consider a newly created opening for an assistant clinical nurse manger. I ended up being the only person who applied for the role and was promoted. I had just turned 20 years old and encountered my first lessons in humility in leadership as I attempted to support a nursing staff over twice my age with significant depths of experience.

Mary Jane Jones, RN, MSN

Vice President and Chief Nursing Officer
Dignity Health – Northridge Hospital Medical Center

My career path started in critical care nursing, working as a CNS and an educator. The decision to go into management came several years later when one of my colleagues asked me to apply for a clinical director position. I was fortunate that the CNO believed in me and saw the potential I had to lead.

Patrick Reinhard, RN, MHA

Chief Nursing Officer
Desert Valley Hospital

I found myself frustrated by the management teams I worked with — the focus on issues that didn’t really impact patient care combined with a lack of interest in those things that truly would make a difference for patients.

Shawna Sharp, RNFA, CNOR

Chief Nursing Officer
Casa Colina Hospital for Rehabilitative Medicine

I was first encouraged to go into management several years ago after serving on my hospital’s practice and leadership councils. I enjoyed the opportunity to promote excellence in patient care and the professional nursing practice. What better way to continue these opportunities than to become a nurse manager?

Patricia Stone, RN, MSN

Vice President and Chief Nursing Officer
California Hospital Medical Center

While I was a good nurse and loved what I did, I found that as I was placed into leadership roles, I was able to impact the greater good. I was good at addressing and removing the impediments that got in the way of caring for patients. First, it was the processes that impacted the ICU nurses in caring for their patients. Then, as I had greater leadership opportunities, it was impacting care on a larger scale: budget, care delivery models and organizational culture.

Judith Lloyd Storfjell, RN, Ph.D., FAAN

Chief Nursing Officer and Sr. Vice President for Patient Care Services
Loma Linda University Health

I didn’t seek out management — it found me, starting with my first position after graduating from college. I loved front-line nursing, but I could see the need for change: for looking beyond today and planning for the future. I had a fairly strong business background, which was a tremendous asset and allowed me to integrate clinical issues with the business of healthcare.

Reanna Thompson, RN, MSN

Chief Operating Officer and Chief Nursing Officer
PIH Health Hospital – Whittier

Going into management was not a professional goal early in my career. I made my first step into management because a nurse leader saw something in me that I didn’t see in myself and encouraged me to apply for my first management position. Hence, I understand the importance of having strong nurse leaders who are in touch with the top performers and can begin mentoring them early on and influencing them to become leaders.

Lynne Whaley-Welty, RN, ACM

Chief Nurse Executive and Sr. Vice President of Clinical Operations
White Memorial Medical Center

After being in clinical practice for about four years and having three different managers, I decided I wanted to make a difference on our unit. The desire for stability, support for the clinical processes and the opportunity to affect bedside nursing were the driving forces.


Tell Us About Your Mentors.

Peggy Berwald, RN, MSN, NEA-BC

Sr. Vice President, Patient Services and Chief Nursing Officer
Torrance Memorial Medical Center

I had a mentor before I realized she was my mentor. She guided me throughout my early years at Torrance Memorial Medical Center and gave me opportunities to grow not only on the operational side of a department or service line, but also in program development, which touched on many disciplines and taught me to influence people indirectly as well as directly.

Katherine Bullard, RN, MS, NEA-BC

Regional Chief Nursing Officer
Providence Health & Services

I have had various mentors in my professional and personal life over the years. My greatest mentors, though, have always been my parents. My dad, who passed away recently, was a physician and I learned more about compassion and clinical excellence from him than from any other professional. He loved his patients and had tremendous respect for nurses.

Karen Grimley, RN, MBA

Chief Nursing Officer
UC Irvine Medical Center

First, my dad: He taught me that the only person who can put limits on what you can do is you. Beyond that, a vice president of patient care services who encouraged me to apply for my first nurse manager position and coached me during his tenure; a COO who taught me patience and the benefits of the Serenity Prayer in healthcare; and two incredible CNOs who served as guides through a very challenging time in my career.
There are people who contribute to your development on every step of your professional journey. Sometimes you don’t understand their role in your development until after they are gone.

Mary Dee Hacker, RN, MBA, NEA-BC, FAAN

Vice President, Patient Care Services and Chief Nursing Officer
Children’s Hospital Los Angeles

He was a professor in my postgraduate education who really challenged all of my thinking and forced me to think about leadership from a new vantage point. He died several years ago, but he still serves as a sounding board for me; I often think about how he would approach a challenge.

Margaret Pfeiffer, RN, MSN

Vice President, Patient Care Services and Chief Nursing Officer
Good Samaritan Hospital

I did not have any one mentor, but instead was able to gather advice from many different people I have worked with. It is important to recognize strengths in others and learn from those strengths instead of looking for the one person who “has it all.”

Patricia Stone, RN, MSN

Vice President and Chief Nursing Officer
California Hospital Medical Center

I feel I have been mentored by many individuals. I have also been guided by those who were not stellar examples, but who through their actions taught me what not to do.



What Are Your Biggest Challenges?

Lori Burnell, RN, MSN, Ph.D.

Sr. Vice President and Chief Nursing Officer
Valley Presbyterian Hospital

Effectively integrating technology into practice with the overarching aims of improving communications and decreasing nurses’ documentation time.

Linda Burnes Bolton, RN, DPH, FAAN

Vice President and Chief Nursing Officer
Cedars-Sinai Medical Center

The biggest challenges today are related to the transformation occurring within our healthcare delivery system, including the increasing demand for value-based healthcare services. It is important to engage staff and the cross-disciplinary team in the design and implementation of healthcare services that are patient-centered, efficient and effective.

Caroline Esparza, RN, MHA

Sr. Vice President, Patient Care Services/Chief Nursing Officer
Simi Valley Hospital

Figuring out how to rapidly transform our hospital to thrive in a market that increasingly rewards value over volume and explaining the nurse’s role in this new paradigm.

Karen Grimley, RN, MBA

Chief Nursing Officer
UC Irvine Medical Center

Creating a consistent message when implementing changes in patient care, nursing practice or the hospital environment. The complexity associated with modifying processes and engaging staff in transitions makes even the simplest change very challenging.

David Neal, RNC, BSN, MS

Vice President and Chief Nursing Officer
Methodist Hospital of Southern California

Daily staffing and the challenges of retaining staff with competitive wages and benefit packages in a time when reimbursement is declining and funding is becoming more and more tight.

Patrick Reinhard, RN, MHA

Chief Nursing Officer
Desert Valley Hospital

The fact that most staff perceive management as an us-against-them proposition rather than a team approach to tackling work that can be hard and very complex.

Shawna Sharp, RNFA, CNOR

Chief Nursing Officer
Casa Colina Hospital for Rehabilitative Medicine

Keeping the team motivated and focused on the big picture, which includes the mission and vision of the organization. Also, communicating with the staff so they feel connected and realize their part in the larger overall purpose of the institution.

Patricia Stone, RN, MSN

Vice President and Chief Nursing Officer
California Hospital Medical Center

Trying to continuously reinvigorate the spirit of caring within the nursing team. This becomes a greater challenge as economic and regulatory forces continue to impinge on the time the nurse has with the patient.

Judith Lloyd Storfjell, RN, Ph.D., FAAN

Chief Nursing Officer and Sr. Vice President for Patient Care Services
Loma Linda University Health

We need to help clinicians understand the importance of patient/family education and providing psychosocial support and coordination of care.

Reanna Thompson, RN, MSN

Chief Operating Officer and Chief Nursing Officer
PIH Health Hospital – Whittier

Developing an understanding that every nurse is a leader in his or her professional role. Nurses lead multidisciplinary teams every day as they care for patients. Another challenge is finding transformational nurse leaders who can lead teams that span multiple generations.


 What Advice Would You Give to a Nurse Who Wants to Become a CNO?

Peggy Berwald, RN, MSN, NEA-BC

Sr. Vice President, Patient Services and Chief Nursing Officer
Torrance Memorial Medical Center

Look for a master’s program that has a strong financial, project management and collaborative practice curriculum or supplement your core classes with electives with that focus. As a Magnet CNO, I would also highly recommend you get your Ph.D. in nursing because the discipline of statistical analysis will become increasingly important in achieving excellent clinical and financial outcomes.

Judy Blair, RN, BSN, MBA

Sr. Vice President, Clinical Services/Chief Nursing Officer
Glendale Adventist Medical Center

Keep a positive outlook no matter what comes your way and take the time to appreciate and recognize your colleagues.

Linda Burnes Bolton, RN, DPH, FAAN

Vice President and Chief Nursing Officer
Cedars-Sinai Medical Center

Volunteer to assume progressive leadership roles within and outside the organization. Leadership is a practiced art and it is essential that candidates seeking executive leadership positions have experiential knowledge and skills in leading.

Katherine Bullard, RN, MS, NEA-BC

Regional Chief Nursing Officer
Providence Health & Services

Make sure that you have strong nursing skills and a few years of clinical experience under your belt before moving into leadership. Also, don’t expect to magically develop leadership skills and competencies. They must be studied and practiced over time.

Lori Burnell, RN, MSN, Ph.D.

Sr. Vice President and Chief Nursing Officer
Valley Presbyterian Hospital

Work in a clinical position for a minimum of two years. Once you are able to organize and safely care for patients, volunteer for committees and special projects. Exceed expectations in each of those roles.

Caroline Esparza, RN, MHA

Sr. Vice President, Patient Care Services/Chief Nursing Officer
Simi Valley Hospital

Try to maintain a calm demeanor even when you don’t feel calm. Also, remember that you don’t have to know everything, but you do have to know what your resources are.

Karen Grimley, RN, MBA

Chief Nursing Officer
UC Irvine Medical Center

Learn to articulate your passion for patient care and your practice, which will help you craft your strategy and map your path to a nursing leadership position. Second, remember that healthcare is a very small world, so it’s important to know that you will meet many of the same people in different places. Finally, realize that being a CNO is not for the faint of heart. It takes operational knowledge, clinical expertise, patience, tact and thick skin.

Mary Dee Hacker, RN, MBA, NEA-BC, FAAN

Vice President, Patient Care Services and Chief Nursing Officer
Children’s Hospital Los Angeles

Never think you know enough.

Mary Jane Jones, RN, MSN

Vice President and Chief Nursing Officer
Dignity Health – Northridge Hospital Medical Center

Set goals with timelines and obtain your master’s degree, at a minimum. Ask for guidance and mentoring from your manager and CNO. Review the literature on leadership and network with other leaders within the organization and outside of your facility to gain a broader perspective beyond nursing.

David Neal, RNC, BSN, MS

Vice President and Chief Nursing Officer
Methodist Hospital of Southern California

Seek all the leadership opportunities that you can possibly find. Set a goal and reach for it. Select your career path and network to make the connections and gain the skill set needed to move into the role of CNO.

Margaret Pfeiffer, RN, MSN

Vice President, Patient Care Services and Chief Nursing Officer
Good Samaritan Hospital

Don’t put all your focus on leadership as an end goal. Instead, focus all your efforts on becoming exceptional at what you are currently doing. Get involved in committee work and improvement projects and work to develop leadership maturity along the way. That is the behavior that is recognized by administrators, who will single you out for growth opportunities.

Shawna Sharp, RNFA, CNOR

Chief Nursing Officer
Casa Colina Hospital for Rehabilitative Medicine

Surround yourself with experts in their fields and never be afraid to hire someone who knows more than you. Also, remember that your role is to support and serve your frontline staff so they are free to provide the best of themselves to their patients.

Patricia Stone, RN, MSN

Vice President and Chief Nursing Officer
California Hospital Medical Center

Don’t let your position or the concept of power go to your head. All that matters is that you focus on what is best for the patients.

Reanna Thompson, RN, MSN

Chief Operating Officer and Chief Nursing Officer
PIH Health Hospital – Whittier

In order to do the work, you must invest in your family and personal time to create a balance. It’s the only way to survive. Also, be sure you have a cadre of trusted colleagues you can call when you need advice or just an understanding ear.

Lynne Whaley-Welty, RN, ACM

Chief Nurse Executive and Sr. Vice President of Clinical Operations
White Memorial Medical Center

Love what you do. Be grounded in your clinical practice. Be sure your path allows you to acquire the business acumen and management skills you will need in this position (e.g., planning, organizing, and budgeting). Establish a formal mentor relationship; you will have different mentors over the course of time. Don’t forget to have fun and find joy in the role.


What Are the Most Important Traits for an Effective Nurse Manager?

Peggy Berwald, RN, MSN, NEA-BC

Sr. Vice President, Patient Services and Chief Nursing Officer
Torrance Memorial Medical Center

The ability to develop and maintain positive, collaborative working relationships at all levels of the organization or system.

Judy Blair, RN, BSN, MBA

Sr. Vice President, Clinical Services/Chief Nursing Officer
Glendale Adventist Medical Center

Having a passion for quality, safety and patient experience. It has to be a part of who you are and obvious to all those around you.

Lori Burnell, RN, MSN, Ph.D.

Sr. Vice President and Chief Nursing Officer
Valley Presbyterian Hospital

The ability to give people a reason to believe. Make your vision large, but pay attention to the details.

Shirley Johnson, RN, M.S., MBA

Chief Nursing and Patient Care Services Officer
City of Hope

Effective communication skills and the ability to truly listen to others. I have needed to ask the forgiveness of my staff many times when my “listening” has not been at its best or when in my haste I haven’t communicated as completely as I should.

Margaret Pfeiffer, RN, MSN

Vice President, Patient Care Services and Chief Nursing Officer
Good Samaritan Hospital

Taking complete ownership of all activity and results within your department. We cannot be passive about accomplishing our goals. If we do not drive a process through to completion, we end up with a lot of unaccomplished goals.

Patricia Stone, RN, MSN

Vice President and Chief Nursing Officer
California Hospital Medical Center

Passion for patient care, respect for every person (including yourself), lots of energy and a good sense of humor, including the ability to laugh at yourself. 


Editor’s Note: Thank you to our exemplary nursing leaders for participating in this story — you are a true inspiration. Also, a big round of applause to the following people for their help with this story: Katrina Bada, Kelsi Boyle, Stephanie Bradhurst, Marlen Bugarin, Laura Coverson, Karen DuPont, Doneva Garcia, Jaclyn Giovis, Alicia Gonzales, Carolyn Kendrick, Susan Kilgore, John Murray, Ann O’Brien, Briana Pastorino, Monique Rodriguez, Susan von Seggern, H. Chung So, Roseanne Weathers and Christina Zicklin. Working with you has been a delight.

This article is from workingnurse.com.

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