Priorities for todays nurse leader

Maureen Swick, R.N., took the helm as chief nursing officer of the American Hospital Association and CEO of the American Organization of Nurse Executives last summer. She had been top nurse executive at Inova health system in Virginia and is a 30-year veteran in the health care field. Swick recently spoke with Trustee about nurse burnout, workplace violence and other hot topics, as well as AONE’s upcoming 50th anniversary celebration at its annual meeting in March in Baltimore.

So far, what has your new role been like with the AHA?

SWICK: It's only been eight months, and definitely I'm still getting up to speed. I can't say I'm there yet. There's so much to learn, having just left a system as chief nurse and moved into an association as CEO. As you can imagine, it is a bit of a transition, and it's two positions. The good side of that is that I was able to spend three years as an AHA board member, so I was familiar with the work of the AHA. But being part of the team is a new role along with getting to know all of the new executives and the different initiatives.

Compare going from the hospital side to the association side.

SWICK: You know, I left a world of being so closely connected to the work from a patient care perspective. I'll speak from a chief nurse perspective: I was in the hospitals, and I was rounding quite a bit. Then I took a national position, and the priorities are different. They're much broader, and the transition is really about staying connected to the work that I left and how that integrates to the work that's being done at a national level. It's been really good, and I think bringing recent experience from the field into conversations of policy and advocacy has been beneficial.

What are the biggest issues that keep chief nurse executives up at night?

SWICK: I would say that one of the major issues is the workforce. Certainly, there are pockets of supply-and-demand issues and shortages of nurses. I think the transition of care from the acute to the ambulatory setting is challenging, along with figuring out how nursing leadership fits in with the population health movement, plus recruitment/retention and the uncertainty of where we're going now with respect to some of the changes happening in Washington, D.C.

What does the new White House administration mean for nurse leaders and for the profession in general?

SWICK: With any change in administration, nursing has always been the one that comes to the table. We always put our patients first. We are the most trusted profession, and I think our relationships with key constituents and the fact that we have more than 4 million nurses in the U.S. today gives us credibility and value. So, as leadership in D.C. turns over every four or eight years, nursing’s ability to build relationships has kept the voice of the patient alive. It's just another challenge in the day.

Nurse burnout is an issue that we keep hearing about. Some even call it an epidemic.

SWICK: Nurse burnout is something that nursing leadership has been dealing with for many years. It's not new. What has added to this issue is technology — and, certainly, the transition that our fellow health care partners, physicians, are going through and where they fit in the new health care world, has created burnout for them. I know that we, [AHA Chief Medical Officer] Jay Bhatt and I, are going to be participating in the National Academy of Medicine group that has been pulled together to look at clinician burnout. I'm eager to participate in this and share some of the best practices that nursing leadership has implemented throughout the years.

How can CNOs try to rein in burnout and keep nurses happy and healthy in their careers?

SWICK: Staffing is a key piece — ensuring that we have the right number and the right mix of staff. The other piece is working with our physician colleagues and other health care clinicians on the teamwork issue, because teamwork is really the secret sauce. Chief nurses collaborating with their physician partners and focusing on teamwork in the health care environment will decrease burnout. When you know you're not on an island and you're working together with others, it makes the work a lot easier, and creates a better environment for patients and families alike.

I’ve also heard you talk about resiliency being critical in leadership.  

SWICK: If you look at the health care environment and the rapid pace of change, nurse leaders need to be role models. And, if you're not a resilient leader, it's going to be hard to do that. Being resilient through my 30-plus years of nursing has kept me in a healthy and positive mindset. It's that mindset that will help those we lead as we charge forward with the changes that are coming about in health care. The changes are unprecedented. In the last five or six years, the pace of change has been incredible, and it takes a strong, positive and healthy leader to lead the team through that. So, nurse leaders need to be resilient if they want to instill that in their teams. Otherwise we're going to burn out, right? The whole key to preventing burnout is resiliency. The more resilient we are, the better we can help our teams be resilient as we improve care nationally.

Given the stress nurses face, would you still recommend the profession to young men and women?

SWICK: I can't imagine doing anything else. It has been a most rewarding career. My only daughter is a relatively new nurse, and I have a son who graduated from nursing school in December. So I would say, yes. I'm a strong proponent of nursing, and I think that there are so many different opportunities for nurses, especially as health care transitions into the community. I could not recommend it strongly enough as a wonderful career and a rewarding one for young people.

What first motivated you to enter the nursing profession?

SWICK: I've always enjoyed caring for people. I’m the eldest daughter of 10, so I've always had a role in caring for my siblings. My mother and her two sisters were nurses, so growing up, nursing was a strong influencer in my family. That's where I got my roots and started as a volunteer candy striper back in the day. I then became a nurse's aide and worked myself up the nursing ladder.

Why are we so short of the RNs needed to make the shift toward value, and how can we improve the pipeline?

SWICK: It's a multifaceted problem. Part of it is that there are many more opportunities for nursing outside of the acute care setting, including the growth of home-based care, community health and ambulatory care. So, the opportunities are growing for nursing. In addition, there is a nursing faculty shortage, and schools of nursing are only able to produce so many graduates.

Engaging membership is one of the things that we're focused on as we look at the aging workforce and all of the retirements to come. How do we engage the nurses coming into our profession and inspire them to become nurse leaders? It's a challenging position right now, and part of our focus for 2017 is on engaging new nurses. How can we interest them in leadership, and what educational programs do we need to provide to give them a good start?

Why does AONE support allowing advanced practice registered nurses to practice to the top of their licenses?

SWICK: Having been an advanced practice nurse myself, when you look at the growth of primary care and the ambulatory world, having advanced practice nurses be able to practice to their education, training and licensure has enabled us to expand access, right? We can see more patients and provide the same high-quality care, and many physician practices are now expanding by hiring nurse practitioners. Others are hiring more advanced practice nurses in the acute care and hospital settings, especially some of the best practices I have seen in psychiatric nursing.

You know, we have a shortage of nurses in behavioral health and psychiatry. Having advanced practice nurses with behavioral health expertise enables us to provide more timely care to patients who need those services. So, yes, AONE has been very supportive of that.

Do you think any of the arguments against this make sense?

SWICK: They don't. The literature and the outcomes from nurse practitioners do not support limiting nurse practitioners’ authority. I think that’s a political fight that goes on, but certainly from a research and outcomes perspective, nurse practitioners deliver high-quality care, and there has been nothing that suggests otherwise.

Violence is a big area of focus for the AHA in 2017. Why is the topic so crucial?

SWICK: Workplace violence is a huge initiative of the AHA and one that AONE has been part of for a few years now. We led work in collaboration with the Emergency Nurses Association a few years ago and published guiding principles on workplace violence and things that nurse leaders need to do to ensure the safety of those we serve, and we'll be expanding that. We met with the head of the International Association for Healthcare Security and Safety in December to look at how we can expand that work and educate our colleagues on best practices to ensure a safer environment.

Certainly, a lot of work has alredy been done. There are a lot of great best practices that, from an AHA perspective, we are collecting and putting on our website so that our members can ensure a safer [work] environment, as well as a safer community. A lot of work is being done now in collaboration with community leaders, because a lot of the violence that happens in our communities ends up on our doorstep — in our emergency departments. This work is off to a great start. Bringing awareness to this is important for the health of our nation.

Talk about the toll such violence takes on nurses.

SWICK: Violence takes its toll, especially for our ED nurses, who are the first responders. Ensuring that there is support for the nursing staff, physicians and other clinicians is critically important. And again, a lot of what we want to work on with our security partners is, from an inpatient perspective, how we can prevent violence. What skills and education do we need to give to our front-line staff to de-escalate and, hopefully, avoid the violence to begin with? There’s a lot of work to be done, and I look forward to that collaboration with experts in the field. We are going to be creating many podcasts and webinars, and we've been soliciting best practices from our members across the nation about what types of things they have in place — first, to avoid the violence and, second, how they support their staff when violence does take place.

Your annual meeting is next month. What are some of the key themes?

SWICK: Care coordination. We have new competencies for nurse leaders for population health, so that will be another key focus. It’s our 50th anniversary, which is huge. I'm really excited about having that celebration in Baltimore. Certainly, it will include looking at the last 50 years and focusing on where nursing leadership started and where we are now. That will definitely be showcased, as well as some of the innovations that nurse leaders are exploring today and what the future may hold for AONE moving through the next 50 years.  

What is it like taking the helm of an organization with such a rich history?

SWICK: For me, it is so exciting to be part of this celebration. I'm excited about the nurse leaders from our past who will be there and who will be sharing their thoughts about nursing leadership through the years. We won't have those from 50 years ago, but we've been doing a lot of work from an archival perspective in trying to capture all of the key moments of AONE from when we started to where we are today. Just being part of that is an incredible honor and privilege, and I am looking forward to where the next 50 years will take us. I know that we have exciting opportunities ahead of us.

Marty Stempniak is senior writer at Trustee.

The Swick file

Who had the biggest influence on your career?

That would be my mom who, unfortunately, passed away at 64. She definitely was the strongest person who influenced me. Her ability to care for others and her positive mindset are what I always think about, especially when I have to deal with tough issues. From a resiliency standpoint, reflecting on her life definitely has helped me to maintain my focus in my life, personally and professionally.

Do you have any hobbies?

I love to cook when I'm home. My mom loved to cook and bake, and I find cooking to be extremely therapeutic. It's funny, but when I'm home only for a short time, my husband will say, "Oh let's go out." Then, I'll reply, "Oh no. I need to bake bread or do something for enjoyment." I don't get to do it enough, but when I do, I find it very relaxing and enjoyable.

What's your specialty?

My mother was born in Sicily, so, needless to say, Italian food is a big focus — lasagna, eggplant parmesan and things like that. I also love seafood. Having grown up north of Boston, of course, I enjoy making different lobster and shrimp dishes. One of my specialties is baked, stuffed lobster.

What are you reading right now?

I actually love to read. I just finished an amazing book by Amy Cuddy called Presence: Bringing Your Boldest Self to Your Biggest Challenges, and I thoroughly enjoyed that.