Leadership Interview of Senior Vice President of Nursing at Medstar Washington

The George Washington UniversityMedStar Washington Hospital Center is the largest hospital in Washington D.C.; With 926 beds and roughly 2400 employees within MWHC’s nursing department, it is also among the 50 largest in the entire nation. The oversight and management of such a large and busy organization is a job which requires a leader who is innovative and accountable, with the ability to adapt to stressful scenarios and inspire team members to perform at their best. Luckily, Susan Eckert, senior vice president and chief nursing executive, is the perfect person for the position.

Beginning her Medstar career as an ICU nurse in 1979, Susan, or “Sue” as she prefers to be called, has dedicated nearly 40 years to the hospital and become a hugely significant figure in its progress and development. In an interview, Sue discussed her experience in the role of a nurse leader, the aspects of it that she finds most challenging as well as the most rewarding, and what she believes makes her so good at it. Leadership InnovationNursing is a discipline that is constantly growing and developing. This impacts all nurses, but nurse leaders in particular are needed in order to understand and take initiative in how they respond to these changes (McElmurry, Kim, & Al Gasseer, 2000).

The use of innovation in an ever-changing field allows us to create and implement change that has a positive effect on our careers, as it can improve patient care and nursing satisfaction. The Agency for Healthcare Research and Quality (AHRQ) defines innovation as “a new way of doing things to improve healthcare delivery” (Brach, Lenfestey, Roussel, Amoozegar & Sorensen, 2008).For Sue, the concept of innovation as a leader is one which she chose to make her primary focus for many years. After having been at MWHC for over 25 years, she began to have concerns about being there for so long, and so she decided that she wanted to try something different. “I was very worried that I was very parochial and narrow in my view, because this is what I knew,” Sue explained. When a physician at MWHC, Dr. Mark Smith, founded the Medstar Institute for Innovation and asked Sue to work with him, she readily agreed, and became the first nurse to work there.

She describes this experience as a “game changer” in terms of how she viewed innovation, not only in how it relates to nursing, but how it impacts health care as a system. Sue admits that she never saw herself as innovative, stating that she thought of herself as “more of an analytical brain as opposed to a creative brain.” Working at the Institute for Innovation for six years changed this belief. She recalls that “when I understood that innovation can also be an open approach to doing something differently, or openness to, in support of, getting to an outcome could be achieved 10 different ways—it really doesn’t matter, as long as you get there—then I would say yes, I’ve gotten so much better at harnessing innovation to try and make sure we get to the best solution.”Emotional competenceFor leaders, few things are as important as emotional competence. Studies done on the subject have demonstrated that “emotional intelligence abilities improve communication, support constructive conflict resolution, and improve individual and team performance” (Codier, D., 2017; Codier, E., 2017).

Sue exemplifies what it means to lead with emotional competence, and emphasizes her passion for staying connected with nurses on all levels. One way in which she displays this is by making a point of periodically visiting each unit to talk with the staff nurses working on them. In a hospital where 48 departments have nurses, this is no small task, but “I feel like it is extremely important to stay in touch with the nurses in the hospital. I want to be seen as approachable, and I want them to know that I am listening to what they have to say, and if they aren’t happy with something, I want to know about it.”

In a hospital as large as MWHC, she is aware that when sitting down with nurses, there are bound to be complaints and concerns voiced. When asked how she approaches these situations, she says that “I just know sometimes it’s going to be hostile, so you’re always equipping yourself to be calm, and not to personalize it, and I need to hear this and to maintain a demeanor so that people feel safe, because if they don’t tell me I can’t fix it.” The significance of emotional intelligence cannot be understated, which is something that Sue learned from her time as a SICU nurse. “I know that nursing is an intense profession, and that it is very emotional. I know because I’ve been there. So in all of my interactions, in all of the decisions I make, I try to keep in mind what is best for the nurses, because I want them to feel understood and supported, because then they are able to do their job and care for patients to the best of their ability.”

Crisis managementThe ability to be a leader in a time of crisis or disaster is no easy task. For Sue, serving as incident commander of Medstar Washington Hospital Center on September 11, 2001 is what she describes as the most difficult day of her entire career. “We stood on the helipad outside of Medstar, and we could see the Pentagon burning,” she recalls. In times like this, it is essential that the hospital have a nurse leader who is well-equipped to handle crisis management in order to ensure that operations run smoothly and productively. Part of this requires always keeping in mind the “human dimension” of a crisis. Leaders must be able to reassure their team of their strengths and inspire confidence “in spite of the fear and anxiety triggered by an incident” (Edmonson, Sumagaysay, Cueman, & Chappell, 2016).

Sue stated confidently that she is an excellent crisis manager. She attributes this to several traits, one of which is her ability to stay collected no matter how stressful the situation. “I’m very calm, and people feed off of it, so I can get everybody calmed down,” she says of herself. She also believes that her ability to collaborate with all members of a team is key to handling crises. She summarizes her approach as one where “I will tell everybody, I need your intellect, I need your human capital to solve this problem. It’s not me, it’s the team.” Sue wrote an article dedicated entirely to the topic of disaster preparedness which was published in the well-respected nursing journal, American Nurse Today.

In this article, she gives advice on what she feels are the most important parts of crisis management and disaster preparedness: protecting yourself, protecting patients, understanding the chain of command, knowing how to communicate, and the importance of collaboration. “Nurses are extraordinarily resourceful and creative,” she states. “Adding emergency preparedness to your knowledge base can greatly enhance the power of your practice—and can help you save lives when the unimaginable happens” (Eckert, 2006). SpiritualityDiscussions on the role of spirituality in nursing have become more prevalent and open minded. Ledlow & Coppola (2014) explain that “it is well known that spiritual principles are the basis for many values and enduring beliefs that guide the moral and ethical development or health leadership practices in our society.”

While it is a concept that is open for interpretation, one consistent theme within the realm of spirituality is a desire for life to have a higher purpose or meaning (Sartori, 2010). For many nurses, spirituality is embodied in the belief that nursing is what they were meant to do. For Sue, the idea of nursing being her calling is debatable. One thing that she knows definitively is that “I wanted to do something with my life that would help people.” This desire helped pave the path to her role as a nurse leader. “I began my career as a bedside nurse in the surgical ICU,” Sue recalls. “I loved it, and it gave me a great sense of fulfillment, but I also believed that I could make just as much of a difference in a leadership role.” While many equate spirituality with religion, Sue believes that they are two entirely different concepts. “While I am religious, being of the catholic faith, I don’t see it as being a major part of my role as a leader.

Spirituality, to me, can manifest in how people interact. It can be as simple as treating others with respect and receiving the same in return.”Change and conflictWhen asked for an example of a time when she disagreed with a change that was being made, and it resulted in conflict, Sue said that there was one she was currently dealing with while serving as one of the CNOs on the Medstar Health CNO council. At several medstar hospitals, they have the role of clinical specialist. The systems CNO made the decision that only Advance Practice Nurses should be hired to fill this role. Sue, who herself once worked as a clinical specialist, disagreed with this decision, as she believes that clinical specialists have a huge influence on the system, and that only filling the role with APRNs would limit this.

The systems CNO wanted a consensus on the new rule she was proposing, and only Sue was blocking the change from being made. “So, I voiced my concerns, shared my different perspective,” but realizing that the council ultimately needed to move forward, “I chose to abstain.” For someone in a nurse leadership role, it is important to remember that you cannot always get your way; sometimes the best thing to do is “pick your battles.” Sue admits that conflict is something that is unavoidable, especially in a role like hers, but it must be dealt with head on. She feels strongly that “in nursing, conflict must be addressed, because if it isn’t, it can ultimately become a patient safety problem.”Transformational Coaching and Leading TeamsWhen asked about the leadership styles that Sue feels best represent her, one of the first ones she mentioned was transformational leadership.

In 1978, James MacGregor Burns came up with the theory of transformational leadership. He defined it as the process of building commitment to the organization’s objectives and empowering followers to accomplish these objectives.” Benjamin Bass later expanded on this idea, saying that “transformational leadership must be grounded in moral foundations that include inspirational motivation, individualized consideration, intellectual stimulation, and idealized influence” (Ledlow & Coppola, 2014). Within the realm of leading teams in nursing, a leader practicing the transformational style is able to build confidence, respect and a strong rapport with their team by acting as a role model. Their example inspires those under their leadership to perform at a higher level and they place value in innovative strategies and solutions, priding creativity and efficiency. They give respect to all team members and their ideas to ensure a feeling of security in expressing outside-the-box solutions.

Crucially, a transformational leader provides a level of motivation and inspiration which persists with nursing team members even without the leader physically present. “I believe transformational leadership and having emotional competence is really critical when you start getting into these roles where you’re mostly influencing as opposed to directly doing,” Sue explained. Medstar Washington Hospital Center recently received Pathway to Excellence designation, making it the first hospital in the District of Columbia to achieve this. Granted by the American Nurses Credentialing Center, this designation is given “only to hospitals that have created a work environment where nurses’ contributions are valued, professional development is supported, and nurses are integral to decision-making” (Pathway to Excellence, n.d.). This honor could not have been achieved without Sue’s leadership, commitment to success, and dedication to the hospital, which show the way for those who follow her to bring the same qualities to their work.

References

1. Brach C, Lenfestey N, Roussel A, Amoozegar J, Sorensen A. Will It Work Here? A Decisionmaker’s Guide to Adopting Innovations. Prepared by RTI International under Contract No. 233-02-0090. Agency for Healthcare Research and Quality (AHRQ) Publication No. 08-0051.
2.  Rockville, MD: AHRQ; September 2008.Codier, E., & Codier, D. D. (2017). Could Emotional Intelligence Make Patients Safer? AJN, American Journal of Nursing, 117(7), 58-62. doi:10.1097/01.naj.0000520946.39224.db
3.  Eckert, S. (2006). Preparing for disaster. American Nurse Today, 1(1).Edmonson, C., Sumagaysay, D., Cueman, M., & Chappell, S. (2016). Crisis Management: The Nurse Leaders Role. Nurse Leader, 14(3), 174-176. doi:10.1016/j.mnl.2016.04.003
4. Ledlow, G. R., & Coppola, M. N. (2014). Leadership for health professionals: Theory, skills, and applications. Burlington, MA: Jones & Bartlett Learning.
5. McElmurry, B.J., Kim, S., & Al Gasseer, N. (2000). Global nursing leadership: A professional imperative. Seminar for Nurse Managers. 8(4): 232-238.Pathway to Excellence. (n.d.). Retrieved from https://www.nursingworld.org/organizational-programs/pathway/
6. Sartori, Penny. (2010). Spirituality 1: Should spiritual and religious beliefs be part of patient care?. Nursing times. 106. 14-7.