Joan Burritt, RN, DNSc

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Can an East Coast nurse leader make a successful transition to the West Coast culture? Are nursing leadership skills transportable across all regions of the country? Those two questions were on the forefront of Dr. Joan Burritt's mind as she moved from Philadelphia to San Diego to assume the role of associate administrator/chief nurse executive at Scripps Memorial Hospital, a 372-bed acute care facility in La Jolla, California—the flagship hospital of the Scripps Health System.

Joan, who was born, educated, and socialized to nursing leadership practice on the East Coast, was not sure if she could survive outside her beloved New England. After 5 years in her current role, it is obvious that she has not only survived, but flourished, as those for whom she provides leadership can testify.

First, tell us a little about you, your family, where you grew up, went to school, your hobbies and your interests.

I was born in Connecticut and grew up in Stratford. I am one of four children and the second in the birth order. My mother was a housewife, and my father ran a successful lumber business; neither attended college. Interestingly, my grandmother was a graduate of Columbia University at a time when few women attended college.

I graduated from the Grace-New Haven School of Nursing, the diploma program at Yale-New Haven Hospital. My BSN is from Boston University, and I received my MSN and DNSc from the University of Pennsylvania. As an interesting aside, I also spent a year at Harvard University as I contemplated, for a very short while, pursuing a degree in medicine. I will say more about that later.

My two children, Jonathon and Andrew, are my pride and joy. Jonathon is a student at University of California at Santa Cruz, where he is studying screenwriting. Andrew is a senior in high school. Both have adapted extremely well to the California lifestyle.

I have always been an avid swimmer, and now I work out and try to be as fit as possible—it's the California way. Cooking, theater, and needlework are activities I enjoy and try to pursue whenever I have any leisure time. And, last but not least, I try to get back to our place at Cape Cod at least four times a year.

Now, Joan Burritt, the nurse. Why did you choose nursing? What do you like best about your job? What bores you?

When I attended college, the traditional career choices for women were teacher, social worker, or nurse. However, I believe I had a calling to nursing and, given a different set of options, I believe I would still choose nursing. My brief flirtation with a career in medicine will highlight that. I had been practicing as a nurse for a little while when some people encouraged me to pursue medicine. I heard that old saw—“You are too smart to be a nurse. You should be a doctor.” So I enrolled at Harvard and began taking the essential prerequisite classes for medical school. Sometime during the course of that year, as I was filling out the application for medical school, it hit me—I could not abandon nursing. The nurse/patient relationship was so precious to me. I considered it then, as now, a sacred trust. I could not imagine any career that would be more important than nursing. So I left Harvard and reaffirmed my commitment to nursing. And I have never looked back.

I have been in administrative practice for 20 years now, and I love what I do. Active engagement in operations means I can influence, either for good or not so good, the patient care experience of 400 people and their families. That energizes me and helps me keep my focus on facilitating the best care practices possible. There was a time I thought that I had to practice in the pediatric environment, no other setting would do. Obviously that is no longer the case. A colleague encouraged me to spread my leadership wings and take on responsibilities across the organization. I did and was successful. That willingness to risk and seek new challenges was important in my professional growth and development.

One aspect of my role that I believe is critical is succession planning. Growing new leaders is a major part of executive practice. Currently, there are six nurses at Scripps who are engaged in doctoral education. I hope and believe I played a small part in their decisions to seek additional education to improve their practice, no matter the area of responsibility they hold.

As for what bores me-- finance! I was once advised by a colleague, “Get yourself a very good financial person!” I have that here. In fact, she believes that her job is to find the money to support my vision for nursing. She analyzes the reports with a fine-tooth comb, summarizes the trends and data points, and together we develop the action plan. We're a good team.

Poorly run meetings irritate me, to put it mildly. I absolutely hate to waste people's time, and I try to facilitate efficient meetings from a time management perspective. I also allow sufficient time for discussion but prevent the group from slipping into analysis paralysis.

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Finish these sentences:

Most people describe my leadership style as…

The three leadership attributes I value most are…

They would say I am a consensus builder around common vision and goals. I also see potential in people that they cannot see in themselves; hence, they are motivated to aspire to roles and responsibilities they would not seek on their own. For example, I once told a staff nurse in the NICU that I saw her as a manager, and she took that message to heart and prepared herself for that position. And she was very successful in that capacity.

It is sometimes difficult to teach nursing leadership, but I always try to role model it and reinforce those traits when I see them in others.

I value integrity based on honest feedback. Even though I may not like the message, I realize the importance of honesty. Integrity is baseline.

I also believe that outstanding leaders are consistent, but that consistency is based on a set of principles that guide their actions and decisions. Moreover, those whom they lead know those principles.

Finally, it is critical that the leader be able to discern between what is important and what is not. The information overload is unbelievable and the ability to sift through that and build a decision framework on the vital elements is essential.

Describe some of your defining moments in terms of your career—moments that remain crystallized and continue to shape your thinking and actions.

There are many, but three stand out in my mind. I once considered being a midwife. I was working at a teaching hospital at the time, and a resident suggested I participate in the delivery process. As a result, I was standing at that end of the table when my nursing manager entered the room. I could tell by the look in her eyes that she was not happy. Although I realize now she could have thrown the book at me, she chose to use that as a teachable moment. She helped me understand that my role was at the head of the bed, supporting the patient. That support role was as critical as the physician's. That helped me clearly understand the difference between physician and nurse practice domains. And I never forgot that lesson, nor the lesson in seizing the opportunity to mentor.

On another occasion, during my clinical practice residency at Yale, I was caring for a terminally ill cancer patient. When I left at the end of the shift, I stopped to tell her I was leaving and that I would see her tomorrow. Both she and I knew that she would not be there tomorrow. I was so troubled by that exchange that I sought out a nurse friend, who gave me a Kleenex and a glass of water and told me I had to go back and say goodbye. I knew she was right, so I returned to the patient's room for that difficult conversation. That was a very powerful moment in my career. Both of these examples validated the role and power of nursing.

As I mentioned earlier, I have always loved pediatric nursing. However, a mentor told me I needed to needed to broaden my horizons if I wanted to maximize my influence as a leader. That was tough for me, and I grieved deeply after I left that specialty. But that was the right move for me. I needed to take the risk and stretch my leadership muscles. I also realize now that every time I took on a new challenge, it was preparing me for where I am today. I am exactly where I should be!

As you look back on your career, are there things you wish you had done differently or opportunities, in retrospect, that you wish you had seized?

I have a short answer to that long question. I would like to be able to tell you I have been thoughtful and systematic in my career planning. However, that is simply not the case. I have never had a career plan, per se. I am an opportunist. And I have been able to take advantages of opportunities when they presented themselves. As I said earlier, I have no regrets.

From your perspective, what have been your most significant leadership contributions?

Rather than talk about significant one-time contributions, I would like to tell you what the patient care staff see as my contributions. In their words, I have a passion for excellence, which is patient-focused and is evident in all my leadership actions. I am humbled and dumbfounded by their assessment. From where I sit, my contributions are simple yet essential to attaining excellence. As a leader, it is my responsibility to continuously discover what the staff needs to provide outstanding quality care to patients and families. Is it knowledge, tools, support? Whatever it is, it is my job to see that they get what they need to do their jobs. I also believe my leadership is strengthened by what I like to call “connected advocacy” tied to measurable outcomes.

Would those who work with you agree?

I think most would say I am absolutely committed to doing the right thing for patients and will go to the mat to make that happen. Early in my leadership journey, I focused on supporting and advocating for nursing. I have matured and now understand how essential it is to work in partnership with all disciplines that provide care.

As you think about nursing today, is there anything you think should be on our professional radar screen that is not getting the attention it should?

We are facing a changing practice environment in which former models of nursing care will not work. Every patient in the acute care setting needs an expert nurse. There is little or no time for nurses to learn by doing, as was the case in years past. Physician practice is changing as well, and often their input is through clinical sound bites. The whole rate of change is so dramatic that acute care facilities must provide a safety net for patients by ensuring that expert clinicians, especially nurses, are available 24/7.

At Scripps, we have initiated a clinical mentor program to provide that resource to staff on all shifts. The clinical mentors are some of our most senior, experienced staff who demonstrate the expert level of practice. These mentors do not take a patient care assignment, and they are responsible for overseeing the care and practice of all staff on every shift. The clinical mentor ensures nursing expertise undergirds all practice decisions. Young and new staff do not have to go it alone, hoping they will not make an error in judgment or a treatment mistake. In fact, they are expected to access the knowledge of the clinical mentor. We have tracked the quality and financial impact of the clinical mentor program, and we've achieved extraordinary results. We're in the process of drafting a manuscript about our experience because I believe the mentor program may be an important practice model for the future.

Can you name colleagues or individuals who have had a significant influence on your career as a leader?

One individual is Dr. Trish Gibbons. Her passion for nursing, especially primary nursing, helped me understand how central the role of nursing is in making sure patients get what they need in the care experience. For Trish, nursing accountability for practice is key, and primary nursing links nursing care and patient outcomes.

Dr. Clair Fagin also influenced me mightily. She is so brilliant and courageous. She has been a trailblazer for nursing leaders.

Donna Diers is my nursing hero. Everything she said, did, and wrote has influenced me as a nurse. I once had the extraordinary experience of hearing Donna give a speech on the importance of therapeutic relationships in nursing. She told of a conversation with a cancer patient who credited a nurse with adding months to her life. The patient attributed this to the strength she received in her interactions with the nurse. Then Donna named the nurse, and it was me. I cannot describe how I felt at that moment. Donna and I share the same values in terms of basing nursing actions on principles and evidence.

What would you like your nursing legacy to be?

I am profoundly fortunate to be able to serve as a nursing leader. And I want my legacy to be that I made a positive difference in the lives of the staff and the patients whom I serve. I am humbled by that realization and it is quite sufficient.

Joan, I understand you recently experienced an organizational situation that became a local and national media blitz that had very negative overtones. Can you share your thoughts and experiences in the days and weeks that followed as you tried too manage the rumors and innuendos that put both your and the institution's credibility in question?

I have been through some significant soul searching as a leader since our last conversation. As you know, we had two internal issues that were leaked and were very upsetting for us. In both instances, we responded quickly to ensure patient and staff safety and to take corrective action. We immediately informed our regulatory agencies. We were open and honest with patients, families, and staff.

I was very proud of the high road our organization took in these two events. As difficult as these situations were in and of themselves, they were compounded by a leak to the press by an anonymous source. The media bombardment that ensued was devastating because of sensationalistic statements suggesting we were ignoring our commitment to safeguarding the safety of our patients.

This trial by fire, with respect to both the internal issues and resulting media attention, has left me shaken, humbled, and much wiser than I was a month ago with regard to how such a thing could happen to anyone. What have I learned?

Lesson #1: I have now gained an acute sensitivity and appreciation that this type of experience is a condition of leadership. In the past, when I learned of other organizations being subjected to negative media onslaughts based on an internal mistake, I was very quick to think, “How did they let that happen?” or “Someone was not paying attention.” I now know that that is not always the case. I will never read about these situations again without reminding myself that I don't know all the facts of the case, and neither will anyone else who reads the only the press account.

Lesson #2: Remaining on course and staying true to your leadership responsibilities is very difficult during these times but even more important, as staff are just as shaken as you by the swirling negativity. You must continue to exert leadership locally while trying to remain vigilant to the threats in the external environment. And to compound the issue, you are stressed, so you begin to second-guess yourself and become defensive as you try to cope with the new demands on your time and energy. Of course, you have to manage all these emotions and reactions, especially the defensiveness, as it is counterproductive and only escalates the negativity. In a phrase, it is tough!

Lesson #3: Someone in the leadership team has to take the lead in managing the knee-jerk and normal reactions that play out in an entire series of what-if scenarios; they always lead to the worst possible outcomes. Panic reigns and energy is wasted trying to second-guess every potentially disastrous outcome. I believe that rational behavior therapy, a methodology that forces one to sort the real from the imagined, is very helpful in circumstances such as these.

Lesson #4: Adopt organizational transparency in these situations. We quickly informed the appropriate regulatory and accrediting bodies. We were open and honest in all of our communications with stakeholders, internally and externally. Our goal was always to do the right thing. Even when there was negligible risk for patients and staff, we exerted maximum effort to inform, communicate, and where appropriate, intervene. In fact, we used these situations as opportunities to improve. That is an important principle.

I should mention a bump in the road during this process. We are a Magnet hospital, and in the chaos immediately following the press announcements, I simply did not think to call them about our situation. I recommend to other Magnet organizations that they notify the Magnet Corporate Office if they experience a similar situation. Upon learning of our press coverage, the executive director called me so the organization could respond to any inquiries they might receive. When I explained the event and our action plan, the positive feedback and understanding was immensely supportive and validating during an extremely stressful period.

As someone recently reminded me, as leaders, any of us are but a moment away from having something go wrong. Sometimes that is within our control, sometimes not. It is the nature of leadership. I understand that statement now at a very different level than I would have in the past. I also realize that it is our response that is critical.

I am proud of this institution as a result of our response and the actions we took during a very difficult time. I believe the staff shares that same sentiment. I am glad I can say I am a leader and a nurse.