Karlene M. Kerfoot, PhD, RN, CNAA, FAAN
Article Outline
- How did you get where you are?
- How do you balance work-life and have a demanding career?
- Life is not always a bowl of cherries. There have been good days and bad days. How do you get through the bad days?
- What's different about you as a health care executive?
- You have spent a considerable time in multiple hospital systems. How do those positions differ from single hospital positions?
- What's the most fun you have in your roles?
- What would you want your eulogy to say?
- With over 300 published writings, it's an understatement to say you write a lot. How do you do that?
- What is your wish for nursing for the future?
- What's good about the future?
- Advice to a new leader?
- If you were reincarnated, would you do it again?
- Who is responsible for who you are today? What has made up your leadership DNA?
- Here's a classic question: What's your leadership style?
- What gets you out of bed every day to keep this up?
- And what are you doing now?
- We often know leaders as leaders, but seldom as people. If we interviewed your good friends and your family, what would they say about you?
- Copyright
How did you get where you are?
I took the path of a second career student and started first as a political science major, intending to be a career diplomat in the American Foreign Service. Then I discovered the American Foreign Service did not accept women, so I had to decide on another career, quickly. I chose nursing because it gave me the flexibility to work anywhere. People often ask if I was angry. No. Rather, I was sadly surprised to discover women were not valued in all positions in what I thought was an equitable world. I have no regrets. Nursing has been a fabulous career for me. All those courses I took in political science and my continuing interest in it have helped immensely in leadership positions.
Like many nurses, I was promoted to positions I didn't have the academic foundation for, so I decided to go to school to find out how I should be doing the jobs I was already doing. I didn't have a specific career goal, but rather a host of scenarios with possibilities for which I needed to be prepared. My career path has been a winding one, bordered by many varieties of roses—the smelling of which, hopefully, has expanded and diversified my thinking. I've changed positions because I felt I had an opportunity to learn and grow and to contribute more. Somewhere I remember a wise philosopher saying that life was like a book: If you read only one chapter, you miss most of the story. It wasn't easy uprooting and moving to a new challenge, but if you don't, you miss so many chapters in the book of life.
How do you balance work-life and have a demanding career?
I learned that you can't have it all at the same time and there's a time and place for everything. Our profession offers incredible flexibility to combine work and family. When our son was born, I was finishing a doctoral program and returned to teaching so I could have the flexible hours and the luxury to work at home. At certain points in my career, I chose to serve on committees in professional organizations rather than running for office because I wanted to be home as much as possible when my son was young. Now, serving on the board of the American Academy of Nursing, which I wouldn't have considered at other times in my life.
The ability to compartmentalize work and family helps. I seldom take problems from work home in my head, so when I'm home, I'm fully home. When I'm at work, I'm at work. Fortunately, my husband has been a great partner and father, and we've been able to manage the handoffs that two professionals encounter with work and parenting. Sure, there are times when the balance isn't there, but over the long term, it is because you constantly refocus on the important goals.
Life is not always a bowl of cherries. There have been good days and bad days. How do you get through the bad days?
My grandmother often said, “Don't get your bowels in an uproar over something you won't remember when you are 85.” I follow that. Unfortunately, there are some things, both professional and personal, I will remember when I'm 85 … like the ache in my stomach and heaviness in my heart during the depths of one nursing shortage when I took a new position, knowing how awful it was for the heroic nurses still working at the bedside with horrible vacancy rates. I was new to my position and hadn't yet been able to implement plans that could make a difference for that night, and I knew it would be weeks or months before anything would get better. It was terrible to know I could make it better but not right away. Then you hear of another resignation. You pray for courage and strength, but you feel very scared and weak.
Like dealing with one more consultant group going through and trying to lower the hours of care when you know the result will be turnover of nurses, bad patient outcomes, etc. And now we have Aiken's work and others that provide sound evidence linking nursing hours of care to outcomes. Luckily, I have had good benchmarking, internal controls, and other data to avoid the slash and burn that many hospitals have experienced.
Like when your pager goes off several times in succession with all different numbers and you know something tragic has happened. You can hardly breathe before you can get a call in, and then all the lines are busy. You then learn that one of the helicopters has crashed and there are no survivors, or there's a fire in an oxygen line in the ICU, or a medical mishap has harmed a patient, a pipe has broken in the ceiling and is endangering patients—the list goes on. In this business, the highs are atmospheric, and the lows are hellish. The position of CNO for patient care is one of extremes.
Personally, the worst days were 4—and the many surrounding them—when I lost 4 advanced pregnancies after the birth of our son. I returned to work with a very heavy heart, distracted by the grief.
In professional situations, you have to suck it up and tell yourself that it's not about you but about the people affected and hurt by these situations. You literally have to set your own feelings aside and be there for the people hurting so much more than you are. Personally, however, it is about you. And even though you can expect scars, you have to do whatever is necessary to take care of yourself and regain your equilibrium. I found solace with a hospital chaplain who was an expert in grief and grieving who became my guide through that difficult journey. It's important to reach out and not go through these experiences alone.
What's different about you as a health care executive?
Everyone has his or her own brand of leadership, either intentionally or unintentionally. In my view, there are three kinds of leaders: the first takes the organization backward to models prevalent 10 to 20 years ago, the second merely maintains the status quo, and the third advances the practice and the profession of nursing by innovating and improving practices and by implementing the evidence we have available to us in our leadership and clinical practice. Hopefully, I'm in that last category.
I hope people would see that I have struggled and strived to advance the practice and profession of nursing in many ways and go beyond just creating a successful operation. For example, our work at Clarion Health Partners on operationalizing the American Association of Critical-Care Nursing's (AACN) Synergy Model and Healthy Work Environment Standards, the Safe Passage Model, our earlier work building an evidence-based outcomes management program at St. Luke's Episcopal Hospital, the programs for retention that focus on creating a spiritual, healing health care community at work, and other innovations—I hope this work will be seen as important, replicated, and made better by others. Meeting the budget and maintaining the status quo is easy. Personally, I like to hang with people dedicated to advancing the practice. They inspire and give me the energy to keep thinking.
Name:
Karlene M. Kerfoot
Hometown:
Altoona, Iowa
Current job:
Principal, Kerfoot & Associates
Education:
PhD, University of Illinois Chicago BSN, MA University of Iowa
First job in nursing:
Pediatrics
Being in a leadership position gives me the opportunity to:
Energize people to awaken their potential to do great things for each other and for patients and their families
Most people don't know that I:
Have water-skied when it was snowing
My best advice to aspiring leaders:
Remember your most important job is to always “carry water for your people” so they can provide excellent care to patients and their families.
One thing I want to learn:
To be a pro at Pilates
One word to summarize me:
Passionate
Early in my career, I took courses in futurism and learned to scan the horizon and other industries for signals that might portend a trend. Scenario planning and possibility thinking taught me to look outside nursing and health care for effective models of leadership and practice. For example, in the patient safety program at Clarion Health Partners, we partnered with Rolls Royce to learn High Reliability Organization concepts and with Purdue engineers and others created a consortium together that was stronger than we were by ourselves.
You have spent a considerable time in multiple hospital systems. How do those positions differ from single hospital positions?
The skill set is very different. A systems position requires the ability to forecast farther out into the future and to balance the strategic view of the future with the monthly operations of the multiple hospital organization. A key challenge of these roles is the development of consistency of quality outcomes across so many different venues with very divergent cultures, practices, and objectives. The ability to align a very heterogeneous and large group of people around a shared vision on this very large scale is absolutely necessary. At the systems level, the executive must be able to thrive on ambiguity and matrix structures and have the ability to make sense of little structure and rules.
Many systems are contemplating adding the CNO role at the system level, and the demand for qualified and interested people is outstripping the supply. It makes perfect sense that the CNO role is needed at the system level. We must help people move from single to multiple facilities by identifying the concepts and providing mentoring and education.
What's the most fun you have in your roles?
Many things delight me, and that's probably why I've stuck it out longer than many do in these crazy stressful positions. I love to laugh and have a good time. I get really excited when I have the opportunity to build a professional practice out of a technical culture and watch nurses who used to be disengaged get excited about the expanded opportunities of working in a professional practice environment where they can really engage with patients and provide the safe and professional practice they were born to do.
The journey to Magnet status is the ultimate journey to professionalization and has been really exciting. When that call finally comes to announce that your organization has been designated as Magnet and the staff are so excited—it doesn't get much better that that. A note that brought tears to my eyes was from a nurse who thanked me for “raising the bar,” which transformed her life and her ability to work at a higher level of excellence with patients.
A second exciting part of this work is the daily opportunity to connect with talented people with skill sets and knowledge I don't have. They grow and I grow from the synergy of those relationships. I actually get goose bumps when I see how people I've known have grown into roles as CNOs in other hospitals, take on national leadership roles, and advanced their practice beyond mine in many ways. It's really exciting to watch that happen.
A third high for me—developing an idea, turning it over to a very diverse team of people, letting go of the control, and watching it evolve into something that I could never imagine. I've experienced it with the partnership with AACN developing the Synergy model of care, the Safe Passage Program for patient safety, the Healing Sanctuary Movement, adopting AACN's Healthy Work Environment Standards, and many more.
The experience of turning over an idea to a group that collectively is much smarter than you is very powerful. I function as a set of “guard rails” to watch over the integrity of the original project, but others build the car and drive it down the road. It's really beautiful to watch.
Finally, it's so much fun witnessing the vacancy and turnover rates drop as you install proven evidence-based programs. It's great to watch the staff evolve from downtrodden, worried, worn-out people to professionals who love their work and their profession and are ecstatic about the quality of the care they can deliver. For me the process is as exciting as watching babies being born—even if it does take longer than 9 months for the turnaround to happen!
What would you want your eulogy to say?
“Lived, loved, and laughed,” would say it all. I've planned a New Orleans jazz funeral, followed by a huge party. I believe in celebrating lives, not mourning them.
I hope people would remember me for doing my best to help the nurse at the bedside be the nurse he or she always wanted to be and that, in so doing, made patients and their families better off. I would hope my family would say our life together was a great roller coaster ride, and they had fun taking it with me. And hopefully the people I've worked with would say we all worked extremely hard and it was worth it because the patients got improved care as a result of the nurses and the staff loving their jobs and their profession.
With over 300 published writings, it's an understatement to say you write a lot. How do you do that?
Writing for me is therapy. There is always some event that causes me to question, wonder and seek out, more information and wisdom. It's hard in these very demanding positions to have the time to put your conceptual thinking hat on and think through an idea or a concept. Writing forces me to read things I wouldn't otherwise and make connections with seemingly unrelated events and concepts. My writing is, in a way, autobiographical because many topics are rooted in an event that puzzles me; it helps me to clarify an issue or prepare for a presentation. Writing does not come easy for me, but the desire to think through a topic is incredibly interesting and stimulating.
What is your wish for nursing for the future?
I wish nursing always had an equal seat at the table. Far too often, we aren't at the tables where we need to be. It would be exciting if our very diverse health care professional organizations would think more synergistically and convene national joint practice discussions and think together about the future of health care rather than in silos with key content experts MIA. I see it as a sad waste of talent when nurses aren't automatically considered for seats on boards and included in strategic discussions. Wouldn't it be wonderful if our nursing organizations could advance a strong synergistic relationship so we could have that very strong voice for the patient and the health of our communities and nation?
I wish all nursing organizations would commit to aggressively raising the bar and leading very serious quality improvement programs. I marvel at how safe anesthesia is now compared to what it was because of the very aggressive efforts of the Anesthesia Patient Safety Foundation, a pioneer in safety and quality care. Many organizations are well integrated in this effort, but we need to do more innovative work quickly to make nursing care safer for both the patient and the nurse who has to deliver that care.
Finally, I wish we would just get over the educational issue and agree that, as the research shows, we need nurses with better educational credentials. We could easily develop a “Leave no nurse behind” program and make available convenient and accessible programs to every nurse everywhere to advance from ADN to BSN immediately. It's peculiar that, while we're often at the top in terms of educational levels in the executive suite, at the bedside we don't compare to our peers in pharmacy, social work, physical therapy, and other health care professionals.
What's good about the future?
Magnet certification and the AACN Beacon Certification are brilliant innovations that are raising the bar and providing a clear pathway to follow to create excellence in organizations. It's exciting to watch the process and to see how a hospital or critical care unit is transformed into a culture of excellence and exceptional quality by making the decision to apply.
With the move to evidence-based clinical practice, there needs to be a movement to hold leaders accountable for making decisions based on evidence, as opposed to their own opinions. Hopefully, that movement will grow and the evidence we have from the human resources and staffing and scheduling literature will be implemented by leaders and managers who are held accountable for evidence-based leadership/management processes. It is wrong to hold clinicians accountable for evidence-based practice when we don't have the same standards for health care leaders.
Fortunately, the external report cards and public reporting of quality are forcing health care organizations to do what we couldn't do ourselves—implement evidence-based medicine. There are great models of organizations that have transformed themselves into high-quality organizations such as the Veterans Administration facilities. We can learn from them.
Advice to a new leader?
If you were reincarnated, would you do it again?
Absolutely! My career has been a happening, too! I never focused on the next job or national position of influence. I always loved the work at hand, and amazingly, that love morphed into many interesting adventures that have taken me to other countries and interesting opportunities where I have been able to commune and learn from the top leaders. Nursing has been a gift, an exciting learning experience and one that has allowed me to lead a life of significance.
Who is responsible for who you are today? What has made up your leadership DNA?
My grandparents are responsible for a large part of my leadership DNA. My parents were busy being first-time parents, but my grandparents were the wise sages of my extended family. Totally relaxed in their grandparenting roles, they were also community leaders who just assumed I would follow in their footsteps. My grandfather wanted me to take over his lumber business, and it never entered his head that there were things women couldn't do. My grandmother was a quiet suffragette. She was the first in the town to bob her hair and very quietly and effectively lobbied for women and children's rights. These people taught me that anything was possible and it didn't make a difference if you were a man or a woman.
My grandmother had a strong mantra: “Leave any place where you are better than you found it,” that is embedded in my DNA.
Many people saw more possibilities in me than I did. Dr. Myrtle Kitchell Aydelotte believed in me and had aspirations far beyond what I had imagined for myself. She infused my DNA with shared governance, connecting, style, and professional grace under pressure. She had also come from the common background of Iowa agriculture and moved on to be a doctorally prepared woman when there were few. She was the dean and CNO at the University of Iowa, and from her I learned to integrate practice and education with leadership.
Sister Sheila Lyne in my master's program at the University of Iowa and Dr. Elizabeth Burns, and Dean Helen Grace, Dr. Barbara Stevens Barnum in my doctoral program at University of Illinois-Chicago taught me about academic rigor and tough intellectual analysis of issues that have also become a part of my DNA.
Early, I learned about Greenleaf's Servant Leadership model and incorporated it as best I could into my leadership philosophy and style. It's the foundation for shared governance, professional practice, and many other initiatives that create environments of excellence for our people.
Here's a classic question: What's your leadership style?
Leadership style starts with who you are and how you leverage that to be the best leader. Highly influential leaders like Hitler or Osama Bin Laden don't morph into a Mother Theresa and vice versa. Genetically, I'm a model of Margaret Wheatley's system of leading through chaos and complexity, planting and growing. I see the world in relationships, in holograms, and in three-dimensional sets of relationships and overlapping complexities. Leaders are the people who see things that others don't. They can see around the corners. I've been blessed with a sense of the long-term view and being able to evaluate downstream and unintended consequences of a move. This plays out to managing with 5-year plans and reinventing the plan for the next 5 years.
What gets you out of bed every day to keep this up?
Well, it's probably that “mission” thing blended with a sense of urgency that drives me. Which is improving the quality of the work life for nurses and caregivers on the front line so they can deliver excellent care and feel good about themselves. It drives me constantly to think about new programs and initiatives that will accomplish that.
I learned early that life is short and you have very little time to do things that will leave the world a better place than you found it. My grandparents outlived most of their peers, and we went to many funerals when I was young, which taught me that life is very short. I'm impatient, I'm goal driven. I think there are always ways to improve what we do and that a better idea is always there. And the time is short.
And what are you doing now?
Reinventing is what life is all about. For example, you must reinvent yourself as the mother of a teenager when your child is no longer a toddler. So that's what I'm doing. I started my own business to see if there is a way to have more contact with multiple organizations to help them improve the quality of life for the front line people and therefore deliver the best care possible to patients. For example I'm consulting at Westchester Medical Center in Valhalla, NY to grow a program of excellence.
We often know leaders as leaders, but seldom as people. If we interviewed your good friends and your family, what would they say about you?
You are probably best-known by the company you keep. My friends are funny, energetic, interesting, opinionated, compassionate, and great fun; I am blessed to have them. They would tell you I have a passion for anything Asian. When you walk into our house, you'll find it decorated with Asian art and kimonos, and the backyard is a shade-covered “Sanctuary of Healing,” complete with a koi pond, waterfall, hot tub, and lots of plants I've nurtured. I'm deeply spiritual but also connect that with real activities in the community, such as helping start the country's longest running free medical clinic in Iowa City and feeding the homeless in Houston and Indianapolis.
My husband Bill, a psychologist, will tell you it's been a wild ride, with never a dull moment. I feel very deeply, and the workplace is not always the best place to show all of your emotions. So he's been there to witness the highs, the lows, and the ordinary every step of the way with me. He'll tell you that not only am I fixing things at work, but also it spills over to home with my list of new plants that need to be in the ground and the list of fun activities that I've scheduled on the weekend. It's so important to choose your life's partner well, and I did that. He's a great partner, friend, and father.
Our son, Kristopher, who is in hotel management, will probably tell you that I was different than most mothers. I packed plastic bugs in his lunch in grade school for fun and got a note from the teacher saying she didn't think it was funny! Kris has chosen his life partner well—his fiancée, Cara, is a wonderful person and a PICU nurse! So the circle is complete and we have a nurse in the family. Two standard dachshunds and two Burmese cats make up the rest of the family, and they would probably tell you that their role is to chase each other around the house and keep everyone laughing at their antics. And it works!
PII: S1541-4612(06)00261-8
doi:10.1016/j.mnl.2006.09.007
© 2006 Mosby, Inc. All rights reserved.
