Carol Reineck, PhD, CNAA-BC, COI

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My passion started as interest and curiosity. As a teenager growing up in the Pacific Northwest during the era of big hospitals, white uniforms, and wonderful, long lengths of stay, I was simply intrigued by hospitals and nursing care. To me, at that young age, hospitals seemed to be places where people with needs were cared for by expert, compassionate nurses, doctors, and therapists. I couldn't imagine how exactly it all worked.

I decided my career path at the ground level. I worked in support roles all the way through my nursing education—as a helper in the Whitworth College Student Health Center, mopping the infirmary floor and typing medication cards; as a nursing assistant in a nursing home in the summer; and as a volunteer graduate nurse in St. Joseph's community hospital in Lewiston, Idaho, before I became licensed as an RN. These support roles gave me a profound appreciation and respect I still have today for all the personnel involved in providing safe, quality patient care.

My brother Al was a captain in the Army when I was in my BSN program at the Intercollegiate Center for Nursing Education in Spokane, Washington. He asked me if I knew that soldiers had Army nurses to take care of them and if I knew that the Army had full scholarship programs for nurses. I did not know that the answer to both good questions was yes. I met with the Army nurse counselor and did not hesitate to sign on the dotted line. In a few months, I was inducted into the Army as a private first class, commissioned as an officer 18 months later while still in school, and promoted to first lieutenant upon graduation. That day, I began a career during which I cared for soldiers and their families for more than 3 decades.

I often summarize my military assignments with the word CARE. That is, in those 31 years, I had 23 permanent moves worldwide to assignments in clinical nursing, administration, research, and education. My naïve curiosity and interest about what nursing was all about grew steadily into more mature scholarly inquiry in my roles in education and research.

I learned so much from the chief nursing executives and nurse managers for whom I worked. I became a nurse manager and CNE myself because they mentored me and because I had the passion to take care of nurses who, in turn, took care of patients. In my faculty role, I feel that I can bring a mountain of real-world experience into the learning environment.

In your current position, what gives you the most satisfaction? What is most frustrating?

Three areas give me the most satisfaction in my role as a nursing professor: watching, working, and translating. The first is watching the students in our nursing administration graduate program morph from aspiring nurse leaders with lots of questions to confident nurse leaders still with questions, but newly equipped with effective ways to access, evaluate, and process knowledge.

Second, I enjoy working with expert and compassionate faculty who share my passion for preparing future nurses, nurse leaders, clinicians, nurse educators, and nurse scientists. With the experience I've gained, I mentor many of the faculty now, yet I still have mentors myself.

Third, one of the most gratifying aspects of my work is translating research findings and educational perspectives into concise information for legislators. Lawmakers need good information prepared in concise language. When a legislator says to me, “I understand more clearly now,” it makes me realize I have been able to help lawmakers and citizens alike.

One of my frustrations is when students come to us with deficits in their writing skills. I am frustrated for them. Their prior life preparation has not always been strong in this important area. In our country, according to Hart Research Associates and the Association of American Colleges and Universities, 30% of employers rate oral and written communication as the most important skills they are looking for in new hires. I am a rather unforgiving grader when it comes to composition and language because I want students to learn how to write and compose well. To help, I take extra time to work individually with students on their writing just as I help them understand and apply the content. I want students to be successful in the workplace and in life.

For example, in the workplace, master's graduates in nursing will most certainly write narratives for capital purchases, draft proposals for new programs, write lesson plans or curriculum revisions, or complete meaningful written performance evaluations. School is preparation for life. Life, well lived, requires writing. One of my colleagues and I started a summer elective in clinical writing, and many students readily enrolled. Last year, our school started a writing center to help students, and it is already proving beneficial.

As an educator, you have worked collaboratively with other organizations, such as the American Organization of Nurse Executives and Council on Graduate Education for Administration in Nursing. Why is this work so important to you? Can you share some of the accomplishments of the partnerships? Also, what obstacles have you been able to overcome?

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You may have heard the expression “town and gown.” This is a friendly way to refer to the chasm that has existed in varying degrees between practice and education. Crossing the town and gown chasm is important to me because it can and must be bridged!

The partnership between AONE and CGEAN began a few years ago. The joint effort grew out of a recognized need for employers (town) and educators (gown) to discuss how the educational preparation of nurse administrators and leaders needed to change. The change was needed to better meet the contemporary needs of employers, but externally mandated constraints and time-honored procedures in educational settings do not make it easy.

We met together in rainy Atlanta 2 years ago. From that intense effort, a three-dimensional model emerged. The model suggests there are certain fundamental domains that nurse leaders must learn about and in which their competency will be expected, certain domain threads that flow through them, and the recognition that nurse leaders will develop from novice to expert over the course of their leadership career.

We recently learned that this work will be translated into Japanese. The obstacle of how to help this effort achieve a more global reach was overcome with this news. Nursing administration programs worldwide will be able to be revised and benefit from the conceptual work done here in the United States.

It is interesting that your work includes assessing readiness for nursing in austere (disaster, war, shelter, or flood) environments and preparation for Magnet certification. These are quite different—or are they more similar than different?

They are really more similar than different. My research program is in the dual areas of readiness and availability of the nursing workforce. The first area has to do with being ready for all kinds of contingencies in the unpredictable, uncertain world in which we live. Caring for patients in a combat zone, disaster, flood, or hurricane shelter will require nurses to be ready in six main areas that I've been able to clarify in my research: clinical nursing competency, survival skills, operational skills (using field or manual versions of equipment), physical/psychological/personal readiness, confidence in leadership and administration, and group integration and identification (knowing your team).

The name of the instrument we've developed is called the READI, or the Readiness Estimate and Deployability Index. My research started in 1997, clarifying the concept of readiness with expert clinicians. It progressed to developing and testing an instrument to measure self-report of readiness. Today, we have a set of tools online for use by Army, Navy, Air Force, and civilian RNs. Presenting these tools in the international medical community has been very exciting, too. Our next step is to add a user-friendly scoring system and to make online educational material available to fill in the gaps. The most distinctive part of this research program is that master's students have played a major role in advancing the instrument toward online availability. The website for the set of Readiness Instruments is http://www.nursing.uthscsa.edu/READI.

The second area is about preventing, delaying, or reversing turnover and retirement decisions. Just as readiness for nursing in austere environments requires preparation, so also does nursing workforce planning to ensure availability of nurses to meet the ever-increasing demand. The preparation, then, is the common ground between the two research areas of readiness and availability of the nursing workforce. As hospitals pursue Magnet designation, minimizing turnover is exceptionally important. Turnover is generally decreased when nurses have input into policy on their units and an opportunity to be supported in their learning and growth.

My Critical Reading of Research Publications program is an independent study for small groups that helps support learning and growth in the clinical environment and gives nurses a sense of self-efficacy. That is, a sense that nurses can effectively solve their clinical problems and patient care concerns. In the six-session program, nurses learn more about understanding the nursing research literature. Armed with that understanding, it is my feeling that nurses can be more prepared to develop research proposals for areas of clinical interest or concern.

Innovation in health care is often difficult because of the challenges to ensure patient safety, resistance to change, and aversion to uncertainty. Yet you have and continue to do many innovative things in online education, teaching research skills, and financial preceptorships. Can you talk about how you have been able to be successful?

I learn as I go. It has been said, it's what you learn after you know it all that really counts!

When online education in nursing was becoming more common just 3 to 4 years ago, I found myself totally unaware of what it all meant. I had grown to like and feel most comfortable in the face-to-face learning environment. As a faculty member, I even arranged that we would go for a coffee break as an entire class of 12 students during our all-day sessions.

But as comfortable as I was, I felt compelled to learn more about online learning as a potential teaching strategy because many students had challenges with access to education. I enrolled in a 4-month formal course of instruction. I learned online how to teach online. Today, my courses in nursing administration are 75% or more online. I have learned, though, from the students, that some face-to-face contact with faculty and colleagues is really important, especially for practicing oral communication and presentation skills. A blended approach works well, part online and part face-to-face.

In my online courses, we have scavenger hunts, interactive budget spreadsheets, online discussions about health care, content modules with audio and video that can be replayed, files linked to the calendar, articles on electronic reserve in the library, and a mechanism for students to submit their assignments in a paperless mode to save the trees. Students who were hesitant to ask questions in the traditional classroom are not hesitant at all online. The courses are asynchronous; students learn during days and times when they are ready to learn. I know I have students learning cost-effectiveness analysis in their pajamas.

Our nursing administration major enrollment quadrupled over the past 4 years. We discovered the need to move beyond the acute care hospitals to arrange sufficient numbers of preceptorships. Now, students are in many community agencies, learning from budget officers, grant specialists, accountants, chief financial officers, and program directors with budgetary responsibility. This migration into the community creates more administrative work to ensure agreements are in place, but it gives a rich experience for the graduate students and creates a better product for employers.

What are the recruiting messages that you give to potential nurses?

When I speak to both adults and children interested in nursing as a career, I say two things: nursing has it all, and nursing gives skills for a lifetime. First, nursing has it all—knowledge, caring, technology, travel, skill variety, critical synthesis as we work with other disciplines and leadership opportunity for those who seek it. Second, nursing skills are skills for a lifetime. The ability to plan and organize, work in a team, manage a crisis, set and achieve goals—these will help not only on the job, but in life.

What advice do you have for aspiring nurse leaders and advanced practice nurse clinicians?

AONE began the Aspiring Nurse Leaders Institute in 2005. It is a resounding success! I am so honored to have served on the faculty. There is such a huge need for leader development. My advice to aspiring nurse leaders is to seek self-development and educational courses in the core areas of managing people, managing business, and managing the leader within. Network, network, network. Don't be afraid of leadership opportunity. Most of us learn as we go. By observing, I also find I learn how not to do things more than how to do things. We can learn in a kind of reverse sense.

For aspiring advanced practice nurses, my advice is both an invitation and a suggestion. First, the invitation. When you graduate, receive your APN licensure and certification, and mature in advanced practice, begin to think about when you will come back to teach. APN faculty members in most universities have a faculty/practice arrangement. For example, a full-time faculty member might teach 4 days a week and practice on the fifth working day. Now for my suggestion: learn the basics of financial management. Learning about budgets, cost avoidance, break-even analysis, and how to evaluate the economics of programs and methods will really help in your practice and put you far ahead.

Finally, if you could change one thing in nursing leadership, what would that be?

We're all in this together. Town and gown need each other. It will take both the educational system and the practice sector working intentionally together to produce, sustain, and advance the nursing workforce for the future. We are in a dependent, symbiotic relationship. We need each other. But there are many cultural norms, time-honored traditions, and constraints to overcome in both settings. In the military we used to call it not the in-box but the “too-hard-to-handle box.”

We need to keep our mutual vision on creating maximum opportunity for patients to benefit from the knowledge and caring of the well educated nurses of the future. So what exactly do we change? I suggest we change from feeling uncomfortable in each other's sandbox to great anticipation of what we can build together for our communities through the powerful, combined efforts of practice and education.