Donna J. Zazworsky, RN, MS, CCM, FAAN

Article Outline

• Tell us about your childhood and whether there was anyone who influenced your decision to become a nurse
• Describe how your nursing program influenced your career path
• Describe your career path from your graduation from Pennsylvania State University to your getting involved in community work
• How did you use your learning from graduate school to continue your interest in community?
• Tell me more
• Your interests and experiences have included some nontraditional activities. Tell us about your media work and how it has helped community health outcomes
• What have been some of your most satisfying moments in community work?
• What has been a motivator for you in your career?
• What are the most important qualities that nurses need to build business capacity?
• Your work in case management has produced some excellent results. Tell us about the roles that nurses should play in community work
• What are some things that AONE members could do to strengthen their community role?
• What do you want to say to aspiring nurse leaders?
• What are you thinking about for the future?
• You have done some interesting work with diabetes—how has this fit in with your leadership journey and continuous learning?
• How would you sum up your career in nursing?
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Courageous, resilient, innovator, continuous learner, and role model are well deserved descriptors of the future-oriented nurse leader featured in this issue. Her interesting career path reflects a journey of excellence based on a high level of motivation, generosity of spirit, and flexibility that have produced outstanding outcomes and personal and professional satisfaction.

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Tell us about your childhood and whether there was anyone who influenced your decision to become a nurse 

I grew up in rural Pennsylvania. My father was a coal miner, and my mom was a homemaker; they only finished the 7^th and 8^th grades, respectively. My father was a firm believer in the power of positive thinking and believed that you could do anything that you set out to do. I grew up in a family that worked hard, and there was never a doubt that my brother and I would go to college and we would be successful in whatever we chose to pursue.

I remember always wanting to be a nurse. I liked to take care of others, organize things and help make a difference in someone's life. When I look back, I remember a beautiful and gentle woman who lived in our community named Betty Morroni. Although she had a job in a hospital, she was always assisting others and was the person who people called on when they needed help. I remember my mother calling her when we were sick, and she would come to our home and provide guidance to my mother. I know my family always felt reassured by her presence and her advice. I didn't recognize it at the time, but Betty was a role model for me—she was a nurse who spent her life improving the health of the community.

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Describe how your nursing program influenced your career path 

I loved my nursing program at Penn State. I took a course from a great teacher early in the program who inspired me to travel and learn about other cultures. He had worked in South Dakota with the Sioux and told us about a summer program that was available for nursing students. I really got excited and applied to spend the summer between my sophomore and junior years working in South Dakota. My parents didn't understand why I wanted to go, but they supported me and my desire to travel and learn as much as I could during my college program.

Three of us went—another undergraduate nursing student and a graduate nursing student. We lived in the hospital compound on the Rosebud Reservation, which is located next to Wounded Knee Reservation. We immersed ourselves in the local culture and experienced being a minority for the first time in our lives. Every moment was an opportunity to learn about the lives of Native Americans and about ourselves. While our nursing background was limited, our desire to learn how to do new things and help others was high.

The graduate nursing student from Penn State worked with the medicine man on a health care project. We benefited from her work on the project with the medicine man, who was willing to share his experience and wisdom. Through her work we learned how the Native people and health professionals defined the meaning of “traditional Native American” and “Western” medicine and the possibilities of how the combined knowledge from traditional and alternative approaches could work together.

It was also an incredible personal learning experience for us because of the significant social changes that were taking place in the Native American community in South Dakota. The American Indian Movement had been gaining momentum for several years, and we happened to come to South Dakota during a period of change. Russell Means and Dennis Banks (social activists) were released from jail that summer, and tensions were beginning to escalate. While we were on the sidelines of the unrest, we were still affected by the restrictions on communication and free movement within the community. Of course there was a lot of national and international attention on Wounded Knee, and this caused anxiety in our parents, who wanted us to return home. I knew something important was happening, and I wanted to learn whatever I could during this period of social change. Happily, they respected our decision to stay and observe history being made within the Native American community. My interest and commitment to learn about other cultures, improve the lives of others, and work on community issues was fueled that summer and has grown and flourished over the years.

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Describe your career path from your graduation from Pennsylvania State University to your getting involved in community work 

My friends and I wanted to do something different after graduation, so we wrote to hospitals in Arizona about nursing jobs. They wrote back and encouraged us to take boards in our own home state before coming to Arizona. So we heeded their advice, graduated, moved to Pittsburgh, got jobs, took our boards, and then I moved to Arizona because of my interest in Native Americans. I took a job working in an ICU in Tucson and enrolled in graduate school in a community health program.

During my graduate program in community health, I became a volunteer community health nurse and worked with the Tohono O'Odham reservation. As part of the program, I took the education tract and decided that I wanted nursing students to have an experience on this rural reservation. Getting approval for the nursing students was not an easy task because there had been a group of health care students a few years before who had gone beyond their work assignment and had gathered health information on the residents that had not been requested.

It took several presentations to the Tribal Council as well as a strong recommendation from the Public Health Service Community nurses to gain final approval. Since I was the first nursing member to bring nursing students on the reservation, I was very careful in my planning because I knew the benefits to the tribe and the students would be worth it.

I brought six undergraduate students to the reservation for 2 days of immersion and work. It is a very rural reservation. The main purpose of this project was to test for diabetes and hypertension and provide health education for these disease conditions.

On the first day, the students went out with the health service nurses to make visits to clinics and learned about the health care needs of the residents on the reservation. A special community meeting was held that first night to give everyone on the reservation a chance to talk about rural health care. We were disappointed that few Native Americans residents of the community attended the meeting. However, we understood that we were outsiders and had not earned their trust. The majority of participants were health care professionals and they were helpful in discussing the challenges of rural health. The second day, with the help of the health service nurses, we put on an all-day screening program and tested everyone who came for diabetes and hypertension and offered concurrent educational session on those diseases. Students reported a high degree of satisfaction with the experience and were able to apply this knowledge in their nursing program outcomes.

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How did you use your learning from graduate school to continue your interest in community? 

After I finished graduate school, I became the program director of a wellness outreach program at Carondelet St. Joseph's Hospital in Tucson. It offered health screening programs to businesses. I loved taking charge of this new outreach venture and hiring nurses for this innovative program that combined a computerized risk assessment with a physical assessment screening program. The program was an immediate success and attracted a lot of community attention and business clients.

It didn't take long for me to receive an invitation from the medical executive committee of the hospital who wanted to learn about our wellness program and its goals. While the physicians expressed a commitment to the concept of wellness, they were careful to remind me that the program should avoid any attempt to “practice medicine.” Although the program continued to experience financial success, administration decided to change the primary focus from risk assessment to health education. As director, I learned a great deal about the politics of health care, what it takes to build and sustain a program, and what hooks help to ensure engagement and sustainability.

The change in the center's focus to health education didn't work, so I decided it was time to try something new. I moved to San Diego and became director of education for a for-profit organization. This was an entirely new world for me. I gained a new skill set and became an expert in developing patient, staff, and provider education. I also became an expert in outcomes management and understanding what was needed to achieve the bottom line.

After a few years, I was ready for a new challenge and moved to Los Angeles. I started working at the Daniel Freeman Hospital (part of Carondelet Health Network) as the corporate marketing director. While I didn't have a great deal of formal marketing experience, my life experiences of knowing how to apply the nursing process made it work. I led the strategic planning process for the hospital and took on other projects using the basic framework of the nursing process to achieve the identified goals.

I was recently married at that time, and we decided to leave Los Angeles and move back to San Diego, where I learned what it takes to start up a new venture—an independent physician association consisting of 35 physician shareholders with over 200 contracted physicians. Again, I learned a lot and was able to incorporate health screenings and other components of wellness into their assessment process of wellness. The association did well for the first 3 to 4 years, but the group was not ready to take it to the next level. I knew then it was time for a change and moved back to Tucson to explore other opportunities.

After talking with the dean at the University of Arizona, I decided I needed to learn more about the academic setting and faculty role before I enrolled as a full-time doctoral student. I became assistant to the dean for development and a faculty member at the college of nursing. This job gave me the chance to learn that being a full-time faculty member was not what I wanted to do. I have a great deal of respect for nursing faculty, but my passion is in the business world.

I resigned from my job at the college of nursing and joined Carondelet Health Network starting out as a community case manager for the multiple sclerosis program working with Phyllis Ethridge, Gerri Lamb, Cathy Michaels, and other great nursing pioneers in case management. We created innovative programs, changed practice models, produced data, and demonstrated substantial changes in health care outcomes. An example of a program that started out small was a community water exercise program for people with multiple sclerosis that grew into a citywide coalition effort that built an Adaptive Recreation Center for people with disabilities.

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Carondelet Health Network began to experience some financial problems because of the changes in payer mix and reimbursement systems and closed the Community Division. I was given a PRN position to do special projects and helped shape the prison telemedicine program, another opportunity to learn more about this new method to deliver care.

Around that same time, a few of us started consulting on case management around the country. There was growing interest in learning about disease management, reducing length of stay, and resource maximization across the care continuum.

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Your interests and experiences have included some nontraditional activities. Tell us about your media work and how it has helped community health outcomes 

I have had a chance to do many interesting things including working with the media. I worked as one of the Four on 4 Medical Expert Team (I was the only nurse with three other physicians) with the local TV station for a few years and was able to learn how to prepare stories from beginning to end. I picked the topics, organized the stories, and selected the patients, providers, and others who were involved in each piece. It worked out well because I knew about health care and the reporters were able to bring it to viewers. I have continued to use media to get the word out through publishing and presentations and encourage others to do the same.

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What have been some of your most satisfying moments in community work? 

I am most proud of being a part of the energy that was initiated around the development of community nurse case management delivery models. The Carondelet Community Nursing Programs inspired others throughout the United States and around the world to develop new nurse delivery models in the community despite the challenges within their health care environ ment.

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What has been a motivator for you in your career? 

My motivation has always been to help people and our communities. In community case management, we always had the philosophy to work ourselves out of a job. Empower people and communities, not by giving them fish but by teaching them how to fish. I look for opportunities, challenges that need to be addressed. I believe there is always something else that needs to be done.

I'm happiest when someone puts me in a job where there is no job description and I have to create one based on what is needed rather than what is. I thrive when I work for and with people who let me loose! Don't get me wrong, I work within a structure and budget, I just need flexibility.

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What are the most important qualities that nurses need to build business capacity? 

First, nurses need to step out of the nursing box and discover what's out there in the real world. I think courage, risk taking, and a willingness to fail are all important to success. Had I taken the MBA path, I may have pursued a different career course, but I was fortunate that my community health program contained a strong component of public health administration. When I first started in management, we were required to serve as an advisor for Junior Achievement for 1 year. We helped students learn about building a business. It's a wonderful way for new managers to be able to learn and coach others at the same time. This was an excellent learning experience for one and all.

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Your work in case management has produced some excellent results. Tell us about the roles that nurses should play in community work 

Nurses represent the heart of the patient, and nurses have the advantage of knowing about the lived patient experience. Nurses are able to use their knowledge base and evaluate what works and make adjustments.

I work with a lot of nurses from varied backgrounds and preparation. The majority of nurses know the evidence, but they need to learn how to apply evidence to their practice. Advanced practice nurses need to be available to mentor and coach staff about using evidence and integrating it into their practice.

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What are some things that AONE members could do to strengthen their community role? 

Communication is so important to nursing's visibility and influence. I think AONE members need to tell the story of nursing as often as possible. We don't do enough publishing and presenting the results of what nurses do, especially with other disciplines and in the public eye. I know it may seem difficult for nurse executives and others to find the time to publish, but it is important for them to do it and make sure it gets done. I publish several articles a year in nursing and nonnursing journals, and I help other nurses to get published.

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What do you want to say to aspiring nurse leaders? 

Take a risk, start, don't use excuses! I know nurses who spend time analyzing every situation before they take action. Take action and learn from things that didn't go well to improve your next project or initiative. Get out of your comfort zone and take joy in your courage to move ahead!

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What are you thinking about for the future? 

Well, I always have new ideas and something new that I want to try. I really want to expand case management in the community, and I know it is the right time to do this. We are constantly faced with the challenges of transition from hospital-based to community-based care. Patients are still leaving the hospital not fully prepared for their continued recovery process. Developing processes for health care professionals inside and outside the hospital to facilitate patient self-management of their health, support families, and foster healing across the care continuum is important.

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You have done some interesting work with diabetes—how has this fit in with your leadership journey and continuous learning? 

I see my work today focusing on building and enhancing alignments with physicians, other health care providers, and insurers, particularly in relation to diabetes. Diabetes is such a devastating disease, yet our health care system is still in a reactive rather than proactive mindset. Through our work at Carondelet Medical Group, we have been able to build models within the primary care setting leasing diabetes educators to the PCPs. Now patients can be seen proactively for prediabetes and diabetes through individual and group visits by nurses and dietitians who are certified diabetes educators. The diabetes educators also work with the PCPs to help them establish eligibility for individuals with diabetes to obtain diabetes education in the American Diabetes Association recognized Diabetes Self-Management Training Programs.

Finally, we've worked with health plans and PCPs to create a multidisciplinary Diabetes Day Clinic, where patients can receive all of their annual requirements (ie, retinopathy exam, podiatry foot exam, lab work) and receive medical nutrition therapy. It's a one-stop diabetes clinic. With the help of community health outreach workers, called Promotoras, we have been able to successfully recruit patients from these clinics into the diabetes classes. Thanks to the PCPs' electronic health records and their pay for performance efforts, we are demonstrating improvement in diabetes HEDIS indicators. It has to be a system approach.

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How would you sum up your career in nursing? 

It's been an incredible journey! On November 10, 2007, I received the Southern Arizona American Diabetes Association Care Award. It was humbling to receive this distinction for something I love to do. It is hard to explain how much joy, energy, and satisfaction I receive from this work! I am grateful that God has given me certain gifts that have allowed me to help others. I feel blessed every day to do this work.

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