Kathy Sanford is the senior vice president and chief nursing officer (CNO) for Catholic Health Initiatives (CHI), a national, nonprofit, health organization with headquarters in Denver, Colorado. CHI is a faith-based system that operates in 20 states and includes 78 hospitals; 40 long-term care, assisted- and residential-living facilities; and two community health services organizations. Many of you remember that Kathy served as president of the American Organization of Nurse Executives (AONE) in 2006.
RS: You have a rich and varied career in nursing and healthcare; describe your career progression.
KS: My career started as a Walter Reed Army Institute of Nursing scholarship recipient. I served 8 years on active duty with the army and then 26 years more as an Army reserve officer, finishing my military career as a colonel with the Washington Army National Guard. Much of my progression evolved from early leadership training and opportunities with the military. In my University of Maryland BSN program at Walter Reed, I learned how to be both a nurse and an officer. This served as the cornerstone for a lifetime of nursing leadership. I was a first lieutenant at 21 and then what we called a head nurse at 23.
My first civilian job was in Castro Valley, California, at Eden Hospital, where I was hired as the manager of the surgical unit. To this day, I remember the job interview. The director of nursing told me she was elated to be hiring a young nurse who already had management and leadership experience. From California, I returned to my home state of Washington, where I first worked for St. Joseph Hospital in Tacoma as the manager of the orthopedic unit and surgical progressive care telemetry unit. A few years after that, I moved to Harrison Memorial Hospital in Bremerton as the assistant director of nursing and, the next year, was named vice president for nursing. Later, I also became the administrator for Harrison's newly built women and children's hospital campus in Silverdale, Washington.
I worked for a short time with the Multicare system in Tacoma, Washington, reporting through the strategy department. My role there included leading a team engaged in building a new facility and serving as the acting administrator for the outpatient and physician practices on the Gig Harbor peninsula. I joined Catholic Health Initiatives as senior vice president and CNO in 2006.
RS: You are now a system vice president of nursing. How is that role different from being a chief nursing officer for a single healthcare agency?
KS: It is different from being a CNO in your own hospital, where you have a large number of staff who report to you, and you have connections to a local community. There are many dotted lines in health systems between the national office and individual hospitals or agencies, but much of my work as a systems leader is based on influence rather than position power. To be effective, it's essential to have excellent communication systems. At CHI, we have established weekly nursing e-mailed updates, regional nursing groups, a nurse executive council selected by each region, and a multidisciplinary clinical leadership council with representatives from the nurse executive council, the physician executive council, and the pharmacy executive council. I'm not on the front lines. It is important that the people who are actually delivering care in our hospitals and the nursing executives in all of our facilities are part of the decision-making process. Our system is quite large. I always tell people that I make rounds; it just takes me 2 years to do it.
Some system CNO roles are similar to executive practice in individual hospitals. I partner with the chief medical officer (CMO) in nationally led clinical quality programs. The two of us work closely with our chief risk officer on patient safety and our chief information technology (IT) officer on system-wide clinical IT projects. In recognition of the importance of nurses in our system, my position is part of the CHI President's Council, led by our chief executive officer, Kevin Lofton. With my colleagues—the chief financial officer, the chief strategy officer, the chief medical officer, the chief human resources officer, the chief operating officer, the chief legal officer, and the chief mission officer—I participate in strategic planning and decision making for the system. I'm proud to be part of a national system that values our profession and wants the voice of nursing at the top executive table.
RS: Among your many achievements was service as the president of AONE; what impact did that experience have on your career and your leadership?
KS: I served on the AONE board twice before running for and being elected to serve as president. I found that my national participation with AONE introduced me to the importance of nursing leaders being involved in the larger arena of healthcare. Our profession has so much to offer in the national discussion on healthcare reform. Nurses are among the professions closest to patients, but our voices are not always heard in the venues where we can make a difference for them and for the entire team of caregivers. My AONE involvement gave me an opportunity to be at new tables, both nationally and internationally. I now serve on the board of directors for the American Hospital Association at a really exciting time in our healthcare history.
Kathleen D. Sanford, DBA, RN, CENP, FACHE
Senior vice president and chief nursing officer, Catholic Health Initiatives
BSN, University of Maryland (Walter Reed Army Institute of Nursing)
MA, Human Resources Management, Pepperdine University
MBA, Pacific Lutheran University
DBA, Nova Southeastern University
First job in nursing
Nursing assistant, Horton's Nursing Home, Bremerton, Washington (First RN job: medical surgical staff nurse as an Army Nurse Corps officer)
Being in a leadership position gives me the opportunity to
Represent and serve our profession and patients while working with healthcare leaders from all over the world in our quest for a brighter and healthier future for individuals, organizations, communities, and countries
Most people don't know that I
Was once named one of five American “New Traditional Homemakers” by the American Frozen Food Industry
My best advice to aspiring leaders
Join and be active in your professional organizations. I serve on the Nursing Organization Alliance (NOA) Coordinating Team, which has solidified my conviction that both individual nurses and the profession are stronger when we learn from and support each other.
One thing I want to learn
How Musical Instrument Digital Interface (MIDI) works, so I can be of more assistance to the composer writing the tunes for my musical plays' lyrics
One word to summarize me
In this role, I am able to bring my experience as a nurse and a nurse executive to our advocacy discussions. I do believe that my national exposure prepared me for my current position as a corporate nurse executive at CHI and also as a board member for Centura Health in Colorado. Had I not done this national work, I don't think I would have had these opportunities presented to me, nor would I have been as well prepared for the responsibilities. One of the greatest things about serving as an officer with AONE was the opportunity to meet so many talented and accomplished colleagues. Their mentoring, role modeling, and friendship have helped me to become a better nursing leader.
RS: Our younger nurses often worry about work/life balance when they consider leadership positions. How do you achieve this in your busy life?
KS: I love this question! I once had a young nurse leader tell me that she didn't want to end up like me because I worked all the time and had no fun. Her comment surprised me because I thought I was having lots of fun. I was enjoying a rich and varied life at home and work. As a matter of fact, that weekend, I was going to fly from Washington State to New York to see a play with my family. The weekend before I'd been dancing at a club where my husband's band was performing. I was candy mom for one of our children's soccer team and a Cub Scout committee chair for another child. As a reservist, I still got to give direct nursing care once a month and had a variety of experiences setting up field hospitals, going on night maneuvers (complete with night vision goggles), and qualifying as a marksman with weapons on the Fort Lewis firing range. I thought I had a really well-balanced life.
The younger nurse's perception helped me realize that I was balancing my life so well that she and others couldn't see it. It wasn't transparent. When I'm at work, I dedicate my heart and hands to work. And when I'm at home, I dedicate my heart and soul to home. Of course, you can't totally separate your two lives, but it works for me to separate them as much as possible and to really live wherever I am.
I've been blessed with a supportive husband and a healthy family. Bill and I have been married for 35 years and have four children who range in age from 31 to our 8-year-old daughter, who we adopted in Hunan, China. Our family has shared activities as diverse as boating, skiing, theater, and lots of travel.
My original career goal was to be a journalist. I sometimes tell the story about how I fell in love with my patients and ended up staying in nursing but have continued to write for personal pleasure. I've been a newspaper columnist, a nursing journal columnist, and a guest editor. A few years ago, I wrote a management book, Leading With Love. I try to write at least one professional journal article each year and am having fun writing fiction. I just finished writing the book and lyrics for a musical play.
The truth is that each person decides what balance means to him or her. Whatever makes you healthy and happy is what you should pursue.
RS: What do you consider to be the major challenges for nurses in healthcare leadership positions today?
KS: There are three that I consider major. One of them is managing the increasing amount of change we all have to live with. The second is making the business case for nursing care and quality. The third is developing a pipeline for nursing leadership in all levels of the organization. We have a lot of challenges, but I believe successfully addressing these three would give us the foundation we need to better serve our patients, communities, and frontline nursing colleagues.
When I visit our hospitals, I hear the same message from staff nurses that I hear from nurse leaders: we are all feeling overwhelmed. We are inundated with so much change that we're drowning in it, and we're having trouble keeping up. When I talk to staff about that, I remind them of the change theory we learned in school. Kurt Lewin proposed that, in order to change, you have to unfreeze from your current state, change, and then freeze. I think that with all the new technologies, new regulations, new payment systems we're facing…we don't have time to complete this cycle, and we don't get time to solidly refreeze. As a result, we have become a bunch of slush puppies! And not only that, the slush is hip deep and getting higher.
Nurse executives have to manage all of these upheavals in our organizations. As leaders, the big challenge is making the decision about which change is truly necessary. Everything seems important, but we have to prioritize what is most important for patients and our staff. We have to help our teams decide what we're not going to do anymore so that we can take on other activities. Throughout all of this, nurse leaders have to be supportive of the entire team. It's much easier to walk through slush if you're holding somebody's hand.
The business case for nursing involves making the connection between quality, an organization's financial well-being, and excellent, appropriately resourced nursing care. Even though we intuitively understand the associations, I think many decisions in healthcare are made today as if there is no correlation. I believe we can reduce costs, increase quality, and improve the working lives of nurses, but we need reliable data in order to make the best informed decisions about everything from staffing to nursing care models. At CHI, we are currently working with academic partners, including the University of Alabama (Huntsville) and Loyola (Chicago) to obtain valid information through system-wide research.
The third big challenge is to fill the management pipeline. It will be impossible to make needed changes in healthcare and establish a strong business case for nursing if we don't have outstanding nurse leaders. We need them at every level. Nursing management has its own area of expertise, just as critical care, pediatrics, medical-surgery, mental health, and all the other nursing specialties do. Because we haven't historically recognized this, we have often not prepared nurse leaders for the competencies they need. At CHI, one of our major nursing goals is to develop a national nursing leadership conduit with management education of nurse leaders at every level, from charge nurses to nurse executives. Our program will include formal mentorships and early career identification of young nurses who are interested in going into the specialty of nursing management.
RS: Many nurse leaders today are looking at initiatives to retain their aging nursing workforce. What are you doing in this area at Catholic Health Initiatives?
KS: Our national HR division has just launched the CHI Healthy Spirit program across the system to help all of our employees stay healthy. In addition, we are in the planning stage for a pilot of a telehealth inpatient nursing care model. We are exploring the concept of virtual inpatient med/surg nursing units where experienced nurses have access to patient medical records along with the ability to visualize and communicate with on-site caregivers through video technology. The concept is already used in enhanced intensive care units (eICUs) and home health services and has huge potential for other types of nursing care. This model will not only help retain nurses who might not be able to perform the physically taxing work on a unit but also provide support and real time mentoring for early career professionals. We think this will leverage nursing resources as we face the impending shortage and increase retention of bedside caregivers at both ends of their careers. CHI plans to be at the forefront of this innovation, where some our most experienced nurses may not be physically present but are only a video camera away.
RS: There are lessons learned in any professional career. If you had anything to do over again, what would that be?
KS: I have enjoyed every job I've had in nursing; I don't regret a single one of them. However, now that I'm older, I realize how few years we each have in our professional lives to make a difference. If I were to relive my career, I probably would not stay as long as I did at one community hospital. I was dedicated to that job, I loved that organization, I loved the staff, and I loved the community. I think I made a positive difference for all three. But I think I should have moved on to jobs with a broader impact sooner, where I could have more opportunity to serve more patients, communities, and nurses.
RS: What future goals have you established for yourself?
KS: I want CHI facilities to be known for outstanding nursing care. As a leader in a faith-based system, I want our system-wide nursing models to be based on carrying the mission of our founding sisters into the future. I want to have a part in educating the public about what nurses really do. I want to help as many people as possible make the connection between strong financial performance and excellent nursing care.
One objective to meet this goal is to contribute data for Dr. John Welton's work on cost accounting and charging for nursing care. Another is to complete the CHI nursing dashboard correlating staffing choices with evidence-based (through CHI/University of Alabama research) patient quality results (including mortality and hospital-acquired conditions) and the financial implications for the organization.
On a personal level, I want to write all the books I currently have in outline form. Perhaps I will go back to school for another doctorate. There are so many more things I would like to learn!
RS: What career advice would you give to young nurses today who are interested in becoming nurse leaders?
KS: If you are interested in nursing leadership, it is important to recognize that it is a specialty with competencies that need to be mastered. Those competencies are just as difficult as the competencies for any other specialty. It is important to get the appropriate education, which includes both nursing and business/financial content. You will work on multidisciplinary teams and must understand the work of other professions and the language of business.
I also believe that nothing beats being a great writer and a good public speaker. If you can write well and speak well, you will be much more influential in your leadership.
Remember that management is not a popularity contest. I've greeted newly promoted nurse managers with these words: “Welcome to always being wrong.” They've looked puzzled and asked, “What are you talking about”? My answer is that when you lead, you must make decisions. Whatever decisions you make, someone's going to think they are wrong. You have to be comfortable with that reality. Leadership requires courage, a sense of humor, and more love than you think you may be capable of giving. You have to balance love for your patients, the nursing staff, the rest of the team, the organization itself, and the community. That's not as easy as it sounds, since any individual decision you make may seem to favor one of these stakeholders over others.
Seek career and mentoring help from other people. In return, help others anytime you have the opportunity to do so. You can make your work go further and your legacy richer if you are willing to help others meet their goals. Finally, remember, leaders can burn out while taking care of other people. It's essential that you love yourself, too. You may have heard the saying, “You cannot give from an empty basket.” The only way you're going to survive as a caring leader is if you care for yourself as well as for all the others you serve.
Photography by Rob Bartee © 2010
© 2010 Mosby, Inc. Published by Elsevier Inc. All rights reserved.