TPOG: It's been great working as a colleague with you in the arena of nursing shared governance and noting your significant contribution to that research. Tell me, Bob, what was it that originally brought you to nursing?
RH: Actually, in my early career journey, I was on the pathway to becoming a Methodist minister. I had pursued a BA from Temple University in comparative religions with an emphasis on Eastern religions. As a result of a broader exposure to a number of different traditions, my career focus was beginning to change. At that same time, I was working at a state hospital and was exposed to what nurses did and became intrigued at the fit between that and my own personal sense of ministry. The nurses there convinced me to go to a hospital school of nursing because of their belief related to its emphasis on practice, which is what I did.
Because of family demands I worked as an orderly during nursing school, so I essentially “fully lived” nursing during that time. Also, the nurses I worked with were great teachers, helping me learn techniques and procedures while I was going to nursing school. In fact, I became known as “the Foley man” as I became expert at urinary catheterization. This mix of learning at nursing school and practical application at work provided a powerful mix of education and application.
TPOG: How did your growing nursing learning and experience tie in with your original pathway to the ministry?
RH: It was really an easy connection. At the time, I saw both of these pathways as a calling. I saw nursing in terms of its caring relationship, a critical interaction with patients in need in a similar framework as I had originally seen the ministry. It was simply an extension of my desire to express meaning and be of service to others.
TPOG: Tell me about your journey to leadership and some of the key moments that were decisive to you in affirming your own personal leadership.
RH: I began my journey to leadership fairly quickly after becoming a staff nurse. After a couple of years of staff practice, I pretty quickly became a charge nurse, and not long after that, I became a head nurse in a critical care unit at a big academic medical center. The complexity and intensity of critical care created a fast-paced environment, challenging my leadership capacity. It was a very traditionally led and under-resourced organization, with the added tension of multiple shift rotations, long hours, and much staff stress. In fact, the demands were brutal, creating such heavy obligations where nurses were overworked, stretched, and stressed, as was I as their leader. It was inevitable that I would feel the impact of this stress and eventually feel in myself the initial signs of burnout.
Fortunately for me, a change in my wife's position brought me to a new state and a new role in home health, where I could reacquaint myself with the foundations of meaning and value in my practice. I worked predominately with those who were dying and was able to marshal the full range of my nursing resources to care and support suffering individuals, their families, their communities, and their caregivers. This reintroduction into nursing foundations and the autonomy I experienced in expressing them helped renew and invigorate me as a nurse.
First row: Diane J. Mancino, RN, EdD, CAE, Executive Director, National Student Nurses' Association, Inc; Kathy Apple, RN, MS, Executive Director, National Council of State Boards of Nursing; Norma Martinez Rogers, RN, PhD, FAAN, President, National Association of Hispanic Nurses; Peter I. Buerhaus, RN, PhD, FAAN, Director, Center for Interdisciplinary Health Workforce Studies, Vanderbilt University Medical Center Institute for Medicine and Public Health
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Second row: Steve Hauber, Publisher & CEO, Gannett Healthcare Group (GHG); Millicent Gorham, MBA, Executive Director, National Black Nurses Association, Inc; Janice Beuhler, MBA, CHCR, President, National Association of Health Care Recruiters
Third row: Judith Mitiguy, RN, MS, Executive VP, Nursing Communications & Initiatives, GHG; Patricia E. Thompson, RN, EdD, FAAN, CEO, Sigma Theta Tau; Robert Hess, RN, PhD, FAAN, Executive VP, Global Programming, GHG; Wanda L. Johanson, RN, MN, CEO, American Association of Critical-Care Nurses
After this brief experience, I was able to reintroduce myself back into the hospital leadership role and moved through several management positions, culminating in a director of critical care at St. Clare's Hospital. At that time, my CNO [chief nursing officer] was Golden Bethune, who, as it turned out, became one of my best colleagues and a strong leadership mentor.
TPOG: What was it in that relationship, different from your past experiences, that is so memorable to you now?
RH: For one of the first times, I actually had a leader who could be both colleague and mentor to me. Golden has a unique ability to lead with care, sensitivity, strength, and competence and demonstrates that as a leader in every possible way. In her gentle and caring way, she was able to nudge me toward greater awareness and sensitivity of the value of connection and relationships while still maintaining a strong analytical focus on setting goals, sustaining performance, and advancing outcomes.
As well, Golden has a tremendous sense of humor, with a marvelous ability to bring fun into the workplace, and she was able to transfer to me the value of fun and humor in the midst of the challenges and stresses of hospital nursing care. It was during that time that I got a stronger, more balanced sense of my leadership, competence, and breadth of skill in a way that helped me see myself more clearly as a leader.
At the same time, I had returned to graduate school, seeking an MSN in nursing administration from Seton Hall University. I had an opportunity to translate what I was learning and to apply it more specifically in my leadership and actually began to see those principles work effectively. I began to recognize the value of leadership principle and theory as applied to nursing practice. I saw myself in the role of translating principle and application, and helping make it real for practicing nurses. I was also able to sort out what didn't work and to build a stronger framework for nursing empowerment.
I saw how important it was for nurses to engage their own practice and fully participate in decisions that have a direct impact on what they did. I began, at this point, to really formalize my thinking about shared governance and applying it as an effective framework for engaging nurses in decisions about their own practice. So often you hear in the language of leaders the need to focus on patients and patient care. I believe as a nursing leader that the real emphasis of my role was to focus on nurses. If, as leaders, we support them, resource them appropriately, and empower them to fully engage their practice, we won't have to spend so much time worrying about the quality and effectiveness of their patient care.
TPOG: That's an interesting notion, Bob: Leaders should focus more on the nurse, and that will impact patient care. How does that work for you?
Michael Goodman, Jessica Acampora, Robert Hess, Clarence Seegars
RH: For me, that's what shared governance is all about. As I was preparing for my PhD work at the University of Pennsylvania, I began to spend a lot of time thinking about nursing empowerment and shared governance, and I wanted to focus my research on shared governance. While I was struggling with whether I would do that, another key person in my nursing life, Florence Downs, strongly encouraged me to build my dissertation work on the study of shared governance. By this time, I was clear about the need for structures of professional empowerment for nurses but wondered what that looked like and whether real shared governance was possible or even operating in hospitals. I heard a lot of hospitals claiming they had professional nursing shared governance, but I saw precious little evidence of any real difference from traditional management structure. I certainly saw the potential in creating a strong nursing shared governance infrastructure, but I also really wanted to know what that would look like and how organizations would assess whether or not they had it.
TPOG: How did that effort challenge your thinking as a leader?
RH: I began to believe that precious few organizations really had an empowering shared governance structure for nursing staff. There was a lot of talk about it and even some superficial design changes that included the formation of councils, etc. Yet, I often saw that managers and administrators were still making decisions that mattered. It looked an awful lot like tokenism to me. If, as I believed, organizational emphasis needed to support professional nursing practice decision making, as the principles of shared governance required, then there had to be much more to shared governance as an empowering infrastructure than I was seeing at the time.
While the theory and principles of shared governance had been well articulated, I felt the need for a stronger research foundation, specifically for nursing shared governance. In fact, I built my dissertation around that effort, and through it, I developed the initial instrumentation now identified as the Index of Professional Nursing Governance (IPNG). It was my thinking that, through a strongly validated research instrument and process, we could measure both the elements and the presence of shared governance in nursing organizations and determine or demonstrate whether a structure for real nursing empowerment was present.
TPOG: Tell me where that work has taken you on your leadership journey.
RH: Well, little did I know where it would take me. I knew I was doing important research work. After my PhD studies, I continued to refine the IPNG instrument and use it as a tool for hospitals in both assessing and measuring the presence and/or processes associated with nursing shared governance. Interest in the use of the IPNG has grown steadily and more broadly in the United States and, now, globally, and the data it continues to generate, not only demonstrate the viability and value of nursing shared governance, but through a number of publications, show what a difference nursing shared governance has made in a number of healthcare settings.
TPOG: Tell us a little bit about The Forum for Shared Governance that you founded as a result of your shared governance research work.
RH: This has been one of the more exciting elements of the research work we have done with regard to shared governance. The Forum is a participatory consortium of researchers and interested participants advancing the interests and efforts of both nursing and interdisciplinary shared governance. It provides an online community site at www.sharedgovernance.org where data can be consolidated, instruments can be found, dialogue can occur, and resources can be accessed. I intend it to be a real community of professionals interested in researching and advancing the principles of shared governance. Through creating this community, we provide an opportunity to share research efforts, information, and support as professionals attempt to develop a truly empowering professional environment for improving patient care.
The nice thing is that it is a dynamic community, continually growing and changing as global members expand the dialogue and enrich it with a wide variety of culturally differentiated approaches to designing and implementing the principles of shared governance. As well, the growing network of connections created through the Forum provides an opportunity for building new relationships and establishing creative partnerships for both the research and implementation of shared governance.
Robert G. Hess, Jr.
Hometown
Voorhees, New Jersey
Current Job
Executive Vice President, Global Programming, Gannett Education, Gannett Healthcare Group; Founder, The Forum for Shared Governance
Education
BA, Temple University; Diploma of Nursing, Frankford Hospital; MSN, Seton Hall University; PhD, University of Pennsylvania
First job in nursing
Staff nurse, Pennsylvania Hospital
Being in a leadership position gives me the opportunity to
Impact quality patient care on a global scale by influencing nurses
Most people don't know that I
Dance ballroom with my wife
Best advice to aspiring leaders
If you want to be a leader, find good leaders to hang out with.
One thing I want to learn
How to write better fiction
One word to summarize me
Tenacious
TPOG: It's certainly been an impressive leadership journey. I'm interested in seeing the connection between this journey and your current role as executive vice president of global programming for Gannett Education, Gannett Healthcare Group.
RH: Actually, there's a natural and strong connection between my work on shared governance and my role with Gannett. Empowering nurses is a central theme of my leadership career. Advancing nursing knowledge through continuing education is simply another form of empowerment, in my view. In this role, I have a tremendous opportunity to advance the knowledge and skills of practicing nurses by providing a medium and tools for building and expanding nursing knowledge. I have been able to lead the team here that has built Gannett Education, Gannett Healthcare Group into the single largest continuing nursing education provider in the world. In addition, I'm proud to say, our team here has twice been recognized with the Premier Providership Award from the American Nurses Credentialing Center. I actually see my role here as the capstone to my leadership journey and a representation of a continuing opportunity for me to make a difference in the lives and work of nurses.
TPOG: What would you tell other nursing leaders that has been a keystone to your own leadership insight and has informed your particular leadership journey?
RH: For me, I think, the pivotal moment was my own shift in focus as a leader from patient to nurse. I simply realized for me that the emphasis of my leadership attention and activity was on advancing and empowering the practicing nurse. I simply trust in and am now committed to the notion that supported and informed nurses will more fully engage their practice and make good clinical decisions, ultimately resulting in the provision of meaningful and effective patient care. I think my leadership in my management roles, shared governance research, and continuing nursing education affirms the significance and value of advancing the power and competence of the practicing nurse. In doing that, I have believed and continue to believe that it can't help but positively impact the patient experience.
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Cover photography by Keith Weller © 2010 Gannett Healthcare Group. All rights reserved. Article photography by Michael Pierce © 2010 Gannett Healthcare Group. All rights reserved.
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© 2010 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
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