Linda Burnes Bolton, DrPH, RN, FAAN

LBB: “Time flies when you’re having fun!” Honestly I’ve so enjoyed every experience I’ve had during these past 12 years. I’ve focused my core value of “human caring” on how I can help others through use of my knowledge, skills, and networks. This is why I went into nursing in the first place. As I think back over the years, I reflect on the journey which Roxane Spitzer helped launch for me. I began as a clinical nurse specialist and assistant director of nursing education; with Roxane’s guidance and mentoring, I realized I could move into executive leadership to make a broader impact.

As I widened my network, opportunities to create and contribute emerged outside Cedars-Sinai and California. I value the ability to “call the circle” of people who care about advocating for patients and all humankind, raising consciousness through communication. I try to role model respectful, dignified, open, and inclusive leadership, soliciting others’ ideas. I am especially interested and involved in the goal to insure equitable access to care and health information to help make good care decisions for themselves and their families.

LBB: I really enjoy leadership in academic, practice, and educational arenas, so that’s my motivation. In addition to being chief nurse at a superb health system, I have the honor of being elected as president of the American Organization of Nurse Executives (AONE) to serve in 2015. I have previously served as the president of the National Black Nurses Association and the American Academy of Nursing. During my tenure with the Academy, I worked on an initiative to improve the clinical practice environment, first in acute care settings, then across the entire care continuum. That led to being involved in the early Robert Wood Johnson Foundation work on Transforming Care at the Bedside with Sue Hassmiller and Risa Lavizzo-Mourey. I first met Dr. Lavizzo-Mourey when I was working on the National Advisory Council for the Agency for Healthcare Policy and Research. Through these connections, I also had the wonderful opportunity to work on three National Institute of Health advisory councils, under Secretary Sullivan of Health and Human Services. An early connection which led me to other leadership opportunities was Sigma Theta Tau, where I worked on a study to increase educational opportunities for nurses. I had the distinct honor of chairing the Veterans Health Administration (VHA) Commission on Nursing for the chief nursing officer (now retired), Cathy Rick. Through Cathy, I had the chance to meet other VHA leaders. Our work on improving the practice environment for nurses expanded with “Aligning Forces for Quality” at the Robert Wood Johnson Foundation. As I became more involved with the AONE board and board committees, I was fortunate to meet many nurse executives from across the United States, as well as international healthcare settings. All are seeking the same connection to “human caring” in their nursing practice and beyond.

LBB: One key insight I learned was as you make a connection in life, it’s not about that connection, it’s about the future that connection presents for you. I’ve been on the path of promoting “human caring” and want many other leaders to join me. How might we create synergy working together? This concept of “collective ownership” for making the world a more caring place starts with being a “courageous circle caller.” The ability to be both a leader in that circle but also a good follower when another assumes the leadership role is very important. The belief that we have been helped by others, so we must “pay it forward” and support others’ growth is very fulfilling. To watch a new nurse leader achieving his or her potential is like watching a butterfly emerge. There is so much joy in being of benefit to others.

LBB: For me, being involved in the community helped motivate me to take the next step on the journey. My community involvement presents a myriad of opportunities to achieve my “true north” goal of human caring. For example, when I was a graduate student at UCLA, I had the chance to be mentored by Phyllis Paxton and Marie Branch, two African-American nurse faculty. It was a wonderful chance to begin exploring volunteering in the underserved communities of greater Los Angeles. I became involved with Upward Bound in Arizona, where minority teens were supported to go on for higher education. I participated in the Western Institute for Higher Education in Nursing (WICHEN) to increase minority student representation in nursing. I worked on fund-raising and scholarship development activities to support opening doors for minority students to successfully attend college. At the American Health Education Center in California, I helped educate consumers on the importance of cultural diversity in healthcare. I also wrote several manuscripts on cultural diversity and challenges to accessing an excellent education.

At Cedars-Sinai, I meet with all new employees and ask them, “Tell me your why? Why are you here?” I’m looking for their underlying values, their sense of altruism. If an employee is committed to using his or her will, knowledge, and skill in whatever role they have, that’s great. If they’re just physically present, but not motivated, it shows in everything they do. I interview all potential new nurse leaders and ask: “What is your purpose in life?” It’s OK to say “I don’t know yet,” but it’s important to stress that everyone must give back, in service to humankind. I want to ignite that community service interest. At Cedars-Sinai, we live the mission of being of service to others. We sent a delegation of about 200 staff to Guatemala to provide healthcare. One of our attorneys served as a cook for the delegation; while he wasn’t a clinician who could provide care, he could support the community mission and his colleagues in his own way.

For staff who no longer have joy in their jobs at Cedars-Sinai, I tell them, “It’s time to walk away. We’ll help you because we want everyone who works here to realize how special it is to be able to give back to our patients and the community.” Everyone should have a path of joy in their life’s work.

LBB: I had the good fortune of serving as the president-elect in 2014, which also carries the responsibility for chairing the Strategic Planning Committee of AONE’s Board. AONE is always seeking to think strategically, always wishing to remain relevant to the members we serve. In the past several years, we have purposefully been on a mission to select nurse leaders at varying stages of their careers. We have taken proactive steps to be more inclusive, balancing board members who are appointed with those who are elected. We believe this will allow us to become more accountable to the diversity of members we serve, in varying roles and varying career stages.

The concept of “servant leadership” is consistent with my own human caring philosophy. There is tremendous change in our health systems today; we must incorporate “other partners in the dance.” I believe it is critical for AONE to develop and sustain initiatives where there are forums for dialogue among all team members. How can we learn from the international community? What team-based learning will help us improve patient care processes and outcomes more quickly, than our traditional silo approach?

There is no better time to look around us and figure out the new landscape presented for all nurses and nurse leaders.

LBB: I believe that APRNs can be in the “driver’s seat” with the new care delivery environment and population health. They and we should not be just task oriented; yes, APRNs can perform many of the same tasks physicians do, but they can and do perform more and different functions. As graduate medical education funds and resident work hours changed, academic medical centers and teaching hospitals viewed APRNs as “physician extenders” or replacement staff. But if APRNs (including clinical nurse specialists, nurse midwives, nurse anesthetists, and nurse practitioners) are engaged in leadership activities around population health, they’ll improve the system. APRNs are good at “E²” consumer engagement and empowerment. APRNs can help address the critical health reform goal of helping people help themselves through enhanced self-care. APRNs can create new paths for engaging consumers.

Let me share 2 examples of how Cedars-Sinai has addressed this opportunity. We provide (and pay for) nurse practitioners to work in key nursing homes/skilled nursing facilities across the community. These nurse practitioners assess residents in these long-term care facilities, providing many with timely and patient-centered health and illness care. The nurse practitioners work with licensed and unlicensed nursing home staff to help promote the residents’ self-care and keep them as healthy as possible, in their own locations. Before an ambulance transports a resident to the Cedars-Sinai Emergency Department, the nurse practitioner will have assessed and agreed with the need for further evaluation. With the ability to have onsite assessment and guidance, Cedars-Sinai has reduced its readmissions by 40%, along with the accompanying hospital-acquired condition risks.

A second example is our program where clinical nurse specialists and nurse practitioners visit patient homes. We modeled our program after the Nursing Improving Care of Healthsystem Elderly (NICHE) program, where people are encouraged to age in place in their own homes. The team supports keeping people safe and healthy in their own homes, with home visits, health education, “tuck-in” phone calls at night, and community support resource connections. We’ve found that readmissions to acute care has decreased for people with chronic conditions such as congestive heart failure. This saves money and prevents exposure to healthcare-acquired conditions in acute care.

I’d say to all APRNs: don’t let this opportunity pass you by!

LBB: It is so important to create your own circle, where you will learn and you will teach. It is important to choose wisely who is in that circle; consider having members outside your own organization, for they have different life experiences to share. I believe you should practice daily self-reflection; be honest with yourself about your own strengths and weaknesses. I think journaling is an important tool to learn about your “authentic self.” That authenticity comes through to other people in so many ways.

LBB: When I was younger, I had an older African-American male mentor. He taught me that I could be an angry black woman, or I could seek the possibility of a just world and he would help me make it happen. I never forgot his wise counsel. I continue to strive for and hope for a world where human caring is the norm in all our interactions, personally and professionally.