Timothy W. Mislan, MS, BS, RN, NEA-BC

RA: Tim Mislan, it is a privilege and a pleasure to talk with you and have you share your professional journey. I know you are passionate about creating a professional practice culture, a sense of well-being for staff and patients, and a culture of safety. Thank you for sharing your wisdom.

Tell us about how you decided to become a nurse.

TWM: Nursing was actually a second career choice for me. I was working full time as an assistant in an immunology lab of the Health Science Center at The University of Oklahoma while working on a PhD in immunology when I realized I was not fully satisfied with my career choice. I loved the sciences. I earned a bachelors of science in biology and chemistry, and then a masters of science in biochemistry. My job was interesting, with great colleagues, and I was using everything I was learning every day, but I had a feeling I was missing something important. I can still remember the very day I figured out what was missing. I was sitting at my lab bench and looking out the window across the street at the entrance to the Oklahoma Medical Center. I saw people coming and going, and that is when it hit me—I missed working with people. My oldest sister was a nurse in the ICU and encouraged me to explore nursing as a career once I shared my thoughts. My fiancée and friends were very encouraging, and I was very lucky to have one good friend, Michael, who had just become a new nurse who served as a great role model for me. A few days later, during lunch break, I walked over to the school of nursing on the Health Science campus and never looked back. To me, nursing had everything I was looking for. The science and the art of taking care of people who need help.

RA: Share some memorable or career-changing experiences you had as a bedside nurse and the lessons learned you have carried with you throughout your career.

TWM: As my entrance into the profession was nontraditional, so were my bedside nursing experiences. I was hired as a new graduate nurse into the critical care fellowship at the Oklahoma Medical Center and received first-class training on how to become an open-heart nurse. It was thrilling and terrifying at the same time. This was in the “old days” before cath labs existed, and a brand new drug called TPA has just become the newest treatment for AMIs [acute myocardial infarctions]. My strongest memory from back then was knowing I had only minutes to get 3 18-gauge IVs into the patient with as few sticks as possible and to get that TPA hung. Every minute counted, and that patient needed me to be my best no matter what else I had going on in that moment. Let’s just say I learned how to focus under pressure. It was the beginning of me learning to lead in ways I knew would matter most to my patients.

Like many other new nurses, I worked multiple jobs during this time in my career. My second job was a nurse supervisor at a 250-bed skilled nursing facility. This was a completely nonlogical extension from my day job, but truthfully, I had an insider’s advantage as my wife was a nursing home administrator. This job taught me the power of teamwork and how important every member of the team was to making things work. I also met my first transformational nurse leader, Linda McNeil, the director of nursing of Clayton House Healthcare in Clayton, Missouri. She was a larger-than-life personality who could fill a room with her presence. She was loud, joyful, and showed me how to lead with heart. She taught me that if you take care of your staff, they will then provide excellent care for patients. This became the foundation of my leadership career. I still channel my “Linda energy” today when I face a challenging situation.

RA: What caused you to transition to a formal leadership position?

TWM: A very unique formal leadership opportunity presented itself to me only a few years into my career as a registered nurse. I had developed an unusual set of nursing skills that combined caring for critically ill patients in hospitals and caring for the elderly in nursing homes. In the early ‘90s, many hospitals had begun opening hospital-based skilled nursing facilities [SNFs] to help with patient through-put and to create new revenue streams. I was comfortable working in both settings, and Linda had shown me what a difference a transformational nurse leader could make. When I was made aware of a nurse manager job of a local hospital-based SNF, I applied and got it!

RA: What leadership lessons have you learned and continue to use in your leadership practice?

TWM: I was fortunate to have a number of impactful leaders with whom I interacted early on in my nursing leadership career. Looking back, after being in formal nursing leadership positions for 30 years, I can see how each contributed to how I evolved to be the nurse leader I am today. The greatest leadership lesson I can share is to learn how to help others you work with feel valued, respected, and heard. This is easy with nice people, but critical when dealing with difficult personalities. If that is your focus as you begin and end your interactions with others, it will become your secret sauce of being a great leader of people. You will notice I use the word impactful leaders as I described those that shaped me early on in my leadership career. I worked for some very difficult bosses as well as some amazing ones. Each of them has taught me things in their own way, so keep an open mind about what you can learn from whomever you work for. One other leadership lesson I learned early on that was helpful in the development of my leadership career was to take chances. Volunteer to do things you have never done. Raise your hand, sit in the front row. Put yourself out there. You will be surprised where it will take you. I certainly have been.

RA: Share some of your most memorable leadership moments and why they have stayed with you.

TWM: These moments have been many over the last 30 years, but 1 stands above them all. I still remember the exact moment we received the call from ANCC informing us we had been successful achieving our initial Magnet Designation® for Missouri Baptist Medical Center in St. Louis, Missouri in 2016. It was the culmination of 10 years of focused work by an amazing team of dedicated nurse leaders. As a team, we persisted and overcame many obstacles to achieve this designation of nursing excellence. Along the way, we established an Endowed Chair for Nursing Leadership, opened a satellite campus for our system’s school of nursing, and supported the graduate education of 20-plus staff nurses, some of whom are now nursing faculty across the United States. At that moment, everything I had learned about how transformational leaders create empowering structures to elevate nursing practice and generate new knowledge that improves patient outcomes was validated.

When I look back, I do have a series of other memorable leadership moments. They are the moments when I got the call from 5 of the nursing directors I had the privilege of leading informing me they successfully been hired into their first CNO jobs. Each has their own unique journey, and I am so honored to have been a part of it. I hope what they learned from me is a part of how they lead the nurses in their own organizations today. These nursing leaders are: Debra Turpin—CNO, Alton Memorial Hospital, Yoany Finetti—CNO, Barnes Jewish West County Hospital, Kelley Kostich—CNO, Children’s Hospital of Michigan, Lisa Parker-Schepers—CNO, OSF St. Anthony’s Hospital, and Edna Brisco—CNO, Emory Hillandale Hospital. I am so proud of each of them, and I cannot wait to watch their careers unfold and see how they ensure their nurses always feel respected, valued, and heard.

RA: It is important to “give back” to our profession, and 1 way is to mentor others. Share with us some tips about important aspects of mentoring.

TWM: I have found mentoring to be a very effective tool in developing a successful nursing leadership career. For new nurse leaders, often the hardest part is just recognizing the importance of having mentors in your professional life. Therefore, the first step in selecting a mentor is to realize you need them. No one ever told me this when I was early in my nursing leadership career. It was more by luck that I ended up with great nursing leader mentors in my life. I have always asked questions, which often led to conversations with nurse leaders who were willing to share their time and talents with others. From there, I built long-term professional relationships, some of which turned into long-term mentoring relationships for me. Some of my best mentors have been the deans from the school of nursing at BJC Healthcare, Dr. Michael Evans and Dr. Michael Bleich, and my Magnet consultant from Nursing Consulting Partners, Dr. Vicki George. My leadership abilities grew by leaps and bounds with their advice, challenging questions, and unwavering support. My principle advice is to be curious, ask lots of questions, and watch who takes the time to answer them for you. There you will find your best mentors. The understanding of best practices and availability of tools for mentoring in nursing leadership development have evolved significantly in the last 3 decades. There are great resources and programs now readily available from ANCC/ANA and AONL. I have been inspired so much by mentors that I felt it was my turn, and I volunteered as a mentor through the ANA Mentorship Program. I believe some of the most important aspects of a successful mentoring relationship include a clear understanding of the time commitment, well-defined professional goals to be worked on, and mutually agreed upon measures of the success of the mentoring relationship.

RA: Share with us 1 important mentoring lesson you learned.

TWM: I think the single most important mentoring action I missed early in my career was being clearly asked where I wanted to be in my career 5 years in the future and what steps I needed to take to get there. All my early mentoring relationships were based around solving a single challenge I was having versus being more globally based on career development. I did not have a formal individual development plan (IDP). These are things I learned later in my career from organization development experts I worked with. Today, I work with all my direct reports to help them write an individual development plan, which includes developing mentoring relationships and career plans with SMART goals.

RA: Being a mentor and mentee has vulnerable relationship aspects. Please share your thoughts about mentor vulnerability and the mentoring process.

TWM: I think you first must be comfortable sharing your personal successes and failures with others. The mentees must see you as a real person they can relate to. Take time to build a relationship and find common ground so they feel they can trust you with their true thoughts and plans. I have found myself more than once thinking I could best help someone in one way only to discover they were not sharing their whole story with me, and my coaching, guiding, and encouraging was not fully on track. Once a comfortable relationship exists, then it is important to have an agreed-upon plan of what the best outcome of the mentoring relationship could be. I love a clear stake in the sand and SMART goals, so I always push for answering in writing where do you want to be in 5 years, and what are the things we can do to get you there. There are many great tools out there. I have always found organizational development partners to be great resources as well. Finally, make a commitment to spend time as a team to work through the plan. There is nothing more effective for me than to know I have to sit down with someone face to face in 2 weeks to review my actions. Put regular follow-up meetings on your calendars at the start of the mentoring relationship. You can always adjust them as needed.

RA: Why has Magnet designation been so important to you and your teams over your years of leadership practice?

TWM: It is well documented in the literature that elevation of the role of the registered nurse in organizations correlates with improved patient outcomes. Magnet designation through ANCC provides an evidenced-based approach to creating an environment where registered nurses can elevate themselves individually and as a profession. It is not easy but very powerful when this happens. I have lived this journey several times and watched it transform individual nurses, departments, and entire organizations from good to great. In the end, the patients are the ones who ultimately benefit the most from an organization’s commitment to Magnet designation. This is why it is so important to nursing leadership.

RA: What is the role of CNO in Magnet designation?

TWM: The journey to Magnet designation or redesignation begins and ends with the CNO. It can only truly begin if the CNOs themselves believe in the power of transformational nursing leadership and are willing to embrace the Magnet standards by investing in resources to establish the structures and processes needed to produce the outcomes required for Magnet designation. So often I see the reverse approach. Many CNOs and other health care leaders focus on applying a variety of process-improvement methods to improve patient outcomes without first investing in the structures and processes that elevate the practice of the registered nurse. I had to learn this the hard way, but it was the most valuable lesson of my career as a nursing leader.

RA: What is culture-changing about the Magnet journey?

TWM: Investing in elevating the role of the registered nurse in an organization is the only sustainable way to improve nursing-sensitive patient outcomes. An organization’s recognition of the large and impactful role the registered nurse plays in the delivery of quality health care is a fundamental first step. This will begin the cultural transformation of an organization and as I heard it so clearly stated at Emory Healthcare by their Chief Nursing Officer Sharon Pappas, “When nursing goes well, the rest will follow.”

RA: Share some of your current support for staff well-being.

TWM: The pandemic has been so stressful for all health care workers. Our organization did many of things that are well documented in the literature to support staff well-being. Rather than repeating those things, I would like to share some of the things we did that I think made a difference as well. We never lost our sense of fun no matter how stressful it got. We established a formal celebration team that planned monthly fun activities for the whole hospital. We modified activities we used to do in large groups to smaller, unit-based fun. We continued to celebrate holidays, special dates, and accomplishments, both large and small. We held mask-painting competitions, guess the baby pictures competitions, and opened the cafeteria once a month on nights to just say thank you to the night shift with theme-based meals and loud, fun music and dancing. It was not the activities themselves that made the difference, it was coming together as a team to laugh, cry, and share with one another in good times and the bad…that became our iron core. Another powerful action that I saw emerge in many ways, but always with the same intent, was acknowledging the sacredness of the human life. Prepandemic, it was never something we talked a lot about or drew attention to specifically as we went about our days. As the pandemic took hold, I saw some of the most amazing things happen. Staff began holding a minute of silence around the room where a patient had just passed, nursing units started holding weekly remembrance ceremonies where they read aloud the names of those who had died the last week and handed out angel pins to the staff who cared for the patients as they passed. The 1 story I will never forget is where our ICU nurses and RTs spent the day planning for a husband and wife to be moved into the same ICU room so they could hold hands as they were terminally weaned off their vents. This is nursing at its best. Caring for our patients and each other’s mind, body, and spirit, no matter what.

RA: In order to support the staff, the leaders must stay healthy. How do you take care of yourself?

TWM: I am the first to admit that I did not do this well! I went for 2 years straight without really taking time away from the hospital. I finally went on a vacation to Mexico in January 2022, and for the first time, I was able to fully disconnect for 2 weeks. The impact was profound. I had no idea the effect of being on-call 24/7 day after day, troubleshooting issues there were no easy answers for, had on my physical and mental well-being. At the end of those 2 weeks in Mexico, it felt like a fog had lifted from my brain. I felt fully physically rested, and a sense of peace and calm came over me. The good news is it has remained even months later! So, the big lesson I learned is you must take time away and completely disconnect, especially in times of prolonged stress and uncertainty. During the pandemic, it became even more obvious that it was critical for the hospital leadership to set the tone and the pace for each day. I drew my strength and inspiration from other leaders I have met along my 30-year career journey in nursing leadership. We texted, called, e-mailed, and communicated on social media with each other through it all. Their words, encouragement, and stories always seemed to be what I needed to face the next day. My final support came from my incredible family. I have 3 grown daughters (2 in health care) and my wife of 36 years. They were always there for me with open hearts and minds. They were often the first reviewers of my new plans to get through the next day. Through them, I would gather my hope, courage, and determination for a brighter tomorrow. In many ways as I look back, I realize as Charles Dickens wrote, “It was the best of times, it was the worst of times.”