Leader to Watch| Volume 20, ISSUE 6, P536-542, December 2022

Joy Peters, DNP, RN, MSN, MBA, NEA-BC

Published:September 30, 2022DOI:
      Joy Peters’s inspiration to join the profession of nursing came from the influences of her father as well as the tragic passing of her sister from a car accident. She saw firsthand how the nurses who cared for her sister, as well as for them as a family, impacted her through the kindness, compassion, and support they provided to them as a family unit. She had several mentors who shaped her professionally, guiding her to a path of nursing leadership. She has a passion for patients and is an advocate for patient experience. She led her organization to achieve prestigious ANCC Magnet Recognition®, which they were able to navigate during the pandemic which is even more inspiring. Joy is currently the chief nursing officer (CNO) for both Jefferson Hospital as well as Canonsburg Hospital part of the Allegheny Health Network in Pittsburgh, Pennsylvania.
      PFC: What inspired you to enter the nursing profession and particularly nursing leadership?
      JP: During my sophomore year in high school, my sister was killed in a tragic car accident. Not only was her car in an accident, but the ambulance transporting her from our local hospital to a trauma center ran a red light and collided with another vehicle. In our small town, this made front-page page news, so the publicity made it more difficult for us as a family. When it was determined she met brain death criteria and was a candidate for organ donation, it was devastating for me and my family. I remember feeling so sad and broken. For several years, I really lost sight of all of my goals, and then one day during my senior year, I had this vision of the nurses who cared for my sister, and at the same time, cared for us as a family. Often they just listened to us cry without saying anything or reached out with a small stroke on the arm or back. Most importantly, they let us be together as a family. While I do not know their names or remember their faces, they inspired me to become a nurse through their kind, compassionate actions. I am forever grateful to them as I can’t imagine doing anything else. I love being a nurse, and while I miss my sister very much, I carry her memory in my heart as my “why” for one of the best decisions I have ever made in my life.
      I think in some respects, I have always gravitated toward leadership positions both informally and formally. My dad influenced me in many ways. He never graduated from high school but worked his way to be a turn foreman in a steel mill. He stressed to me the importance of working hard, being open, honest, fair in decisions, and focused on goals. Throughout my career, there have been several senior nurse leaders who were willing to take a chance on me and offered me formal leadership positions. I learned so much from them and appreciated their mentorship. None of us are the perfect leader, and we all can benefit from others words of wisdom along the way.
      PFC: Who or what has been the most significant influences to you in your career?
      JP: My sister’s memory of course has been a significant influence on me. Her death is my “why” for being a nurse and has significantly influenced my career.
      Education has also been a guiding star for me. When I first started nursing school, from a very fundamental standpoint, I was focused on caring as a nurse. As I continued with my BSN, I became more aware of the importance of evidence-based practice. While completing my MSN/MBA, I was introduced to lean methodology as denoted by the Toyota Production System. Sometimes I refer to this as ‘Joy’ota as I became heavily influenced by the application of lean principles in health care. I was a young nursing director when the Institute of Medicine Report, Crossing the Quality Chasm, was published. My team implemented simple standardized protocols using lean methodology to eliminate central line–associated bloodstream infections. Our work was groundbreaking, and we became health care innovators overnight, and I had the opportunity to present our work from coast to coast. One of the highlights was a presentation in collaboration with Paul O’Neill, former CEO of Alcoa and US Secretary of the Treasury, at the Juran Institute in Minnesota to CEOs from general industry. It was a once-in-a-lifetime experience.
      PFC: What are some of the strategies you have used to engage with the nurses at Jefferson Hospital and Canonsburg Hospital?
      JP: I think the most important thing is to be visible, which is challenging as I cover 2 hospitals that are geographically 45 minutes apart. It’s important for staff to know me as a person, who I am, and what I’m thinking, and for me to get to know them in the same way. These meaningful interactions create opportunities for them to ask me questions and for me to clarify any rumors or reinforce positive results. Connection matters!
      I have a routine for rounding throughout the hospitals during the day and schedule quarterly night shift rounds with a coffee cart and snacks. This is a big hit! Last year, I broke my ankle, and my team created a life-size cardboard cutout of me and attached it to the snack cart for rounds so that staff knew I was thinking about them even though I couldn’t be there in person.
      I write a monthly blog with a message I feel is important to convey based on what is happening at the time. Annually, I send hundreds of thank-you letters to staff who are acknowledged in the Press Ganey patient satisfaction surveys. I send e-cards through a system called Applause for staff who receive advanced degrees or achieve a milestone on the clinical ladder.
      A unique way I engage with the staff is through a video series we created called “Why Not With Joy Peters.” The videos are short, whimsical, and very funny. The backdrop could be anything from a blizzard, a construction scene, or the countdown in Times Square on New Year’s Eve. The idea is to explain the reason why we might be doing something new in about 4 minutes or less and of course summarize at the end, “if you’re asking why we might be embarking on this new journey, the answer is always, Why Not?”
      Annually, we have a nursing retreat on campus with nursing leaders as well as a staff person from every department. The retreat always has a theme and starts with a silly video of me summarizing our accomplishments in nursing, slides with a more in-depth review, table top games, report out from council chairs, guest speaker, food, fun, and prizes. It is an amazing day and always enjoyed by all.
      PFC: You are a strong proponent of patient experience what are some of the best practices you have done at your hospital?
      JP: I have always been committed to ensuring patients (and their families) have the best possible experience. It is so stressful to be a patient particularly when care becomes complex. How each caregiver responds in delicate situations can make a big difference in the confidence patients and their families have in our organization. It is important not to personalize when someone is upset and just apologize, listen, and focus on what could be done in the moment to turn the experience around. It is human and normal to be scared when we or someone we love is sick, and it is the nurse who can make a difference.
      I became fascinated by the patient experience as measured by the HCAHPS survey while I was completing my doctorate. My research project centered on a concierge-type rounding program pairing senior leaders from clinical and nonclinical areas of the hospital to visit patients while asking a scripted set of questions. It helped those in the nonclinical setting actually see the work occurring in the clinical setting, and it built relationships between those leaders who really were working in 2 separate worlds, albeit both in the hospital. The pairing of leaders also helped support accountability in rounds as the partnership ensured the commitment of rounding took place as planned. We have developed similar rounds in both of my hospitals using an online data collection tool and have check-in points as a group to examine trends as well as pearls from the rounds. We have also established similar rounds, with different questions, for the nurse managers and assistant nurse managers. The number of rounds completed is also tracked electronically, and the information is shared at a mid-tier daily huddle with nursing leadership. Patients and their families appreciate that a nursing leader or senior leader has rounded on them. The key is to have a process for ensuring the rounds are completed consistently.
      Another area of focus has been in purposeful hourly rounds by the bedside staff. When we first implemented the process, the director of nursing and I held a 5-minute huddle on the nursing unit every 4 hours to understand the barriers to completing the rounds. We knew if we didn’t place an emphasis on the importance of being intentional with the rounds that the process would fail. It had some rough spots, but after about 3 weeks, there was great synergy with the team and the staff felt “calm.” Call lights prior to implementation were going off 31 times an hour! After implementation, the number dropped to 6! Wow! Evidence-based practice in its finest hour!
      During the height of COVID-19 when visitors were not allowed in the hospital, it was particularly difficult to have a loved one in the COVID-19 units as many were dying, and it was clear that families were very anxious from afar. We implemented “connection” rounds using the iPad, but felt that families needed more consistent information. As a result, we established a process to call every designated COVID-19 family member daily with a brief scripted update regarding how the patient slept, an update on their oxygen demands, the treatment plan for the day, and in general, how they were doing. While we couldn’t change the outcome in many cases, we were able to prepare families through this process of updates. It was also very helpful for the nursing staff as managing the updates to families through the scheduled calls minimized the interruptions while they were in the isolation rooms.
      PFC: You also are an adjunct instructor; how do you balance that work with your busy role as CNO?
      JP: A few years ago, I was asked to coteach a course, Reflective Leadership and Ethics, at Georgetown University. I have had the most wonderful opportunity to share the course with Dr. Carol Taylor, who is known internationally for her work in philosophy with a concentration in bioethics. I teach the leadership portion while she focuses on the ethics side, understanding that you need both to lead today. We worked with a company called 2U Studios out of Arlington, Virginia, to pre-film our lectures so the actual classroom time with students is spent applying the concepts learned from the videos. It was a lot of work to prepare the video lectures, but they turned out really well, and it was an amazing experience. Sharing the course works really well for me as a CNO over 2 hospitals. The students are in the DNP or BSN to DNP track and come from all over the country. In the beginning, we would gather for a weekend on campus at St. Mary’s Hall at Georgetown, but once the virtual platform was complete, it became all online. As a CNO, it is very helpful to understand the perspectives of those at the frontlines from around the country. The challenges are the same, and while there aren’t easy solutions, I get ideas from the students, which helps me approach local issues differently. We learn from each other.
      PFC: You recent earned prestigious ANCC Magnet Recognition; what did this mean to you both personally and professionally?
      JP: Achieving Magnet® status was an incredible, transformational experience. It had always been a dream of mine, but never in a million years did I imagine how powerful the journey and the process of designation was going to be for me as well as for our nurses and the organization at large. From the very moment I began working at AHN Jefferson, I really felt the spirit of Magnet from the people. All the people, not just nurses! It is 1 of the things that makes me so proud to work in the organization as, regardless of your role, each person understands how important and valuable what they do is for patient care. The commitment and dedication to caring for patients like family while focused on quality outcomes is the number 1 priority.
      In nursing, as we developed the foundation and council structure for Magnet and empowered the frontline staff to be at the center of decision-making, momentum accelerated. It has been amazing to watch our nursing staff develop in leadership roles on the councils and gain confidence with executing evidence-based practice into care. To our nurses, Magnet means they are working in an environment where they are supported, and to our patients/community, it means that you are receiving your care in an exceptional hospital.
      As the journey is long, it is emotional to hear that your organization has been designated. I felt so overwhelmed by the news because I know how hard all of our nurses worked to achieve the milestone in the organizations history and how much nursing was supported by others throughout the hospital and our network.
      PFC: Beyond achieving Magnet Recognition, what else are you most proud of in your career?
      JP: I am so proud to be a nurse. It wasn’t my original plan in life, but it was God’s plan for me. It has been a privilege to be able to enter into the lives of so many people when they are the most vulnerable facing illness or even death. I have always felt that with each interaction I could make a difference in either encouraging a patient to be optimistic or by just being there at the end. While I’m not directly caring for patients anymore, I do round regularly and consider the conversation I have with them to be very special. I am most proud that I have always done my best to make each moment matter. I have learned so much from people along the way. Every interaction causes me to reflect about my own life and the legacy I would like to leave behind.
      My team would say that they are proud of the way I led through the pandemic. When COVID-19 started, we had a healthy culture and shared leadership infrastructure in place for many years because we were on the Magnet journey. This infrastructure is why I believe we were able to be so fluid during those unprecedented times. It’s why the team continues to be healthy and resilient. During the initial phases, there was so much fear, the hospital stopped all elective surgeries because of a shelter-in-place mandate from the state, and staff found themselves doing work outside of their normal scope. The leadership team and I rounded frequently with consistent messages and information to nursing and allied health departments so that everyone had the same information and direction. People needed leaders and wanted to be led through the uncertainty. So we gave them information and support as much as they needed. In the second phase the census and acuity was high. I garnered support from traditionally non-patient facing areas on the units such as nursing education and professional practice. Everyone helped in the way they could so that staff felt like they were not alone. It was an “all hands on deck” approach.
      The last major stage was the politically charged vaccination process. We needed to get a vaccination clinic up and running quickly. The priority was to keep our own workforce healthy, providing them with vaccines as supplies allowed. There were early adopters, and those who were fearful. I spent many days in the vaccination clinic talking with staff one-on-one to ease anxiety and fears. I also spent many hours vaccinating people to get them through the process and back on the nursing units quickly. The days were long for all of us, but the time was well spent. As vaccine supplies became available, we supported essential health care workers in the community and then as vaccine shortages lifted, we vaccinated the vulnerable and underserved communities. In the end, we vaccinated over 5,000 people.
      PFC: Certainly the pandemic has impacted the nursing profession in so many ways; what lessons learned or reflections would you like to share with our readers?
      JP: We were very fortunate in that we had some time to prepare for the first wave unlike our colleagues in other parts of the country. Our network was able to secure P-100 masks from MSA, which was critical because our staff did not have to worry about a shortage of PPE. Fear was so rampant that this was a game changer for us in that employees felt safe and protected. Frequent communication and leadership were also key to ensuring our staff knew facts. The motto was we were all in this together, and we supported each other as a team. The leadership team was transparent in how many COVID-19 patients we were caring for at any given time. We innovated and allowed staff to control what they could in the day-to-day care delivery.
      As Mr. Rogers would say, “Look for the helpers. You will always find people who are helping.” When I reflect upon the event in its entirety, there were many people who emerged as informal leaders and helpers throughout the pandemic. Staff who would not have otherwise had an opportunity to showcase their skills because of their job or the scope of their work. I am grateful they felt empowered to lead from where they were, becoming a beacon of light for their peers.
      There are so many generations currently in our nursing workforce what strategies have you and your team done to support and engage the nurses?
      Treating all generations with respect for who they are and the skills they bring to patient care has been successful. Respect builds connections. Feeling connected and needing connection is a basic human need that transcends all generations. Having places for connections to grow such as shared leadership councils nurtures healthy cultures.
      As the leader, people follow my example by staying positive and calm, which sets the tone for everyone else. Giving a genuine smile or displaying compassion are human actions that are sometimes undervalued in the modern world, but the impact of empathy on relationships can transform people from all generations.
      Technology cannot replace human connection, but it can augment the ways we connect to touch more people. As I have mentioned, I round in the hospital regularly on patients and nurses, and augment this with the “Why Not With Joy Peters” videos. I attend shared leadership meetings and host “lunch with leadership” sessions. I also empower my leadership team to do the same; they are an extension of me and my leadership. By spending time nurturing my leaders I am also nurturing the staff and patients.
      PFC: How would you describe your leadership style?
      JP: When I reflect on the parts of my leadership style that are most important to me, being positive, calm, and humble are the hallmarks of my personality. I like to engage with people and feel that we all learn from each other. Therefore, I think of myself as a transformational leader. I encourage my teams to stretch themselves by making a safe space for them to learn and grow. I trust them to work out the details as I guide and motivate them to think differently and bigger. When appropriate, I walk beside them through difficult situations to mentor behaviors that create meaningful change. And sometimes we learn from failures and move on. These connections create opportunities for coaching and reflection. It also creates a culture of mutual respect and admiration.
      Joy Peters.
      Zelienople, Pennsylvania.
      Current job:
      Chief Nursing Officer of Allegheny Health Network’s Canonsburg and Jefferson Hospitals.
      First job in nursing:
      During nursing school, I worked as a nursing assistant in a skilled nursing facility. It was a great experience! My first job as a nurse was in a cardiac telemetry unit. I loved it so much that I remained a cardiac nurse throughout my clinical career.
      Being in a leadership position gives me the opportunity to:
      Create a vision, establish culture, set expectations, ensure nursing has a voice, and create an environment where nurses are supported to be the best they can be.
      Most people don’t know:
      that I am a landlady and help my husband manage a number of rental properties.
      My best advice to aspiring leaders is:
      to believe in yourself and lead with your heart.
      One thing I want to learn is:
      how to sail.
      One word to describe me:


      Paula F. Coe, DNP, MSN, RN, NEA-BC, is vice president, nursing education and professional practice, at Allegheny Health Network in Pittsburgh, Pennsylvania. She can be reached at [email protected]
      Photography © Alex Jones