Jan Jones-Schenk, DHSc, RN, FAADN, FAAN

JJS: My path to nursing and nursing leadership has been somewhat unusual. I finished an associate degree in political science but had no particular career path identified for a couple of years. I happened to become involved with the health care needs of some young women friends and was inspired to pursue nursing to become a nurse midwife. Nursing school was enlightening and invigorating, but I found myself more interested in critical care and ED [emergency department] than L&D [labor and delivery]. Early in my career, I became involved in nurse advocacy work. Some aspects of the work environment were troubling to me and a group of colleagues, so we attempted to work within the organization and then within the local nurse’s association to make changes. Ultimately, we found we couldn’t affect changes within either path, so we formed our own local union and held the first national certification election for nurses in Utah in 1980. This was a difficult time for all of us who felt we had no way to advocate for improvements to nursing care environments through any other means (this preceded shared governance). The election failed by a very small margin but did result in many significant changes that reflected our voices and concerns.

Nurse advocacy was in my blood, and I decided the best way for me to be an effective advocate was to pursue a path in nursing leadership. I have worked as a nursing supervisor, unit director, assistant director of nursing, and chief nursing officer (CNO) in a community hospital. I became very involved in my state nurses’ association and led the redevelopment of the Utah Nurses Foundation for nursing scholarships and ultimately accepted a position as executive director of the State Association. When I ran for a position on the ANA Board of Directors, and won, I didn’t realize the extent to which that experience would develop me as a nurse and a leader. The work I had the privilege to engage in during my 8 years on the board was wide ranging and exposed me to international nursing colleagues and gave me the unique opportunity to work with some of the great nursing leaders in the US. I was appointed to the board of American Nurses Credentialing Center (ANCC) during the first few years when the Magnet® recognition program was launching. I ultimately became the president of the ANCC Board where I served for 3 years. At that time, there were less than 10 designated Magnet® hospitals, and there was much to do in refining and scaling that program. I had the great honor to be mentored by Margretta Madden Styles with whom I worked closely and traveled extensively as we developed the international credentialing arm of the ANCC. It was this work in credentialing that ultimately led me to nursing education.

For several years, I engaged as a consultant on implementing federal regulations in hospitals, advanced practice credentialing, and Magnet® preparation. I worked for a few years with a variety of national assessment organizations including ETS and Prometric, and for a brief time, in an internet startup focusing on improving clinical consistency and evidence-based product solutions. Each of these unique experiences gave me a variety of perspectives and widened my lens as both a nurse and a leader. When I was approached by the president of Western Governors University (WGU) to develop the first competency-based prelicensure nursing program that would meet the educational requirements of all 50 boards of nursing, I was intrigued and excited by the magnitude of the task! It was the first of my work specific to nursing education, and it has become a passion that has given me purpose and excitement during these last 14 years. By the time of my retirement, I had led and developed a variety of nursing and health professions programs and had helped over 95,000 individuals to achieve a high quality bachelors or masters degree.

JJS: I have been incredibly fortunate to know and learn from some of the greatest nursing leaders of our time. My first mentor was someone who was a nursing instructor and ultimately became the CNO of the hospital where I was first a staff nurse. Judy Hougaard was an inspiring leader, and I credit her with my early professional development. I was also mentored by a local nurse who became a state legislator and taught me so much about policy and politics. Paula Julander preceded me as executive director of the Utah Nurses Association and urged me to run for the ANA Board. While on the board, I met and was supported by Bev Malone, Margretta Madden Styles, Pat Murphy, Ruben Fernandez, and Michael Evans, all of whom became dear colleagues and from whom I learned so much. Pat Yoder-Wise and Alexa Green were influential as I was developing as an educator, and I was honored to have the guidance of Patricia Benner and Polly Bednash in that early work. There are so many wonderful friends and colleagues to whom I owe a great debt. I was fortunate to become close friends with the great Maggie McClure who served for over a decade on my advisory board. As a member of AONL since 1988, I was deeply influenced by many great leaders in that organization, including Ann Van Slyck and later by Linda Burnes Bolton, Marilyn Chinn, and Carol Bradley, all of whom informed my early work in prelicensure education. Linda Knodel and Syl Trepanier became close and constant advisors and colleagues for many years.

JJS: The best advice I can give is to be open to new leadership opportunities and to learn from different kinds of leaders. I’ve worked in a wide variety of organizations, and each has given me a perspective and new leadership challenges. Continue to develop your skills through professional organizations and through local, community organizations. I was in the first community leadership class my town hosted and served on the recreation board, a county planning committee, and ran for my local school board. It is the diversity of experiences and encounters that I believe was most valuable to me.

JJS: I believe nursing is at a turning point in many ways. Thankfully, we have begun to understand the breadth of nursing care needs are community and population based. We are seeing the folly of institutional silos and of episodic care. This means as leaders, we must rethink and redesign how and where care is delivered, what systems are needed to support and retain high quality care givers, and how to infuse value into nursing practice in all settings. Traditional compensation and support systems will no longer serve these needs. Nurses in all practice settings must have work environments that support healthy lifestyles and allow for the passion and compassion that is our hallmark to flourish.

JJS: There is a great need to map and align skills and competencies across a variety of entry-level roles all the way through undergrad and graduate nursing. Our educational systems don’t do this now, so someone who is a CNA [certified nursing assistant], EMT [emergency medical technician], or MA [medical assistant] can take years to even access a nursing program much less advance a career path. This must change. We are beginning to see that our traditional ways of measuring education (hours and seat time) are not relevant or viable. Hours measure time, but not competence, and not everyone achieves competence at the same time. Closer collaboration with practice leaders and nursing faculty is essential in defining and aligning competencies. It is also critical to be more open to ways that practicing nurses can mentors and support clinical learning of students. This includes compensating them for this work and providing support and development for them to become even more expert in teaching students.

JJS: I see 2 things that could be immediately helpful. One of the biggest barriers in scaling nursing education is the lack of clinical placements and a traditional method for all clinical placements that is inflexible and unnecessarily competitive. Nursing schools should receive clinical education grants that enable them to pay for clinical education support provided by practicing nurses with concurrent teaching skills. This would solve several problems. It would make nursing student support and development more attractive to practicing nurses and concurrently aligning clinical learning with practice environment realities. It would improve the quality of clinical learning especially with well-defined clinical competencies. And, it would shift the perspective about student rotations, access to them, and align their purpose with shared goals of the organization and the individual student. It would provide employers and new grads with the opportunity to make good decisions about hiring and fit. The second thing is to abandon old thinking about career advancement by making sure nursing programs map competencies across roles so potential students can see a clear career path. Organizations want and need nursing professionals that look like the communities they serve, but traditional admission and enrollment policies often exclude individuals who would be able to fill these gaps. Programs that are accessible to unlicensed care givers and individuals who work in environmental services or other roles in health organizations are an important pipeline for future nurses. Nurse leaders working directly with deans and directors could reframe admission and enrollment policies and practices to improve access.

JJS: The use of simulation and telehealth training advanced considerably during the pandemic. The effectiveness of such models is well-suited to competency-based learning which emphasizes outcomes. That said, state boards of nursing (SBON) exercise significant control over the use of such technologies within curricula. Despite an extensive study of the value of simulation for clinical learning, many states limit the use and type of simulated learning. Technology can add significant value in nursing education, but this sort of innovation is often stifled by inflexible and traditional state regulations that control curricula. The role of SBONs in educational oversight is an outdated method that has an outsized impact on nursing workforce development. We are seeing this right now in some states where nursing shortages are extreme, and the state regulations are clearly a factor. One thing that is clear from the pandemic is that while simulation cannot replace clinical learning, it is an essential preparation for critical thinking and actually amplifies the value of live clinical learning. Students whose access to clinical learning during the pandemic did not include sufficient opportunity in live clinical rotations did not develop fundamental clinical competencies. In short, a comprehensive clinical learning model is most effective when in combines multiple technologies, well-designed and measured simulated experiences, and high quality clinical experiences where students engage in realistic patient care situations. The challenge of not being able to engage in live clinical learning rotations during the pandemic has had a negative impact on student competence. If clinical competence is a ladder and technology and simulations are 2 rungs, and clinical engagement is the third, we cannot evaluate the first 2 if the third rung is not available or implemented.

JJS: Right now, I’m chairing the NLN’s Strategic Action Group on competency-based nursing education. This is a great honor and is critically important work. I’ve always deeply valued my connection to AONL and the many leaders there, so I hope to ensure that this work is aligned with practice partners as well. Educational innovation remains a great passion, and I know I’ll continue to work in this area. I also plan to engage in more governance work with health care organizations to continue the work I began at WGU in establishing the Institute for Advancing Health Value. I firmly believe value-based care is an essential part of how we must redefine our health care delivery system and that includes developing a workforce that understands value and can be part of creating a high value care experience. I continue to write a bimonthly column on leadership for JCEN [Journal of Continuing Education in Nursing] and appreciate the voice I have as coeditor with Syl Trepanier of the leadership column. Finally, I’m developing new “muscles” by taking classes to develop new personal skills for fun and health. All that we are is what we bring to our engagements. I’ll continue to learn, and hope I can continue to bring value!