Portal de Periódicos da CAPES

Tara A. Cortes, PhD, RN, FAAN

2013; Elsevier BV; Volume: 11; Issue: 1 Linguagem: Inglês

10.1016/j.mnl.2012.11.004

1541-4620

Sylvain Trepanier,

Global Health Care Issues

ST: You've had a spectacular career and I congratulate you. Please help us understand why and how you became a nurse leader. TC: Absolutely. I have always believed one must love what they do and do what they love. I have always loved nursing and have been very blessed to be able to wear many hats during my 45-year career. Upon graduation from Villanova University, I worked in an intensive care unit (ICU) and then became a supervisor of the ICU and recovery room. After 4 years, I joined the faculty at Hunter Bellevue School of Nursing. I was there for 21 years and spent part of that time as the director of the undergraduate program and then as associate dean. I became restless and decided I was still young and had many years left in my career and wanted to do something different. After almost 1 year as director of research and information systems at a major medical center in New York, I accepted the position as chief nursing officer (CNO) and associate director of Rockefeller University Hospital. Five years later, I became the director of medical services at Mount Sinai Hospital. During this time, I was very fortunate to be selected as a Robert Wood Johnson Executive Nursing Leadership Fellow, which was transformational for me. After 5 years at Mount Sinai, I moved to Bridgeport Hospital/Yale-New Haven Health System as CNO and senior vice-president of patient care services. I would say that each position built on what I had learned in the past one. In 2005, I was recruited as president and chief executive officer (CEO) of Lighthouse International, a leading not-for-profit organization dedicated to fighting vision loss and helping people prevent vision impairment. I was able to use my background in education, leadership, policy making, and population health to further their mission. Along with the staff and board, we transformed the organization from a social charity to a healthcare provider with billable services. After awhile, I felt the need to be more involved with nursing again and came to the Hartford Institute for Geriatric Nursing at New York University College of Nursing as professor and executive director of the institute. In this position, I am able to influence the care older adults receive from an interprofessional team at a crucial time in the evolution of our national healthcare delivery system. ST: What prepared you to have such a prestigious appointment at Hartford Institute for Geriatric Nursing? TC: My love for geriatrics began at Mount Sinai Hospital, where I worked very closely with Dr. Albert Siu, who is now the chair of geriatrics and palliative medicine there. Together, we developed an interprofessional model of care for older adults across the continuum. Since that time, I have embraced the unique needs of older adults and the problem of access to quality care for this vulnerable population. While at Lighthouse International, I implemented a program in collaboration with Cornell University's department of ophthalmology to further develop the skills of nurse practitioners (NPs) and ensure their competency in completing an eye exam. This program created some lively discussions with optometrists who feared these NPs would be taking away their patients. We had to educate our colleagues that these NPs were being educated to conduct eye exams on older patients who were homebound, had no access to care, and would not be seen at their (the optometrists') practice. In other words, we were not going to take any business from them. We found out that one of three patients was legally blind and eligible to receive state-funded vision rehabilitation and devices to help them function more safely. ST: Can you give me more details regarding the use of NPs in your program, maybe some details behind the decision making of using NPs? TC: I firmly believe that NPs will become the backbone of primary care in this country. There are simply not enough primary care physicians in this country to meet the healthcare needs of the growing number of people, particularly older adults who need more primary care to maintain optimal function. The “triple aim”—better healthcare, better outcomes, and lower cost—of the Centers for Medicare and Medicaid Services (CMS) can best be achieved by allowing all professionals to function to their full scope of practice. We need to collect and analyze outcome data to demonstrate care effectiveness. ST: As you reflect on the current barriers that some states have regarding the practice of NPs, what advice do you have? TC: Many groups are addressing scope of practice for both RNs and NPs. The Institute of Medicine's Future of Nursing report from 2010 has been a catalyst for action groups on the state and federal levels. Other national nursing membership groups and coalitions are involved in addressing practice issues. It is important for nurse leaders to step up and speak out. Too often nurses think of policy as something else that others do, not them. Our practice, our research, our education can influence the implementation of models, regulations, and rules. It is important for nurses to have an equal seat at the table and use the extensive knowledge they bring to educate others in the ways we know our practice should be conducted. ST: What are you the most proud of in your career? TC: I am always deeply touched when young and not-so-young nurses come back to me and tell me what an impact I have had on their lives. I am always humbled when told I made a difference for them. Leadership is not how to do, but how to be. There are many things I have done in my career, but perhaps none as important as helping others to optimize what they can do in their own lives. ST: Can you share with us the most difficult challenge you have encountered as a leader and how you overcame it? TC: I had a brief position as a director of research and information systems at a large medical center. I had left a tenured position at Hunter to take this job. Originally, the position was only in research, and 3 days before I was to begin, I was asked to assume responsibility for nursing informatics as well. This was in 1992—we did not even have e-mail then! However, I received a faculty appointment in the Department of Medical Informatics and worked with a fabulous team of physician informatics gurus, received grant funding, and was busy developing computer tools for nurses on hospital units. Nine months into this job, we had a change in leadership; a new CEO came along and said he needed nurses who could pass bedpans and answer lights, not highly educated nurses. I and my department of eight were laid off, and after just 9 months, I found myself out of a job. I was devastated. Three months later, I was offered the position at Rockefeller University Hospital. This was the turning point of my career, and without that position, which gave me a very firm foundation in nursing and hospital administration, we probably would not be talking about me today. ST: As you think back on your career, is there anything you would do differently; if so, why? TC: I can't think of anything. Even thinking about taking a risk after 21 years and leaving a secure job, I would not have done anything differently. Risk taking is an important behavior if one is to have personal and professional growth and make a difference in the world around you. When the passion is not there anymore, you have to reinvent yourself, otherwise, you become stale. I encourage all nursing leaders to be wary of becoming too comfortable in anything they do. ST: In 2010, the Institute of Medicine offered us a landmark report on the Future of Nursing. One of the recommendations speaks to “expanding opportunities for nurses to lead and diffuse collaborative improvement efforts.” What suggestions would you have to our readers that would allow us as nursing leaders to act upon this particular recommendation? TC: I think nurses need to help nurses with these opportunities; we need to identify opportunities for each other and share. We sometimes don't think about the development of others as one of our roles, and I think this is a mistake. We must play an important role in the development of our profession. Identifying opportunities to sit at a decision-making table is very important. I have had the opportunity to sit at local, state, national, and international boards, and opportunities like these helped me to be where I am today. These opportunities allow nurses to bring the voice of nursing to a different forum. The more opportunities we have to sit on various boards, the better we are, the greater the audience. This will allow us to disseminate our message, increase collaboration, and further enhance our discipline in the eyes of others. ST: What's next for you? Any professional dreams you would like to share with us? TC: I think as long as I am making a difference, as long as I can keep influencing healthcare systems and the well-being of others, I will keep doing what I am a doing. I never planned to have an advanced degree or to move into any particular position; it just all kind of happened. I believe that things happen for a reason. I love what I do and I do what I love. When I think I am no longer making an impact, it will then be the time to move on. Where? I simply don't know. Hometown: New York, New YorkCurrent position: Professor and executive director, Hartford Institute for Geriatric Nursing at NYU College of NursingEducation: BSN from Villanova University, MA and PhD from New York UniversityFirst position in nursing: Intensive care unit nurseMost people don't know that I: Love to cookBest advice to aspiring leaders: Use every opportunity to listen rather than speakOne word to describe me: Inclusive Hometown: New York, New York Current position: Professor and executive director, Hartford Institute for Geriatric Nursing at NYU College of Nursing Education: BSN from Villanova University, MA and PhD from New York University First position in nursing: Intensive care unit nurse Most people don't know that I: Love to cook Best advice to aspiring leaders: Use every opportunity to listen rather than speak One word to describe me: Inclusive ST: Please share with us a piece of advice for aspiring nurse leaders. TC: It is very important to remember that leadership is not an individual act. You must have confidence in yourself and surround yourself with smart and motivated people. You have to instill leadership deep into your organization. Harness the power of the organization. As someone else said and I always reminded my unit leaders: “You are the CEO of your unit.” At the end of the day, the patients do not know who the CNO of any organization is; they remember the nursing assistant and the nurses. They recognize the people who are present in their immediate environment. Those are the ones who make the organization great in patients' eyes. This is why it is important to instill leadership as deep in the organization as you can, which, in turn, will create a strong organization. Frances Hesselbein, one of my mentors, said, “The more power you give away, the more power you get.” I always remember that. ST: Do you still have a mentor? TC: Of course I do—I have more than one. Frances has been my mentor for over 14 years now. Everyone should have at least one mentor throughout their careers and even their lives. It may not always be the same person. It is also important to have mentors who are outside of nursing to allow for further development and expand your world. ST: Your last words for us today? TC: I would like to stress the importance of integrity. Mean what you say and say what you mean to ensure you never have to worry about what you are saying. Embrace learning with a passion. Every morning, I ask myself, “What will I learn today?” The world is full of people who I can learn from. If I stop learning, I stop growing. Never believe there is nothing more to learn or opportunities to learn from. And finally, always be humble. Arrogance leads to poor leadership, poor decision making, and failed organizations.