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Original Articles

Always a Nurse

The Chief Operating Officer

Youngblood, Elizabeth MBA, BGS, RN, FACHE

Author Information
Nursing Administration Quarterly: January/March 2020 - Volume 44 - Issue 1 - p 18-22
doi: 10.1097/NAQ.0000000000000394
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AS THE CHIEF OPERATING OFFICER (COO) for the Texas Division of Catholic Health Initiatives, a division of CommonSpirit Health, I am responsible for ensuring the effective and efficient operation of the division's hospitals. This includes managing to defined metrics to achieve clinical, operational, and financial excellence; ensuring the alignment and implementation of a high-quality, cost-effective integrated health care delivery system; and integrating the system's strategic plan into operations.

I am also a nurse and the things that I have learned from my profession have helped prepare me for what I do now. I am proud to be a nurse and have always maintained an active nursing license. The way I see it, I worked hard to get my license and I am not willing to give it up, even now.

I wish I had some sort of wonderful and inspiring story to tell you about why I became a nurse. I love hearing those stories from others. But, the truth is, my rationale at the time was purely economic.

Growing up, I wanted to be a medical doctor. In fairness, that was because my grandmother wanted me to do it, not because I had some burning desire to do so. In high school, I discovered my love for journalism and decided that I would become the next Barbara Walters. So, I headed off to college to enroll as a Communications major. Unfortunately, I had somehow missed the letter that apparently was mailed sometime between me leaving Connecticut and arriving in Texas that stated that the tuition rate had been tripled. Given that I was paying for my education and living expenses on my own, and that I already had no idea how I was going to do that before the tuition rates were increased, I decided that I would work full-time and go to college at night.

Within a few days, I landed a job at a company called Nurse Finders. Back then, they were owned by a gentleman named Larry Carr and his wife. To this day I do not know what Mrs Carr saw in me, but for some reason she decided to hire an 18-year-old with no experience as an accounts payable clerk. I did not even know what an accounts payable clerk did. I was just answering a job ad in the paper and hoping for a paycheck. I remember during the interview she asked me whether I knew what a 10 key was, and of course I had no idea. She handed me one and told me to go home and add up all of the phone numbers in the phone book as a way to learn how to use it. So, I went home and added up the phone book, page after page. It took me weeks, and to be honest, I never got through the whole thing. The white pages were easy; it was the yellow pages that threw me off.

As part of my job, I was assigned the task doing the payroll for the nurses in California. I remember being in awe at how much nurses were being paid. (Please understand this is not a statement about what nurses are paid, but instead an explanation of what it looked like to someone who was being paid a hourly rate that was just barely over minimum wage.)

In time, I began to think about whether or not I should become a nurse. After all, I was barely getting by working full-time during the day and taking a couple of night classes every semester. I had also worked as a junior volunteer for a few years during high school, so I figured I knew something about hospitals. At the rate I was going, my guess was that it would take me about 10 years to get my degree and even then there was no guarantee of a decent paying job and let's face it, I liked to eat. So, I decided to go to nursing school.

I did not know whether I would like being a nurse, so a diploma school seemed like a good choice. Back then, nursing students were essentially free labor to the hospital and week 1 you were on the units making beds and bathing patients. As it turned out, I loved the profession and never looked back. I enjoyed feeling like I was making a difference. Even just making a bed allowed me the opportunity to talk to patients and their families. For a brief moment, I could help them forget that they were sick or hurting. It made me feel good to make them feel good.

During nursing school, I financed my education with multiple jobs, everything from bar tending to cleaning physician offices. I also worked as a waitress and as a nurse's aide in a nursing home, for a home care company, and in a hospital. I had the opportunity to work on one of the first inpatient hospice units in the country. Working in all of those roles made me appreciate the contribution of every member of the patient care and service delivery team, both those who directly interact with patients and those who provide support functions.

After nursing school, I moved to Florida and took a job on a 50-bed medical unit on the evening shift. I was one of 3 nurses (one was the charge nurse) who were permanent hires. The rest of the staff members were travelers. As you can imagine, it was a bit chaotic. I had to learn fast and so I did. This was back when not much was known about HIV and AIDS. I remember the fear and uncertainty in the eyes of those patients when I would walk into the room. Not only were they having to adjust to a very scary diagnosis but they were also having to deal with the fact that some people were afraid to care for them. As a nurse, I saw it as my role to care for everyone. This and a number of other experiences help keep me focused on why we do what we do. We are here to care for people, not diagnoses.

After getting engaged and moving, I worked for 5 more years providing direct patient care on a surgical unit. I loved it. We took care of patients who had general surgery and thoracic surgery. On average, my patients would stay about 5 days, and during that time, I got to know my patients and their families well.

We were in the panhandle of Texas at the time. If you are familiar with the area, you will know that when the wind blows hard, you can see different colors of dirt on the horizon, depending on the direction of the wind. The farmers who I took care of taught me that if the dirt was red, it was from Oklahoma; if it was light brown and sandy, it was from New Mexico; and if it was dark brown, it was from Kansas. I also learned that when the wind blows hard, it can blow away precious top soil. As a way of preventing that from happening, the farmers would go out and till their land.

It was in Texas that it really clicked for me how important it is to understand patients' lives outside of the hospital and to include their significant others in their care. One patient of mine who was a farmer kept insisting on leaving the hospital against medical advice because the wind was blowing hard and he needed to save his top soil. I tried to convince him to stay. I told him about the risk of postoperative infection and wound dehiscence and came up with all of the big scary words I could to explain medically why that was a bad idea. He would not budge. He was leaving. In frustration, I finally blurted out that I was going to call his wife and let her know what he was doing. (I had met her the day before and I could tell that although she was a quiet woman, she was in charge.) As soon as I said that, he got right back into bed and decided he would stay after all. His wife crocheted oven mitts for me as a thank you present the following day.

During my time taking care of patients, I also learned about the interdependency of the caregiver team. When I went to nursing school, we were taught that if a doctor came by and there were no chairs, you should get out of your chair and give it to the doctor. For years, even as an administrator, I struggled to call a physician by his or her first name; it just did not feel respectful enough. I still hold our physician providers in very high regard, but I now understand the balance and the importance of the entire care delivery team. Early in my career I did not have a balanced understanding. I rarely said anything to a physician other than what was needed/expected of me as a nurse on the unit. However, I soon learned that I was a patient advocate and that it was my job (really all of our jobs) to stand up for what we know is best for our patients.

We had a wonderful group of surgeons at our hospital who truly understood the value of nurses. However, every once in a while things got a little tense. One day I had a patient whose fever spiked very quickly. She had had surgery the day before. I do not remember the type of surgery, but she had a long vertical incision down her entire abdomen and large retention sutures to help hold the incision together. Her fever kept getting higher, even with the medications that I was giving her to help bring it down. I remember getting so nervous about her temperature that I filled gloves with ice and placed them in her armpits and along her body in an attempt to cool her down while calling the doctor.

When I got him on the phone, I tried to explain the situation, but instead he wanted to let me know how upset he was with me that I had called. (Apparently I had woken him up after a long night of being on call.) I let him say what he wanted to say and when he was done, I said calmly, “I want to be sure I understand, you do not want me to call you when your patient runs an uncontrollable fever?” There was a long pause (in which I was afraid to say anything else) and he finally said to me, “I appreciate you calling me, I will be right there.” He came to the hospital, saw the patient, and immediately took her back to surgery. It was then that I learned the importance of advocating for the patient. They are counting on us, sometimes with their lives. It was then that I also learned that I can speak up, and if I did it professionally, I would most likely get a professional response in return.

After taking care of patients for a little over 5 years, I tried my hand at quality improvement, which at that time was purely chart audits and data abstraction. I did not enjoy it very much and, fortunately, was asked to become part of a new department called Discharge Planning. Up until that point, I had used a highly scientific method of post–acute care service provider selection. When I received an order from the doctor to discharge my patient with home health, medical equipment, or other type of post–acute care, I would take the phone book, open it to the yellow pages, close my eyes, put my finger somewhere on the page, open my eyes, and wherever my finger was pointing was who I called. I had no idea whether one company was better than the other, and this seemed like as good of a way as any to select someone. After all, I did not want anyone to think I was biased in my selection. (Yes the jars of M&Ms delivered to the unit were nice, but that certainly did not factor in to the decision on who to call.) With the advent of discharge planners, we became more sophisticated about how we connected our patients with services.

About a year after I started doing this work, I was on the unit when I received a call from one of our thoracic surgeons. He had a patient in his office for a preoperative visit and was concerned that the patient would not have the needed transportation to get to his postoperative visits. He wanted me to come see the patient in his office and find him some help. I was not sure what to do. I did not even know whether it was okay for me to leave the hospital, and it certainly was not in my job description. I was, however, intrigued, so I left and went to see the patient. It was great. I was able to connect the patient to some resources, and he had a very successful recovery. This became a bit of a pattern. Every once in a while this doctor would call, and I would leave the hospital and drive to his office to help one of his patients. To this day, I do not know whether my boss ever knew that I was leaving the hospital to do this. Looking back, I realize that this physician was a leader in trying to prevent readmissions. The great thing is, I do not think it was something that he even knew he was doing. He just knew he had a patient with a need and he happened to know someone who could help with that need.

After about 9 years on the patient care units, we moved again and I found another job as a case manager. Because the program was in flux, I reported directly to the COO of the hospital. She was (and still is) incredibly inspirational to me. She is a nurse who moved into administration and managed to go through what was then a nontraditional route into a COO role. I never thought about moving into hospital administration until I met her. Even then I did not have any specific goal, I just thought it might be nice to be a manager someday. In time, she gave me that opportunity and several more. To this day, she remains a dear friend and trusted advisor to me and to many others. It was not until she took me under her wing that I realized how important the mentoring relationship really is.

She soon learned that, like any good nurse, I was really good in finding creative ways to get things done. Now, I am not advocating that people work around established processes. I am simply pointing out that most nurses can get really creative and figure out safe and effective ways to get their job done. Given that I also possessed this talent, she would ask me to take on projects and departments that were struggling and I would “fix” them. That is how I started taking on departments and projects that were both clinical and nonclinical. In time, because of my experience, I was given more opportunity and was able to further develop professionally.

Eventually, I went back to school and finished my bachelor's degree and got a MBA degree. It felt like I had a clear understanding of the clinical side of health care but not a good grasp of the business side. I wanted to be able to understand the finance and strategy portions of what we did, and I had a keen interest in mergers and acquisitions. It was not easy for me to go back to school. I had a more than full-time job, my son was in middle school, and I had not taken a test in a very long time. But I knew that it was important for me to keep learning and so I did it. It ended up being a great decision and an even better experience.

Like everyone, my experiences have helped shape who I am. I have been fortunate to have worked in for-profit, not-for-profit, teaching, and traditional academic settings. My days of taking care of patients and interacting with them, their families, and other members of the patient care team still impact how I think and how I make decisions today. I know what it is like to have a heavy load of patients and to feel the responsibility of someone's life being in your hands. I understand the trust that patients have that you will take good care of them. I know what it is like to be someone who helps out in a different, but equally important, support role, whether that be cleaning a room or bathing a patient.

A colleague once said to me that it was obvious from my actions that I wore 2 hats, my patient care hat and my business hat. He was right. I do wear those hats, along with my mother hat, my wife hat, my family member hat, and numerous other hats. We all do, and those hats help define who we are, how we think, and what we do.

I love health care. It is ever changing and ever challenging. I am proud to say that I am a nurse. It has not always been easy, but it has always been interesting and I would not have it any other way.

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