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Original Articles

Always a Nurse

The Process Engineer

Glorivic, Fazon-Ruiz MSN

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Nursing Administration Quarterly: January/March 2020 - Volume 44 - Issue 1 - p 59-61
doi: 10.1097/NAQ.0000000000000388
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WHEN I decided to go back to school for my master's degree, I decided to get a master of science in nursing degree with concentration in leadership. Some of my colleagues asked why I did not get a master of hospital administration degree if I wanted to be a leader. My answer, “I will always be a nurse, so why wouldn't my graduate degree be in nursing?”

It did not start that way. I went to college with the full intention of becoming a medical doctor. My mother, in her infinite wisdom, convinced me to have a fallback plan. She said, “A medical degree takes at least 10 years.” She added, “If you take nursing, you could still learn about the science of health. But, should you tire of studying, you can always work and make a good living.” Wise words, and I am glad I listened. I finished my bachelor of science in nursing degree before pursuing medicine. A year and a half into medical school, having observed working nurses, I decided to put my RN license to work. That is when I discovered my love for nursing.

I started as an operating room (OR) RN, as both a scrub nurse and a circulating nurse. For a new nurse, the work was very exciting and scary. Exciting, because it is an immediate deep dive (figuratively and literally) into the human anatomy. It made me feel like I was part of this “elite team” that gets to “fix” people. There was also a sense of instant gratification, because after every completed surgery there is a feeling of being successful, at least for that time being. I learned that to be a good OR nurse you have to be a good communicator. On a surgical team, it was critical that we clearly communicated among each other. Lives depended on it, quite literally. This was a hard lesson to learn for me, because at that early stage of my career I did not yet have the maturity to assert myself. During that time, surgeons ran the ORs. Instruments thrown at staff members or walls were somewhat common practice. I quickly learned that I needed to speak up for myself and, more importantly, for my patients. I learned about communication, advocacy, and endurance (while also strengthening my bladder).

After the OR, I made a total change in specialty. This is the beauty of being a nurse: you do not have to stay in one area or one specialty. From the OR, I moved to a locked Alzheimer's facility. I started there as a medication/treatment nurse, became the quality nurse, and went on to run the facility as the Director of Nursing. From direct care nurse to being the director was a challenging transition for me; I had trouble navigating the shift in my role from nurse to manager. My first learning was this: just because you are a great floor nurse does not guarantee that you will become a great leader. There is a steep learning curve. I quickly realized I needed to learn about (and learn fast) staffing, staff development, budgeting, payments, revenue, surveys, and regulatory requirements. I also realized that, although being a leader meant dealing with things I have never encountered as a regular RN, I could still apply my basic nursing skills. I could use my assessment skills, develop a plan, implement, and then evaluate my plan. I further discovered that using these skills with a team works even better!

After almost 10 years of specializing in Alzheimer's, I was at a point in my career where I found myself wanting to be in acute hospital care. As much as I loved gerontology, it was becoming difficult for me to constantly face end-of-life care. So off I went to work in an acute care setting. I started as a float pool nurse. I was learning to be a generalist, learning different nursing specialties at the same time. I floated between medical-surgical, telemetry, intensive care unit (ICU), and the emergency department (ED). From there, I wanted to grow and expand my view from individual patient care to a hospital-wide view. I became an administrative house supervisor. In that role, I often found myself reflecting, “How lucky I am to be a nurse.” There are so many specialties I could learn and explore, so many opportunities to learn and grow. No matter where I went, no matter how far I was from the bedside, the work I did as a nurse still impacted the patient. That was important to me.

From being a house supervisor, I went to work as quality manager, where my practice took me further from direct patient care. My work is now focused on core measures for diseases such as acute myocardial infarction, congestive heart failure, and pneumonia. My areas of expertise have grown to include patient outcomes, standards of care, and regulatory requirements. As if that was not enough of a departure from traditional nursing, I went on to become Director of Performance Excellence (PE). First, I led the PE department for the hospital where I worked. Then I transitioned to an enterprise role as system director of PE. The hospital where I worked at that time is a member of a 39-hospital care system. This was another massive shift for me. Moving from clinical-focused work to process engineering was like jumping over a chasm. My area of expertise was now focused on facilitating organizational process and operational changes across the system. The role required skills in Lean Six Sigma (LSS), project management, and human-centered design. As a nurse, I likened the work to “PDSA (Plan-Do-Study-Act) on steroids.” It felt like moving from little league to the major league world series. It was at this point in my career that I decided to get my master's in nursing. The system PE role did not require a nursing degree. However, the system VP who recruited me told me that she wanted me on her team not only for my black belt in LSS but because I was a nurse! The projects requiring our engagements were mostly clinical in nature. Having a nurse as an engagement director offered an advantage in running cross-functional teams. Some of the enterprise projects required lots of interaction with nursing and physician leaders. Having the ability to speak a common language with these leaders allowed for an easier communication and, therefore, improved collaboration.

Currently, I work as a Director of Patient Care Services for the same large health care organization. I was very excited to switch back to a traditional nursing department. At my transition interview, my previous leader asked me, why are you going back to nursing? I remembered saying, “Once a nurse, will always be a nurse.” I am very grateful for having been able to do all the different works that I have done. The different experiences gained from rotating through various specialties allowed me to collect nuanced knowledge and skills that are foundational to my growth as a nurse leader. In this highly evolving, highly competitive world of health care, nursing as a profession has to evolve, too. I am amazed by how the profession has continued to grow. This is not to say that there are no challenges for us. In my work facilitating change in EDs, it is evident that nurse leaders still struggle to be recognized as equals by physician leaders. However, I believe that, as a profession, we are heading in the right direction. When I set up teams and invite providers to the project teams, it always makes me proud when a nurse practitioner (or two) shows up. It is great to see nurses as independent providers! As a profession, we need to continue to pursue higher education, because it is a reliable way to continue to elevate our profession. Needless to say, when I do proceed to get my doctorate degree, it will definitely be in nursing!

One of the things I got to do as a process engineer was to teach LSS to Cal-Poly engineering students. I was teaching as an ad hoc LSS subject matter expert. Students often asked how a nurse becomes an LSS expert. It did not seem to be a natural match for them. I told them, “I am a nurse first; and because I am a nurse, I can be a lot of different things”—including a teacher for engineering students! I further shared that as a nurse, if I am into anatomy and physiology, I can become a surgical nurse; if I want to care for extremely ill people, I can be in the ICU; if I like an adrenaline rush, I can be an ED nurse; if I love babies I can be a maternal and child nurse; if I want to do preventative care, I can be in clinics or ambulatory care; if I love computers and information, I can be in a nurse informaticist; if I want to lead, I can be in nursing leadership. The choices are endless.

No matter what nursing specialty or specialties a nurse chooses, at the crux of it will always be patients. As a nurse, whatever it is you do, will always impact lives. No matter what one chooses, the work will always be meaningful and will always make a difference. That is why I will always be a nurse.

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