AONL Foundation Spotlight
Award-winning author and AONL Faculty member Barbara Mackoff support nurse leaders
By Dani Ward, director, AONL Foundation
Dr. Barbara Mackoff is an inspiring woman. She is a consulting psychologist, author, and leadership educator who’s worked around the world with health care leaders and Fortune 500 companies. She is a senior member of the AONL faculty and has facilitated the AONL Leadership Lab for more than 10 years. Over the years, Dr. Mackoff has also worked with the AONL Foundation to research the impact of the AONL Nurse Manager Fellowship program.
Last fall, her newest book Leadership Laboratory for Nurse Leaders, First Edition received first place in the 2022 AJN Book of the Year Awards in the category of Professional Issues, designating her book as one of the most valuable texts of 2022.
AONL Foundation director, Dani Ward, had the opportunity to speak with Dr. Mackoff about her book, her experiences, and her generosity. Here is a recap (lightly edited for clarity) of that conversation.
Dani Ward: In one of our early conversations, you shared that your mother was a nurse manager, is she the reason you have focused on nurse managers for so much of your career?
Dr. Mackoff: My mom is a nurse manager, and my dad is a physician. My three sisters and I used to call them “Dr. and Mrs. Overcautious” because they had so much medical information, and they used it mostly for things they didn’t want us to do as kids—like eat too much Halloween candy.
I did have my mom as a nurse in the back of my mind, because she showed such care and commitment. But my path to work with health care leaders was broader than that. I had about 20 years of working and teaching leadership internationally with all kinds of organizations, from Fortune 500 companies to health care organizations. What I started to notice over time was that the nursing leaders and health care leaders were the people who were the most likely to really run with and apply leadership lessons, the most self-reflective, willing to experiment. Probably about 14-15 years ago, I made a decision to work pretty much exclusively with health care leaders, specifically nursing leaders. It was a very deliberate decision on my part.
I also had the good fortune of meeting Pam Thompson, then CEO of AONL, at the time AONE, at a national program for women in leadership. I said to Pam, “Pam, I really wanted to devote my leadership work to working with health care leaders and nursing leaders.” She brought me into the AONL, then AONE, fold.
One of the very first things that I did was work with the Nurse Manager Fellowship in 2009. Prior to that, I had done a national study called the Nurse Manager Engagement Project, funded by the Robert Wood Johnson Foundation, focused on exemplary models for nurse manager engagement and why they stay in their organizations. These findings were published in the book Nurse Manager Engagement: Strategies for Excellence and Commitment.
I was fresh from hearing all of these stories and specifics from top nurse managers from across the country in six different hospital settings. That planted two things in my mind:
1. The importance of storytelling alongside strategies, and
2. The incredible combination of reflecting on your own lived experiences with evidence based practice, expert counsel, and strategy.
Yes, my mother was a nurse manager, which very much attracted me to that position, but my experiences and my career trajectory and opportunities influenced me as well. Since about 2010, I have pretty much limited my practice to working with health care organizations.
Ward: And since you’re still doing this, you obviously enjoy it.
Mackoff: Absolutely!
My father used to always say on Friday nights, the Jewish Sabbath, was that he “was grateful for a chance to work in a meaningful way.
For me the question is always are you using your gifts wisely?
If you have certain strengths, or particulars that you want to offer, what is the most meaningful setting where you would offer them?
For me, in the last decade to be able to take all of the changes that have happened in health care to say that these are people that I want to share their adventure to shed some light to enhance and nurture their leadership – that’s where I want to be.
Those adventures in working with nurse leaders all over the world have been the love of my professional life.
Ward: And you continue that today?
Mackoff: Oh yes, in addition to my work with AONL and the Nurse Manager Fellowship programs, I was happy to have the opportunity to become a Fulbright Specialist. In this role, I’ve been privileged to work with nurse managers, nurse directors and nurse leaders in Denmark, Finland and now Switzerland. It’s been able to help build a large world view. It’s extraordinary how, when I collect stories from leaders in a large European hospital, that you can put them right alongside the kinds of issues that our nurse managers bring up in the fellowship, that our nurse directors bring up in the fellowship, and conversations that I have with nurse executives.
There are some worldwide similarities about the challenges of being in charge as a nurse leader.
I’ve found that fascinating. All of that makes me feel as though this is the arena that I want to stay to be able to continue to contribute. This is a wonderful place to live and learn and educate. And it’s always a mutual process of teaching and learning.
Ward: I love that you say that. You commented that in your book that you learn almost as much from your participants, if not more.
Mackoff: I do! I learn so much from stories. My love of story probably comes from my original training as an anthropologist and psychologist.
The stories that insiders tell are so insightful—both about the person telling the story, and about the lived experience of the role. Embedded in that story is often incredible best practice.
I did this over and over again and used hundreds I’ve used so many stories in the book because it’s such a powerful way to learn.
When I ask someone: Tell me story about a time when you were able to motivate a really difficult or negative person on your team. When someone tells that story, you’re able to step back and unpack it and ask, what are the specific attitude and behaviors and gestures. And in those stories are the strategies and actionable tools that can be immediately put to work.
We do this in the AONL Online Leadership Lab. Every time we do this, someone else has another idea that I haven’t heard before. It excites me, and I want to pass on to the rest of the colleagues on the Leadership Laboratory.
Ward: There’s something special about story, as you said, we all learn through stories.
Mackoff: We do! And I say this in the book – stories are sticky. If I tell you about my mom, it’s going to remind you about your mom. It will somehow loose up in you memories, and you can draw from those.
That’s why I organized the book around stories. It’s an interaction between a story you would tell reflecting on your own experience and stories that your peers would tell reflecting on a challenging topic like motivation, or how we set boundaries, or how you manage emotions. Then, we pair that with established, evidence-based counsel from experts.
We have these huge aspirational concepts like transformational leadership and emotional intelligence. Those are absolutely crucial.
Yet, the question for me in my teaching is: How do you break it down? How do you break it down into what you actually do as a nurse leader in a particular situation?”
In this book, I look at some aspects of what I think are emotional and also strategic challenges that nurse leaders face. I try to get them into manageable pieces so that you’re looking at these challenges in three ways:
- Your own experience, for example, of creating boundaries so you’re able to lead.
- And, you’re comparing that to some of your peers and getting ideas from them.
- AND you’re also learning about what people who have studied it in research or practice settings have to say about it.
The essence is often always in the stories.
That dynamic trio of your own stories, your peers’ stories, and recognized experts really can bring the message and help it sink into your own heart and mind, and that’s the dynamic I was trying to create.
Ward: Your love and passion for this work really shines through, what made you decide to do this book at this time?
Mackoff: This book means so much to me because of the years of meeting nurse leaders all over the world, I carry so much knowledge with me. I felt the real desire, quite simply, to pass it on.
I really wanted to pass this on at this point in my work. Ten cohorts of people in the Leadership Laboratory and then leaders from all over the world – all their stories and strategies residing in my notes. I wanted to put it together and pass it on.
My original impetus for this came from some of the columns I did in Nurse Leader. When we were first putting together the Leadership Laboratories, I wrote some shorter columns. Some of those are still included in this book, but with major expansion!
Ward: Of the, potentially millions of stories you’ve heard over the years, do you have any favorites or ones that stand out as the most moving or most impactful?
Mackoff: I met a nurse leader at a national conference. Her name was Doris E. I had given a presentation, and part of that presentation was about how we become purpose driven. How we make decisions about time in light of purpose, and the idea of line of sight. Line of sight means that regardless of how many meetings, texts, emails, budgets, etc., that you are still able to remember why you do what you do. The poet David White calls this the “Discipline of Memory.”
During the Q&A section Doris E., a nurse leader in a pediatric unit, stands up and said “What you said about why we do what we do made me remember something…“ She was having one of those days where she was aging in dog years and she was in her little cubical, and she said, “I need to get out.” She goes and takes a walk down the hallway in the unit. As she looks down the hallway, what she sees is someone on her team bended down on her knee so that she can get eye level with a patient. And Doris says “I realized, in that moment, this is what we do. It is that nurse on bended knee with that patient. You know, I get so caught up in my paperwork and putting out fires that I forget this is why we do what we do.”
That story has stayed with me for years because that ability to keep that line of sight is essential to nurse leaders. When you’re at the bedside, it’s very clear why you do what you do. As you move into leadership roles, you move away from the bedside. There has to be an evolution of understanding that you care for your team so that your team can care for their patients. That line of sight is why nurse leaders do what they do, and it’s more crucial than ever.
Why we do what we do is something we have to remind ourselves no matter what our role.
Ward: If you could distill it down into one or two sentences, what are you hoping people will take away the most from this book?
Mackoff: This is going to be more than three sentences, but here’s what I hope.
I imagine this book being used in one of three ways:
- An individual could buy it and go on a self-guided adventure in leadership where there’s self-reflection, strategies and expert counsel.
- That it would be used in a leadership curriculum within a college or university program.
- For organization to introduce it, perhaps with peer leadership as a group exploration, internally to improve leadership practices.
What I would want is for any person, who reads this book, to learn as much about their own strength and style as a leader as they do about strategies to lead. And that those strategies will come from their peers and from expert counsel.
I hope that they would find it enjoyable and elevating. While the research is rigorous, and the self-reflections can be demanding, I want people to find this accessible, conversational, interesting, and resourceful. I want people to look at this in terms of their own, personal style of leadership. I want readers to adapt it to their own leadership sensibility, their own leadership strategies—really, their own leadership soul.
Ward: How do you grow as a leader yourself?
Mackoff: I read very widely—all different kinds of fiction, lots of political commentary, novels. I am constantly trying to understand the lived experience of other people. That kind of empathy to me is a key to leadership. It’s reading widely in different fields, not just nursing journals.
I am very inspired by paintings, drawing and sculpture. I use artwork in the book to elicit a reflection. I find metaphors of interest about leadership in looking at artwork. When I look at art, and sometimes in novels, I find analogies or metaphors that are inspiring to leadership ideas.
I’m blessed with having some really brilliant peers that I can tell the real story to. That has made a real difference. I continue to catch up with and share notes with peers in other countries. My daughter Hannah and her husband Ezra are each leaders in their own rights. My husband Jeremy is an architect who leads with vision and community service. I look at them closely to see how leadership develops and is expressed.
Last thing – there are some senior leaders who have been very generative with me. Those people have brought me in to this field and have been supportive of me. I’ve been able to observe and enjoy their leadership.
Ward: You have led a fascinating life, Dr. Mackoff. Thank you for your support of nursing leadership, health care leaders.
Dr. Barbara Mackoff is very generously donating all of her proceeds from sales of Leadership Laboratory for the Nurse Leaders to support financial aid packages for nurse managers to participate in the AONL Nurse Manager Fellowship program through the AONL Foundation. Thank you so very much Dr. Mackoff.
Leadership Laboratory for Nurse Leaders is available online.
