Voice of the President | January 2020

I also would like to recognize Mary Beth Kingston for her significant contributions in 2019. As AONL president, she led the organization through a name change to better reflect our membership and extend the reach of AONL. I look forward to continued collaboration with Mary Beth as our immediate past-president. 

I have had the honor of serving as AONL Region 3 director and during this time assisted with the annual conference, served on the System CNE Committee and participated in the academic/practice partnership between AONL and the American Association of Colleges of Nursing. 

I am trained as an oncology clinical nurse specialist but like many of you, my career path led me to serve in many progressive leadership roles including frontline clinical manager, service line director, clinical associate professor, associate operating officer, and CNO. Since 2011, I’ve had the privilege to serve as vice president of patient care services and system chief nurse executive for Duke University Health System as well as the associate dean of clinical affairs for the Duke University School of Nursing, Durham, N.C.

Younger generations

This issue of Voice focuses on generations X, Y and Z and how we can support and enhance the work of all nurses, regardless of their generation. As a core value of AONL, we know that a robust and diverse nursing workforce is essential to the health of all Americans. From rethinking social constructs about professional image policy to developing and retaining first- and second-year nurses to giving our millennial colleagues a leadership voice, this issue chronicles several innovative strategies to advance this work.

At Duke Health, I find that we are navigating many of the challenges that are addressed in this issue, including the multi-generational workforce, retention of early- mid- and late-career nurses, and preparing a new generation of nurses to lead in a dynamic industry.

Deborah Davis at Grady Health System shares an excellent case of collaborative leadership success, which was used to improve the complex problem of first-year nurse resident retention. Stakeholders working within silos were identified and brought together to address retention and developed strategies to meet nurse resident needs. The work at Grady made me further reflect on the high nurse retention rate we have enjoyed across Duke Health for the past several years. However, when meeting with nurses with one to three years of experience at a recent retention summit, it was clear that after the 12-month residency program, our staff felt unsupported during year two of employment. This led to turnover by year three and an idea from our second-year staff to create a nurse fellowship program. We partnered a core group of our recent nurse residency program graduates with our education experts to create this one-year program. The goal is to provide support during the second year of employment in areas identified by the residents, equip the nurses to advance on our career ladder and sit for their clinical specialty certification exam. We are just getting ready to implement the program and I hope to be able to share some successful results in the future.

We have found when we can create [growth and development] experiences for staff . . . we help increase retention and support staff satisfaction.

As leaders, we strive to have a workforce representative of the community that we serve; this diversity helps to provide an environment facilitating comfort and safety for all. Managing across multiple generations can be a challenge. I believe, however, that if we understand the people we serve as individuals we will have an increased chance to achieve whatever the specific goals may be according to the situation. Lauren Kalember nicely describes some of the key characteristics of the generational workforces and how the time period of birth may foster some preferences, such as the adoption of technology, speed of expectation of response or preference for type of feedback. She speaks specifically to motivation, noting how people prefer to learn and how to provide support, especially through mentorship. 

At Duke Health we strive for retention and I’ll share two related experiences from my health system. The first is a systematic “stay interview” process. Managers meet with their staff (not during a performance review) quarterly or every six months to discuss how they can help create experiences for staff to grow and develop, to better understand the staff members’ dream roles and help them achieve them. We have found when we can create these experiences for staff—which more often than not are lateral moves—we help increase retention and support staff satisfaction.

Second, in the past we had a challenge recruiting into nurse manger roles. We did not have systems in place to best identify or prepare a pipeline of staff interested in the roles. As a mentor to one of my CNOs who was completing her doctoral program, I encouraged her to establish a leadership development program for nurses at the advanced levels of our clinical ladder. The program used online leader learning modules, paired with select didactic sessions with nurse leaders. The program received overwhelming support from all generations from millennials to baby boomers and they loved sharing with each other. We had one missing element—a formal mentoring program––just like Kalember highlights! Mentoring is now incorporated. And guess what? We no longer have nurse manager vacancies!

Kalember also speaks to the importance of feedback and recognition. I believe that we should be open to both positive and not-so-positive feedback. Constructive feedback doesn’t always feel good but provides us a great opportunity to grow. We use a 360-degree process and I find this most helpful. As leaders, we also have the responsibility to develop the skill of delivering constructive feedback. We should be thoughtful so that our comments are specific and individualized, with recognition and opportunities for growth as appropriate. We cannot underestimate the importance this has on the success of our team and our organizations.

As we continue to focus on generations X, Y and Z we recognize every nurse is a leader and that is indeed the focus of AONL. We have changed our name to promote diversity and inclusion of our younger generation nurses, and appointed early careerists as board members. In addition, we have established specific leadership development content and recognition programming and awards for those earlier on their leadership journeys. These complement the already broad array of offerings for nurse leaders across the span of their careers. 

Today’s health care environment is dynamic, holding an uncertain future. This requires that nurse leaders be prepared, available and engaged to innovate, transform and lead care wherever it occurs, and AONL is uniquely positioned to support you in these efforts. I hope that you enjoy this edition of Voice. Again, I am so honored to be serving you this year as your board president. 

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