Today’s disruptive healthcare environment has set the stage for nurses to step up as leaders and use their skills and expertise to address the many challenges the industry faces. As the largest practitioner group in the healthcare team, nurses are taking the lead to ensure delivery of care is safe, efficient, and cost-effective and meets the needs of the individual patient regardless of the setting.

I recently had the honor of meeting a nurse who seized the opportunity to demonstrate her skills and expertise in leading one of the most prestigious healthcare systems in the country. I first learned about Regina Cunningham, PhD, RN, NEA-BC, FAAN, as I was scanning my Facebook page. The post that caught my attention read: “Oncology Nurse, Regina Cunningham has been named Chief Executive Officer of the Hospital of the University of Pennsylvania (HUP).”

As a native of Philadelphia, the headline made me stop, click on the link, and read further. HUP is one of the premier hospitals in the Philadelphia area and nationally, so I wanted to learn more about the oncology nurse who was appointed its chief executive officer.

I read the press release and found it interesting but wanted to know more. I was granted an interview with Cunningham. We had an interesting conversation that lasted over an hour, and I have listened to the interview several times since—each time discovering insights from her career journey that can help guide all nurses working to reach their full potential in today’s complex and exciting healthcare system.

Cunningham started her career in the surgical intensive care unit before moving into an area where she always wanted to work: medical oncology. She worked at Memorial Sloan Kettering Cancer Center (MSK) for several years, honing her clinical skills. It was at MSK that she became very interested in the way nursing services were organized and delivered, as well as the impact nursing models have on clinical outcomes.

When Cunningham enrolled in her master’s degree program, she focused on nursing administration because she wanted to influence the practice environment. Her resume is impressive and shows how she advanced over the years into leadership positions. Through each move, she learned more, took on new challenges, and, importantly, had fun.

Cunningham said that many leadership opportunities emerged at times when she was not looking for a new role, but she seized the moment. On each occasion, she learned more that added to the value she brought to the organizations she worked for, both clinically and academically.

When she assumed the position of chief nursing officer of a small cancer center, it enabled her to understand more about how cancer centers work, their funding mechanisms, how research priorities are set, and the importance of research to clinical care and advancing the delivery of care.

The CEO position came to Cunningham at a time when she was happy in her current post as the chief nursing executive and senior vice president at the University of Pennsylvania Health System, with responsibility for the whole system, not just the hospital. The chief nursing role was challenging and gave her the opportunity to work with other talented people. When the then HUP CEO announced his retirement, he asked Cunningham to think about taking on the role.

The promotion was not something Cunningham was looking for, but as she thought about the opportunity, she realized this was the perfect time for a nurse to assume this role. Nurses understand quality, how to drive value, and recognize waste in the system. Nurses understand care coordination, how to collaborate, and how to manage transition of care as patients move from one setting to another. Nurses recognize the importance of educating patients, so they can understand their conditions, the plan of care, and be active participants in their care.

Cunningham’s decision was made when she realized what an incredible opportunity taking on the role of CEO presented; she could represent patients, their families, and all employees as strategic directions were discussed and decided.

Another tip Cunningham shared was the need for mentors and having good people to help guide you along the way. An important part of her career included active participation in the Oncology Nursing Society, which helped to fuel her professional development and allowed her to network with fellow nursing leaders. She participated at the national level to help drive standards of practice and standards of care to advance cancer nursing. She advises all nurses to join a professional organization and be an active member. Doing so will allow you to grow and advance yourself personally and professionally.

Cunningham spoke candidly about how she stayed in touch with her clinical roots as she advanced in her career. She shared that even though she has moved away from the clinical side, she continues to read and keep up-to-date with research that impacts her field. She believes this is critical because as nurses, our clinical knowledge distinguishes us in any leadership position we assume. It is an extra skillset and knowledge base that nurses bring to the table that many in the upper levels of administration do not have.

Cunningham always understood the importance of staying close to the frontline workforce. To make decisions effectively, nurse leaders need to understand what is happening on the frontline and the perspectives of those who work there.

Today, many people think the powerful roles in healthcare are the higher-level roles in administration. But those in the most powerful roles are the people at the bedside, because they are the ones who make decisions every day that drive any organization’s outcomes.

Even as the chief nursing executive, Cunningham often made rounds on the floors and says she will continue to do this as CEO. She wants the staff to know her, to feel comfortable enough to ask questions, and to use their voice.

Nurse managers hold one of the most important roles as the liaison between staff, patients, and leadership—translating an organization’s mission and values to the frontlines. With so much information coming at these managers from all directions, Cunningham feels it is her role as the CEO to help them and others to differentiate the priorities from all the noise coming at them.

She does not want staff paying attention to issues that are not going to make a difference; she wants everyone to pay attention to those that impact quality and patient safety as that will make all the difference. By being visible and in touch, she can help focus other leaders on what matters most and ensure all stay on track.

Ensuring today’s nurses and other healthcare team members are prepared to meet the demands of the healthcare system is essential, Cunningham stresses. “We need to make sure that people have the knowledge to drive quality and to drive safety. When I think about quality and safety, I think about high reliability—doing the right thing for every patient every single time.”

To achieve high-reliability work settings includes first ensuring the staff is knowledgeable and knows what needs to be done at every turn. Second, staff must understand best practices and how to access the best clinical evidence available and put that evidence into practice, armed with the knowledge and skills to drive quality and ensure they are following best practices for each patient all of the time.

Another critical point is to comprehend data and know how to use predictive analytics. Doing so enables us to see who is going to be at risk for what and employ strategies to prevent setbacks. Thus, either in the prevention or in the intervention stage of care, you need to make sure that people are following the best evidence to drive the quality of care. Nurses, at the point of service, are best positioned to do this. They are the ones who care for patients, day in day out, shift after shift, and have a huge impact on patient outcomes. It is the job of senior leadership to make sure nurses have the resources and the knowledge to perform their roles consistently.

A strong proponent of education for nurses, Cunningham shared that with the complexity of today’s healthcare system, advanced education is part of our professional development. Healthcare is extremely multifaceted, and a lot of what nurses need to know today about managing populations and illnesses over a trajectory requires a high level of knowledge. Education does not always have to be formal, however. It can be a combination of both formal and continuing education. As nurses, we commit to lifelong learning because everything changes. To be responsible and responsive to our patients, we need to commit to lifelong learning, so we are prepared for the highly complex management our patients demand.

Finally, I asked Cunningham how she was going to take care of herself as she moves into one of the most challenging roles of her career. She said she has thought about this and realizes that to be effective, she must take care of herself. She referred to Steven Covey’s Book; The Seven Habits of Highly Effective People. The seventh habit is referred to as “sharpening the saw," and through it, Covey talks about the importance of people taking the time to preserve and enhance their greatest asset—themselves.

Sharpening the saw means having a balanced program for self-renewal in 4 areas of your life: physical, social/emotional, mental, and spiritual. Cunningham knows she will need to make time to exercise, eat well, and get restful sleep. She realizes that a good work—life balance depends on this, and that to be successful, she will lean on the team of talented people who surround her. She also plans to celebrate her husband’s 59th birthday by taking a much-anticipated vacation this year.

I hope this article inspires you to seize the day! Be the best that you can be, and lend your expertise in making the healthcare system safe and caring for all who use it.

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Regina Cunningham discusses her path from oncology nurse to hospital system CEO and shares insights on how nurses can leverage their unique skills to assume leadership roles.

Anne Llewellyn, MS, RN-BC, BHSA, CCM, CRRN

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