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 healthcare industry faces today. 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 has 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 Philadelphia native, the headline made me stop, click on the link, and read further. The University of Pennsylvania 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 the chief executive officer at HUP.

I read the press release and found it interesting but wanted to know more, so I put on my journalist’s hat, made a few calls until I reached the media department at HUP and was granted an interview. 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 Cunningham’s career journey that can help guide all nurses as you work to reach your full potential in today’s complex and exciting healthcare system.

Cunningham started her career in the surgical intensive care unit and then moved into an area where she always wanted to work: medical oncology. She worked at Memorial Sloan Kettering (MSK) Cancer Center for several years, honing her clinical skills. It was at MSK that she became very interested in the way the 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 CV is impressive and shows how she moved forward over the years into leadership positions. Through each move, she learned more, took on new challenges, and had fun.

Answering the Call When Opportunity Knocks

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.

This 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 sealed when she realized what an incredible opportunity taking on the role of CEO presented, where she could represent patients, their families, as well as all employees as strategic directions were discussed and decided.

Another tip Cunningham shared was the importance of mentors and having good people to help to 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 the importance of staying 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.

As she moved forward in her career, 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 and 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 the 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 the staff paying attention to issues that are not going to make a difference, but she does want 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.

Professional Development for Today's Challenging Environment

Ensuring today’s nurses and other healthcare team members are prepared to meet the demands of today’s 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 needs to understand best practices and how to access the best clinical evidence available and to put that evidence into practice, armed with the knowledge and the skills to drive quality and ensure they are following best practices for each patient all the time.

Another critical point is to understand data and 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 stages 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 be able to perform their roles consistently.

As 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 complex, and a lot of what nurses need to know today about managing populations and managing illness over a trajectory requires a high level of knowledge. Education does not always have to be formal. It can be a combination of both formal and continuing education. As nurses, we commit to lifelong learning because everything changes. We are constantly learning. 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.

Achieving That All-Important Work—Life Balance

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 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

 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 has thought about this a great deal and realizes she will need to make time to exercise, eat well, and get restful sleep. She plans to celebrate her husband’s 59th birthday by taking a much-anticipated vacation this year. 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.

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.

Anne Llewellyn, RN-BC, MS, BHSA, CCM, CRRN, is a healthcare leader with over 40 years of experience as a critical care nurse, case manager, professional patient advocate, educator, digital journalist, and most recently as a patient with cancer, having been diagnosed and successfully treated for a central nervous system brain tumor. She is involved in educational projects in the state of Florida and nationally. To contact Anne, send an email to 

Articles

Regina Cunningham, PhD, RN, NEA-BC, FAAN, discusses her career journey, which led her to become CEO of the Hospital of the University of Pennsylvania, and shares insights on how nurses can leverage their unique skills to assume leadership roles in healthcare.

Nurses Taking Charge: Leading Change, Advancing Health

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

Vascular access is an important component to improving quality of life for patients with cancer. Access is required not only for chemotherapy, but also for frequent blood sampling and intravenous supportive measures. Vascular access devices provide reliable venous access, protect peripheral access, and increase patient comfort through reducing repeated and difficult venipuncture.

Today, numerous devices are available for this purpose and selection is dependent upon type and duration of access, patient factors, and physician preference. These include implantable devices, tunneled catheters, and peripherally inserted central catheter (PICC) lines.

Venous access is not without complication. Although insertion and placement problems are rare with modern access and imaging techniques, catheter-related infection, thrombosis, and loss of function continue to be major problems. In order to combat complications, best practices are emerging.

As a nurse for over 40 years in the Emergency Department and Respiratory Intensive Care, I am familiar with the important role venous access devices play in caring for patients who have serious medical conditions as well as the complications that can occur.  

Venous Access Device Team Made All the Difference

When I was diagnosed with a central nervous system lymphoma in 2014, I knew that I was really sick when my hematologist told me I would need to have a PICC line placed so I could get chemotherapy because the tumor was inoperable.

Looking back, I realize I am alive today due to the aggressive treatment protocol prescribed by the hematology team, but also because of the excellent nursing care I received that protected me from infection and the other complications that I was at risk for as a result of my condition. During the early part of my treatment, I was not aware of what was happening to me. My husband was my advocate as I was confused and could not comprehend things.

As I became more alert, I was able to observe what was happening to me as a patient on the oncology floor of the Sylvester Comprehensive Cancer Center at the University of Miami. One thing that stood out for me was the care that I received from the oncology nurses who worked on the inpatient unit as well in the outpatient settings where I was treated.

The systematic processes were very apparent to me, especially in how my PICC line was changed. I had not seen this before, and I was curious to know how such a large team of nurses working across so many settings could work so well together. One of the nurses who came to see me daily to examine and redress my PICC line was open to answering.

Wendy A. Nunez, RN, is a member of the center’s Venous Access Device Nurses. On one of her visits, I asked her what the nurses on her team do and what they look for when working with patients who had central lines.

“We want to know if the patient and the caregivers understand what is needed to care for and maintain a central line,” Nunez explained. “It's important that every patient understands what to look out for to prevent infection. Also, we want to be sure the patient knows when a dressing needs to be changed, and what to expect from the nurses who are caring for the line.”

Importantly, all of the nurses who were involved in my care (inpatient and outpatient) used the same technique when they changed my PICC line. “The Venous Access Team works closely with the education department to be sure that all nurses are practicing according to our policy and procedures as well as standards of practice,” Nunez noted. “We are strict with following these policies because the oncology population is vulnerable to infections.”

Educating Patients About Caring for Their PICC Line

As I progressed in my treatment, I realized that I and my husband had an important role to play in my plan of care. One thing the nurses stressed who cared for me was how to care for the PICC line when we were home.

“The venous access team strongly believes that patient education is key,” stressed Nunez. “Patients who are knowledgeable in the care and maintenance of their line report problems sooner, protect their dressings more, and have less fear about the central line. Teaching the patient and caregiver reportable signs and symptoms and when to call the doctor cannot only save their line, but, more importantly, can save their life.”

“We let patients know it is important for everyone to perform hand hygiene before touching the central line,” she continued. “We teach how often the dressing should be changed, that the dressing change must be done using sterile technique, and everyone should wear a mask while the dressing is changed. We make sure the patient understands that the hub of the central line must be scrubbed appropriately between each injection and connection to the central line.”

In addition, the nurses explain that the dressing should always look pristine, clean, dry, and intact, and who to call if it is not. “It's important as nurses to arm the patient with knowledge about central lines in their fight against cancer. The central line is central to their treatment, so it's important for them to be well informed about it.”

I could see that the education Wendy’s team provided was working because regardless of where I was in the system, each person took their time, explained what they were going to do, and followed the same protocol. As a result, I felt safe and secure in their care. My husband, as the main caregiver, understood what he needed to do in order to care for the PICC line when we were home. He was given the resources to allow me to shower and the information he needed so he could pick up on a problem and who to call if a problem arose. This gave us both peace of mind.

As a nurse, I know that hospital-acquired infections are serious problems across our country. As I thought about what I was observing, I wanted to know if the training and standardization of processes throughout the University of Miami Healthcare System/Sylvester Comprehensive Cancer Center helped to decrease infection rates. Nunez shared that, “Yes, we did see a decrease in infection since the standardization on all of our inpatient units.”  

I know it is a challenge to do system-wide training, so I asked Nunez how they accomplished this task: “The Venous Access Device Nurse Team worked closely with the education department to train incoming nurses. During orientation, we train them on the policies and procedures for central line care and maintenance. We make sure all nurses are on the same page when they are employed. We want nurses to be vigilant and aware regarding central line care and maintenance, as well as educating patients to care for their line.”

As a patient, I am grateful to all of the professionals who cared for me. I feel fortunate that I had a good outcome and continue to heal. As a nurse, I know that complications can occur, but with the focus on education and instituting a culture of vigilance and caring, positive outcomes do occur. Today, it is being recognized more and more that the challenges we face in the healthcare system will not change until we ensure the patient and the caregivers are recognized as members of the care team.

To read about another nurse's experience as patient, with staph infection from a chemo port, click here.

Association for Professionals in Infection Control and Epidemiology (APIC)

APIC Implementation Guide to Preventing Central Line—Associated Bloodstream Infections

National Institute for Health and Care Excellence (NICE)

Infection: Prevention and Control of Healthcare-Associated Infections in Primary and Community Care: Partial Update of NICE Clinical Guideline 2

Anne Llewellyn, RN-BC, MS, BHSA, CCM, CRRN, is a healthcare leader with over 40 years of experience as a critical care nurse, case manager, professional patient advocate, educator, digital journalist, and most recently as a patient with cancer, having been diagnosed and successfully treated for a central nervous system brain tumor. She is involved in a number of educational projects in the state of Florida and nationally. To contact Anne, send an email to 

Venous access devices can come with major problems, such as catheter-related infections, thrombosis and loss of function.

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

Articles

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