Bill Klaproth (Host): So, let's talk about professional governance and the role of the chief nurse executive, as we talk with Sharon Pappas, Chief Nurse Executive for Emory Healthcare and a key contributor and author on the Section on Professional Governance in the AONL Workforce Compendium.

Host: This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth. Sharon, great to talk with you.

Sharon Pappas: I love being able to talk about this important topic. So, thank you, Bill.

Host: Absolutely, as we talk about professional governance and the role of the chief nurse executive. So Sharon, why don't we talk about that professional governance. Why is it important that we raise awareness about this?

Sharon Pappas: Well, let me maybe start with a couple of contextual factors here. Number one is that when you're a professional, like a professional nurse, and you're a leader, I think it's important that you view yourself as leading your peers, not as leading your subordinates. And so when you're leading peers, it creates a context of collaboration, a partnership, respect for what each other brings. And nursing is such a broad and diverse profession that none of us know everything about everything. And so, you're much better off when you have multiple minds contributing toward problem-solving and the great work of patient care, which is a lot of what nurses do. So, I think that's one contextual piece.

And then, the other thing is that sometimes it feels like you're swimming against the tide because healthcare is a pretty highly regulated, bureaucratic operation. So when you think about the fact that healthcare is also very complex, it's very hard to solve problems in complexity with linear solutions. So, bureaucracies kind of promote linear solutions and in an environment where you've got a lot of complexity. So, it's important that we be in a situation where we create a context that allows us to operate within that complexity by leading as peers and by creating important platforms by which you fully understand the work of nurses at every level in an organization.

Host: So, I think there are some really good thoughts. You said there, leading your peers, not your subordinates. You use three words: collaboration, partnership, respect. And I think when a leader approaches their job with collaboration, partnership, respect, it's easy to see how you certainly can get more done, especially when, as you said, you tend to be swimming against the tide a lot of the times.

So, what did you do then when it comes to professional governance? What are specific tactics or initiatives or what can we learn from you on what you did to address this?

Sharon Pappas: Sure. Well, I think you have to, first of all, anchor yourself in the belief that nurses in professional settings are really accountable. And that's a key word there is accountable for nursing practice, for the quality outcomes of their practice, for the competency of nurses who enter that practice and for the knowledge development within nursing.

And so when you think about those four accountabilities, you've got to think about, "Okay. So, what mechanisms do we have for nurses to do that work?" And so, I think you ground yourself in we're not here just to advise each other, we're here to really own and be accountable for those four things. And so when you think about the concept of professional governance, you think about the fact that we convene ourselves in a way that is not just a meeting, because professional governance isn't a meeting. Professional governance is a way to actually exercise that accountability for practice quality, knowledge, and competence of professional nurses. So, grounded in that and then come together and create agendas and create discussions around those things that nurses are accountable for in organizations because that organization has entrusted you as a professional nurse to actually own that accountability for those things. So, it's like a trusting relationship with the organization to be that professional nurse in that setting. And so, that's how the two things work together.

Host: So, you said you have agendas and discussions. Can you take us inside a discussion so we can really understand what you're talking about or what a normal discussion would look like or sound like?

Sharon Pappas: Yeah. I have two examples. I think that might be really helpful. I remember when I first became a chief nurse, trying to exercise what was my accountability in that role. And the leader for supply chain called me up one day and he says, "Okay, you're the chief nurse. I need you to decide what type of IV start kit should I buy for the organization, for the system?" And I'm like, first of all, I don't use those IV start kits, so I won't be able to tell you much about which one to purchase. And number two, that's not very respectful for me to tell clinical nurses that, "Here, I decided this is what you're going to use." You can see there the importance. That was a practice item, that was a tool nurses use in nursing practice. And so, it wouldn't have been very inappropriate for me to have made that decision. Instead, I shepherded that decision to the people who used the equipment.

A second example, and this was during the pandemic, we were in a situation where we were quickly running out of isolation gowns, which are the gowns that nurses wear to care for patients with infections, either to protect the patient or to protect the nurse from a transmission of the virus or bacteria. We were trying to make a decision about whether or not in this time of shortage of these gowns, should we save the clean ones, the ones that didn't have holes or soil on them, should we save those in order to reprocess them in case we couldn't get them and we had to use them down the road? And I'm like, "Hold on. I'm not one of those people wearing those gowns." And so really, it would be important for the nurses who wear them to be the ones to decide are we going to reprocess and what would they feel about that if we did. And so, I convened a Zoom call because we were not doing anything in person. and the convened a Zoom call and had an adequate number of clinical nurses on that call representing all of our facilities plus our ambulatory sites. And I posed the question to them and they made a decision about what we were going to do with gowns, were we going to reprocess them and how we would do that? So, you know, it's really creating a situation of what level in the organization should these decisions be made and really understanding that the people who use the equipment or supplies are people who actually execute nursing practice with the tools that they have are the right ones to be making the decision about which direction to go. Does that help Bill?

Host: That certainly does, and that's a great example of what you said earlier, leading your peers with collaboration, partnership, and respect instead of top-down leadership, "You will do this. I will decide. You're going to use this." You got their buy-in. You went to them and said, "Hey, what should we buy? What do you use?" What works best for you? So, that's a perfect example of collaboration, partnership, and respect. So, what are the results then for someone who approaches their work like you do, collaboration, partnership, respect? What have the results been for you so far?

Sharon Pappas: Yeah. Well, certainly we're not perfect. But I will say that there's been a couple of indicators that I'm very pleased with. You know, one is the fact that we're watching our nurse turnover decline and get closer and closer to pre-pandemic levels. And what that says to me is that nurses like to practice here. And what it says to me is that because they feel like that they have ownership and that the organization recognizes their value. And so, you know, when you recognize the value of decision-making by professional groups, then you do more of that. So, I think that's one indicator.

And the other one that I think is important is that we have a system-wide practice council. You know, Emory Healthcare is comprised of 11 hospitals and over 250 ambulatory clinics or sites. Every one of those organizations has its own individual form of professional governance. And so, what I do every month is that we convene the chairs of all of those groups, and we call that the Emory Professional Nursing Practice Council. The system council comes together, and that's a meeting I really try never to miss because the importance of that is that that is a platform for me to understand what's important to the nurses who take care of patients every day, which is our core business. I think it provides that platform. I'm not a voting member. I am a person who comes and contributes when asked and invited to do so. But I have such respect for the clinical nurses here that it's important that I know what they're working on, what their challenges are, what things I could create as strategic priorities that would enable them to improve in different areas. And so, I always try to use that monthly meeting as a way to stay very connected and very street aware of the things that are important.

Host: Yeah. You sound like a great person to work for, Sharon. I just got to tell you that.

Sharon Pappas: Oh, I have plenty of words. I have plenty of words.

Host: What is the overall takeaway from your point of view on professional governance and the role of the chief nurse executive?

Sharon Pappas: What's important to remember is the fact that you are leading peers, you are working with peers, and you expect leaders at every level, not just your level. I think it's also important to remember, do you have the adequate platforms to really understand the practice of nursing in your organization? And within those platforms, are nurses focusing on the things that are their professional accountabilities? Because when nursing goes well in an organization, the rest will follow.

Host: Absolutely. And as we wrap up, Sharon, thank you so much for your time, is there anything else you want to add as we talk about this topic today?

Sharon Pappas: I just want to say thank you to all the nurses, all 4 million of us in this great country. I'm grateful to be part of the profession and for what nurses contribute every day. And just to always remember that nurses in the right culture will do fabulous work.

Host: Very well said. Sharon, thank you so much for your time. I appreciate it.

Sharon Pappas: Very good.

Host: And once again, that Sharon Pappas. And for more information, please visit aonl.org. And if you found this podcast helpful, please share it on your social channels. And check out the full podcast library for topics of interest to you. This is Today in Nursing Leadership. Thanks for listening.