As a brand-new nurse in maternal and child health back in the 1970's, Robyn Begley didn't originally set out to become part of healthcare leadership.
She'd pursued the career in the first place because she was inspired by one of her mother's friends who'd worked as a nurse. Her first jobs in Massachusetts and New York included working in postpartum, in labor and delivery, in neonatal intensive care and pediatrics.
"I think I just found myself in situations where I was offered positions and I accepted them and learned as I progressed through my career," said Begley, who went on to work for 35 years at Geisinger's AtlanticCare Health System in New Jersey, including 20 years as its Chief Nursing Officer.
We recently spoke to Begley about her experience, the top issues she plans to focus on first and the changing role of nurses in healthcare leadership.
What are you expecting to bring to this new role after such a long career leading at a health system?
Although my last 20 years as CNO have really been deeply steeped in operations, I was very fortunate to be part of an organization that is very team based. So I had a lot of exposure at the executive level to do strategic planning, to do a lot of work that wasn’t always just traditional nursing operations. So at the system, I had responsibilities across the continuum of care and that positioned me well for this new role ... [AONE] is an organization I believe is very committed to being the voice of nursing leadership across the country and it was very compelling to me when I learned of this opportunity to leave an organization that I thoroughly enjoyed and had mixed feelings about leaving to join an organization that I believe will be just as rewarding.
How did your role in healthcare change over those 20 years as Chief Nursing Officer?
In the beginning, it was very hospital-focused. We weren’t a system back then. We were Atlantic City Medical Center and the scope was narrower ... The more narrow focus we had exclusively on hospitals really did change to care across the continuum. During those 20 years, we went through nursing shortages and healthcare redesign. I was able to learn along with my entire team and focus on things that I don’t know were so top of mind. For example, workplace violence in the healthcare settings and the opioid crisis. Now we are really faced with workforce issues such as baby boomer retirement and another nursing shortage that is beginning to set in. Some of these issues are cyclical but some are pretty unique and new.
How is the role of nurse executives changing?
In the traditional view, the chief nursing officer was the nurse executive role. But now we see lots of nurses in various positions in healthcare leadership. For example, the organization I’m coming from-AtlanticCare—our CEO, our COO, our VP for Quality, our VP for innovation, they’re all nurses. I believe as you look across healthcare, you see nurse leaders in nontraditional leadership roles. That also applies to nurses across the continuum where they might not have nursing in their title but they are nurses and they are nurse leaders in academia, in industry such as our IT companies, there are a number of nurses leading these different enterprises not just nursing.
What unique traits to nurse leaders bring in healthcare?
Nurses really do have outcomes and patients and communities at the forefront. Their actions are goal-directed toward benefits to those folks. I know nurse leaders, through their education and work experience even early in their careers, are used to working as a team. That’s very important in today’s healthcare environment. The interprofessional team is one asset and one facet that we really must embrace and focus on and I think nurses know how to do that.
What are the top priorities facing the industry you’re expecting to focus on? The opioid crisis, workplace violence, those are issues our AONE board and the AHA leadership has top of mind, at least for the past year to two years. It’s one thing to talk about yes, we need to be part of a solution. But really thinking about how to form coalitions, how to work with different stakeholders with such a pervasive national problem. When we had our annual conference in April for AONE ... every group around the country said those are absolutely in every region of our country. We learned what are you doing? What are your best practices? And we share those with our members.
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The Title 8 workforce development program which has passed the house and is in the queue in the Senate is something we strongly advocate for that because we need more nurses, we need more money for nursing education and, in particular, we need more nursing faculty. We have many potential nurses in the country who are well qualified and can’t get into nursing program because there is not enough faculty.
We're also trying to address the administrative burden in healthcare in partnership with the AHA. There are 629 mandatory regulatory requirements for all health system, hospitals, post-acute providers and we spend collectively nearly $39 billion on non-clinical regulatory requirements. We’re not saying regulations aren’t good. We want to be safe. But I found as the chief nursing officer at AtlanticCare, we had state regulations that were a little bit different from federal or CMS regulations. And we also had accreditation bodies like the Joint Commission. So we had many folks literally reviewing records, checking boxes and as many as a quarter of those people in every hospital are nurses that are not doing direct nursing care. We think if we reduce some of the regulations or at least coordinate all these regulatory requirements maybe save some money and make the system more efficient but also have some of the clinical or nursing staff dedicated to non-clinical work be able to be back at the bed side.
What is your biggest goal in the new role? The board and the staff are in the final stages of solidifying our strategic plan. My priority is, of course, to get to know my team. It’s very important to me. I come from a team-based environment and I believe it's most effective. So I want to engage with my team. The two words that stick out to me when I think about what I need to accomplish in the first year is inclusivity and engagement.