Executive Nurse Leader interview with Dr. Mary Beth Kingston

– Well hello, and welcome to a discussion with one of the key influencers in Duquesne University’s Executive Nurse Leadership and Healthcare Management track. I’m joined today by Dr. Mary Beth Kingston. She is the Advocate Aurora Health Chief Nursing Officer. Dr. Kingston, Welcome.

– Thank you. Delighted to be here.

– Well, Mary Beth is one of the members of the Executive Nurse Leadership Advisory Board. That means she helped shape our curriculum to make sure we had real-world, practical application in the classroom. We’re thrilled to speak to you because we know you have a lot of experience. You’ve had a great journey to where you are. So, if we can start out by just telling us a little bit about how you got to the role you’re in today.

– Take a while because it’s been 44 years in the making. But, I’ll just give you a little, short synopsis. So, you know, it started out as a clinical nurse in a surgical setting, actually. Went back to school pretty quickly. And through my next position as a clinical nurse specialist, which I loved, but I realized that, I felt that I wanted to be in a position where I was definitely influencing care in a broader way, and decided to move into a formal leadership role. The clinical nurse specialists are leaders too, but a formal administrative leadership role. And really found that that was something I loved. And, I think I loved it because you’re working with teams, you’re not doing something alone. You’re pulling people together with a common vision, and you’re seeing something through to the end. So, I became a nurse manager of a large emergency room and trauma center. Moved out to the suburbs after that. My children were small. And, that’s an important point as you go through leadership, you have to make some decisions based on your family. And really enjoyed the community setting, as well. But I took a detour then, and moved into consulting, which was exciting and enjoyable, but I found, that for me personally, I received my greatest satisfaction and rewards from being in a clinical environment, even if I wasn’t the clinical nurse. So, I liked being a little bit closer to the mission. So, I went and jumped back into the provider end, and was a system chief nursing officer, and then became a system chief nursing officer in a larger organization. So, that’s kinda my story.

– That’s an incredible path. And, I think that leads us into one of the first questions that I have. So, I think, without a doubt, most people that you talk to in the nursing field will say the word that I heard you say a couple of times, which is love. You do this because it is a calling, because you wanna help other people. And you wanna have a direct role in possibly changing or helping save a life. But, you’ve talked to us before about the fact that you don’t want people to look at nursing as the end of the journey, that it’s a part of a journey, that it could be just one step on a career journey. So, what do you mean by that? And, what opportunities are there, that some people may be looking at nursing as just that end-goal?

– Yeah, I think that nursing, and you’ve heard this, I think, many times from different people, there are so many opportunities. I think the key is finding what excites you, what ignites your passion, and finding roles where you are contributing your talent. So, it’s really important to know yourself. What do you do well? What do you enjoy doing? And then, what positions are you in where you can really learn? So, to me, contributing, being able to contribute your talents, and yet, always learning are the things that make roles really exciting. And so, there are tremendous opportunities in clinical roles, every setting, communities, and that is growing by leaps and bounds as we focus on the health of communities. There’s also opportunities in industry. There’s opportunities in, I mentioned community health, home health care, different venues, different settings, and many nurses also take their nursing skills to broader leadership opportunities. And that often can be in that chief operating officer or a chief executive officer role. And, I could go on. There’s just a tremendous amount of opportunity.

– So let’s talk about the type of person that you need to be able to get into these leadership roles. I think what’s great about being a nurse, is you have to thrive at both the micro and macro level. So, you’re dealing with the issues that are happening in that given moment, but you also have to make sure that the treatment kind of aligns with the long-term treatment plans for the given patient. So, knowing all of this, how does this prepare nurses for potentially taking on a nursing management role, where you are looking at the holistic approach, the totality of care?

– Yeah, you know it’s interesting, because I think all nurses develop leadership skills. They might not all be in what we would think of as formal leadership roles. But when you’re advocating for patients, when you’re multitasking, you’re assessing a patient, and you’re also doing and working with a patient while you’re talking with the family, you’re coordinating the different disciplines, and the communication, these are all skills that give you an extremely strong foundation to continue to develop your leadership skills. Again, not everyone wants to go into that route, but all nurses have leadership skills, or they would not be able to really be the patient advocates that they are. So, I think that your clinical role is a great preparation for moving into leadership roles. Now, with that being said, you do need to develop additional skills for that. But, there’s so many opportunities and so many places to hone your skills. And if you look for those opportunities, I think that people can easily move into a variety of different roles, including leadership roles.

– So, when we’re talking about these different roles, I know that there are a variety of them out there. You’ve touched on a few of them. But you’ve got more frontline workers who are looking to advance their careers. They want to possibly get out of the hectic nature of being on the frontline. Sometimes they just wanna have more influence over what’s happening when looking at a broader scope. So, what are some reasonable expectations in the workforce right now, with the economy being where it is, where the health industry being where it is, for students who wanna be a part of this Duquesne track, to be looking at career options in the future?

– It’s interesting because moving into these roles doesn’t get you out of the hectic piece of it at all. Unfortunately, you stay in that. So, that piece is there, but you do spread your influence a little bit. And, I think that’s a really important piece when you have something that you want to contribute. You know, it’s very fascinating because many nurses today, and I would say in the past few years, who are looking for advancement, are tending to move into advanced practice roles. And so, we haven’t seen quite as much interest in some of the formal leadership roles. I think sometimes there’s a hesitancy there, where people are saying, “Am I ready for that?” “Is that something where my skills match-up?” So we do see more folks moving into advanced practice roles. And that’s tremendous, because that’s essential for meeting the healthcare needs of the nation, I believe. But we also need really strong nursing leaders. I can’t tell you how many phone calls I will get. I mean, I’ve developed relationships over the years with a number of the search firms. And, they call me and they say, “I cannot find anyone for this system chief nursing officer role.” “I can’t find someone for the chief nursing officer role of a community hospital or a large academic medical center.” And, I think it’s up to us as nurses, and in the nursing world, to say, “Okay, is there… How do we identify individuals in nursing who may have the potential for these positions, and how do we mentor, grow, and develop them?” This program is a key piece to that. You know, having that formal educational leadership is a key piece to it. But, I think people have to want to do it. But they also sometimes don’t know that they have that ability. So, for example, I sometimes, have held back from doing things. And someone will tap you on the shoulder and say, “You know, I watched you do that.” Or, “I’ve been seeing you in a meeting. You really have some solid skills. Have you thought about X?” So, we have to be open to that tap on the shoulder. And we also, as leaders, have to be tapping people on the shoulder and saying, “You know what? I watched you lead that shared governance meeting, and wow! You know, you’ve really connected with people. You were able to organize things. Have you thought about furthering your career in nursing leadership?”

– So when we hear the word nursing, I think for the general public, it seems to have a very defined role, but we all know that nursing is one of those gray areas sometimes, where they have to take on so many different things. So, I imagine that only expands wider when we start talking about chief nursing officer. So, can you talk a little bit about where they fit into the management hierarchy, and what type of influence they have in decision-making?

– It varies depending on the organization. So, we can have chief nursing officers in healthcare, hospitals, at varying sizes. We can have them in industry, as I mentioned before. Many organizations will have the chief nursing officer report directly to the CEO. So you’re at the top leadership in your organization. So in my role, I’m on the executive leadership team. I am responsible for areas that are also not nursing, sometimes. Oftentimes, chief nursing officers will be responsible for areas, all the clinical areas, for example. It could be physical therapy, pharmacy, other areas. It could be patient experience, some content areas. So, sometimes they’re responsible strictly for the nursing practice and standards. So, it varies a little bit, depending on the organization. I think the key is, when you go into a role, you want to ask those questions. Who do I report to? Where does the chief medical officer, who is my, what we’d call a dyad partner, where does that individual report-in so that we are truly working together as partners? And that hierarchy that you sometimes see is not present, because we know that the best work gets done when you have these disciplines working together. So, seeing where you fall in the organization is very important. The other thing that varies is how you influence. Maybe not your level, but for example, if you’re in an academic, if you’re the chief nurse of an academic medical center, you lead by influence, certainly, but you have a line-responsibility, typically, in one site. When you’re in a role such as I have, which is a system role or an industry role, you don’t often have that many direct reports. So, the chief nursing officer of one of our hospitals has a tight matrix relationship to me, but that person reports to their hospital president. So, you really have to hone your skills on how to influence without always having that formal line of authority. So, lots of questions and lots of variability. And something that, I think, as nurses move into leadership roles, they need to consider, to see if it’s the right fit for them.

– So, you talk about influence. I’m gonna have to actually read this here, but you’ve served as President of the American Organization for Nurse Leadership. And, you currently serve on the Board of the Milwaukee Urban League, and recently elected to the Board of Trustees of the American Hospital Association. Of course, that’s in addition to your role at Advocate Aurora Health. So, you obviously place a lot of importance on being a part of these organizations. How much have they helped in your career, and why are they so important?

– I just cannot overestimate the importance that being in professional organizations has had, at least on my career. So, I mean, I could go back and start. When I was a very new, novice nurse, I joined the American Association of Critical Care Nurses. And, I learned just by going to those meetings. I met people from around my region, which helped. I learned how to run a meeting. It was the first time I was really up, speaking publicly in front of people. And it was a small, I was in a Chapter, so it was a smaller organization. But, I began to pick up some skills that I might not have been getting in my work setting. Then, I’ve been fortunate that my organization has supported me in some of these big, big roles. But, the opportunity to be President of the American Organization for Nursing Leadership, it’s just life-changing. I mean, you have the opportunity to meet nurses from across the country, to participate in leadership development activities, to listen to nurses and nurse leaders about the issues they’re facing, and to work together in an organization. Same thing with a team, to try to address those issues. And, you have more focus-time on specific topics than you typically have in your work setting, where those operational issues often are taking priority. The American Hospital Association has given me an opportunity to broaden that beyond nursing. To be sitting on the board with chief executive officers and others from, again, organizations from across the country, learning what other people are doing, contributing what we’re doing. And all of this, it helps you grow as a professional, but it also helps your organization, because you’re bringing this information back. Again, I can’t say how important that is. Another thing that I think influenced me, and I think, can assist others, is looking for opportunities outside of work, as well. Whether it’s a board, and that can be a community board. It doesn’t have to be a healthcare board. But nurses have a connection with people. They understand what people’s needs are, in terms of health and well-being, and have so much to contribute to boards. So, that’s one area that the nursing profession is very focused on. Having more nurses contribute on boards. I also had the opportunity to participate, and actually, one of my colleagues in this cohort was the Dean of Duquesne, Mary Ellen Glasgow. Mary Ellen and I we’re in a group of 20 nurses who had the opportunity to go through a three-year, Robert Wood Johnson Executive Nurse Fellows Program. And, that was just amazing. You focused on developing your own leadership skills. You developed a project that you brought back to your work setting. And again, met people from across the country that enriched your role and your career. I would not… I made a move. I’d never worked anywhere but the Philadelphia region in my career. And nine years ago, I took a position out in the Midwest, the position I’m currently in. And, the reason I think I had the courage to do that, was because my colleagues helped me through that, and showed me how I could make that work, and what the benefit of that might be. And, I don’t think I would have done that had it not been for some of those experiences that I’ve had.

– It almost goes without saying that this impressive resume, these connections, this vast amount of experiences, is why you’re involved with this program at Duquesne. So, when you are tapped for advice, when you are looking into helping with the curriculum, is there one kind of guiding principle that you have when you’re offering advice or input when you think about the students that would be participating in this program?

– I think sometimes we focus too much on the traditional trajectory. So, I sort of followed that. I had a few detours, but you know, you’re a supervisor, and you’re a manager, and then you’re a director, and then you’re a chief nursing officer. And, I think we should begin to really look at individuals, at nurses that have really strong leaderships and interpersonal skills and the ability to influence, because we need nurse leaders that can change and transform healthcare for this country. And, nurse leaders are going to be able to do that. And, I think that having a variety of backgrounds and competencies, bringing those together, enriches everyone. So, I would say that the individuals who would be best suited to this type of program are those that, you know, the patient is still the center of everything. So, those who have that philosophy, and who have a desire to really improve healthcare, both at the sites they’d be working in, but really, overall in their communities, because that’s where we’re heading. It’s a transformational time, I think, in nursing and in healthcare. In some way, and formed by the recent pandemic we’ve been through, that we’ve got a lot of big issues, not just in our facilities, but in our country, that nurses can influence. Health, health care inequities. And, just in general, bringing that nursing knowledge to those type of challenges.

– So speaking of Covid, was there something that the pandemic kind of exposed in the healthcare industry that is now being addressed, or still needs to be fixed? And, how do you see it changing the future of healthcare, as we have students who could be looking into what their career opportunities will be, and what kind of influence they may have as they move forward in their career journey?

– I think the pandemic has just created tremendous, tremendous change, and some of it very positive, and some of it highlighted, as you said, big gaps that we had. So, let me start with the gaps. You know, for example, we had in healthcare, a just-in-time approach to our supply chain management. Well, that didn’t work in a pandemic, and we learned that very quickly. So, I think that’s one very concrete thing that we saw. Of great concern, were the fact that our communities of color were disproportionately impacted. And this is an outgrowth of the healthcare inequities that we’ve seen for a number of years. And so, I do think that’s something nurses are very cognizant about and can make a difference. Our healthcare organization became quickly overwhelmed. We saw the benefit of being able to have nurses in some instances, cross state lines, so we had many staffing challenges, as well. And, I think that highlighted that we need to maybe take a look at how we do that. What is the scope of practice in our different states for advanced practice nurses? How do nurses move to one state to help when it takes four months to get a license? So, some of those things were relaxed during the pandemic, but they are longer-term things that we’ve got to take a look at. On the plus side, and I could do a few more gaps, but on the plus side, and I know in my organization this was true, nurses just stepped right up to the plate. I know I personally was the co-incident commander for our system, with our chief medical officer, helping to drive the entire response of the system. I had another member of my team was responsible for all the clinical operations planning. Another member was responsible for the system labor pool, and now the vaccine, the whole vaccine implementation program. And, another one of our senior nursing leaders up employee health, because then employee health became very overwhelmed, initially, with the degree of exposures that they were. So, nursing gained a visibility in a lot, I know in my organization, but a lot of settings that we didn’t always have. And, I think a recognition that that nursing background and those nursing skills can be applied in broad settings. So, it’s not that, oh you know, you are to do nursing. Now, I can lead a broad initiative as a nurse. And, I think that recognition, we wanna make sure that that continues as we move forward, because it really makes a huge difference. And, as I round, I have nurses that will say to me, I saw, let’s say Jane, “I saw Jane leading the vaccine.” Can I tell you how proud that made me as a nurse, to see our nursing leader or one of our nursing leaders in charge of this whole initiative, and the outcomes have been tremendous. So, I do think we have a number of challenges though, as well. So, that’s the plus. And, I said some of the gaps. One of the big aha’s, and I think this is important for everyone, everywhere, but particularly nurse leaders, one of the big aha’s, and we’ve known this for years, but it was never more apparent than during the pandemic, is that the health and well-being of our nurses is critical to our ability to deliver care. And, you know, we’ve had anxiety. I mean, understandable anxiety. And people still coming to work, worried that they were going to have something that they would bring home to their family. Worried about having PPE. Seeing tremendous amounts of death. Yes, we deal with patients who are dying, but not in these type of numbers. And so, that is another thing that was truly highlighted during the pandemic. And, that’s something that I’m hoping, not just nursing leaders, everybody in healthcare takes with them, that the health and well-being of the workforce is critical to our ability to do work. And, I think that’s gonna be a key competency of any nursing leader moving forward, to be able to address those type of workforce issues.

– So for someone who is really considering a position in nurse leadership, what advice would you have for them as they’re really looking to take, what is a substantial leap, to go from a comfort zone that they’re in, from something that drives them every day, to something that’s unknown? What would you tell them?

– I would say that you have to recognize that your satisfaction, you know… I mean, there’s nothing more, in my mind, more satisfying than providing care to patients and their families, and helping them through either an illness, or even sometimes a dignified, respectful death. Nursing leadership’s a little bit different. You’re doing a lot of your work through others. And so, you have to recognize that. That this is… You’re always part of a team, but this is a bigger team, in order to accomplish the work. So, I think that’s something that you have to say, yes, I like that, I love doing that, that’s what I want to do. And if that’s not something for you, then that nursing leadership probably isn’t the route to go. I also think it’s extremely important that people recognize that they have to have a balance in their own lives as a nurse leader. I think you can always get pulled into many things in different nursing roles, but, if you’re working a certain amount of hours, it can be stressful. You go home, the nurse leader can have, just constant, your work doesn’t end, so you can always be working. And I think, as a role model, I think as nurse leaders, we’ve gotta say, here’s the boundaries, and to be able to take care of ourselves, just as we’re saying our staff need to do. So that’s another piece of it. I would also say that it’s probably… To me, it has been, just nursing leadership in general, has been the most rewarding and enriching experience of my life. I have learned. I have, as I said, hopefully contributed. I’ve grown. I’ve made a ton of mistakes. And that’s the other thing, you gotta make mistakes. I’ve made mistakes, I’ve learned from them. And, I’ve had the opportunity to work with, just, some tremendous people in all different disciplines. And, I’ve been able to contribute to helping others as they move along their career. And I think, if you’re thinking about a career, an executive nursing leadership or nursing leadership in general, you just have to recognize that you give a lot, but you get a lot back, too.

– Well, I can see now why Duquesne tapped you for your expertise. It’s been great insight you provided about your role, about the industry as a whole. And, and we can’t thank you enough simply for the work that you’ve done in your community to save lives. And, I think that there are a lot of people under a lot of stress who are unsung heroes. And, I think you’d be among those. So, thank you for all you’ve done.

– Well, thank you. I’ll tell you, I was speaking with someone the other day, and they were asking me about some of our nurses during the pandemic. And, I just started to talk about how our nurses helped each other. You know, they just stepped-up and said, “I’ll go to that other state and help with certain, specific, critical care units that needed help.” And, as I was talking about it, I filled-up. And I just said, “I don’t know where that came from.” And I think, that right now, our emotions are just, they’re just here. And, we’ve gotta give each other some space to recognize that and to appreciate the tremendous work, that yes, nurses at the bedside did. But, I’m here to tell you our nurse leaders, whether it’s nurse managers, our shared governance leaders, our directors, our chief nurses, they have done some tremendous work during this time to support those who are providing care. So again, that, to me, is our role. We’re supporting those who are providing care, and helping to develop innovative ways of meeting the needs of patients. And, I can’t think of a better job.

– Well, thank you for your support of Duquesne and thank you for your time today. I know you have a lot going on, so we’re really grateful to get your insight. Thank you so much.

– Great, thank you. It was a pleasure to be here. Duquesne University’s online Executive Nurse Leadership and Healthcare Management track is offered at various different levels, including master’s and doctoral degrees, and post-master’s certificates. To learn more, you can visit our website to get in contact with our enrollment advisor team today.