Executive Nurse Leader interview with Dr. Paula Coe

– Hello and welcome to a discussion with an advisory board member for Duquesne University’s Executive Nurse Leadership and Healthcare Management Track. I’m joined today by Allegheny Health Network’s Vice President for Nursing Education and Professional Practice, Dr. Paula Coe, Dr. Coe, thanks for joining us.

– Thank you for having me.

– We’re glad to have you here because the important role you play with these programs and that’s that you really helped shape the curriculum because of your real world experience. So I think what’s important for the people who are watching first today is to talk about your role now and how you got to that position.

– Sure, thank you, Ben. You know, I’ve been at Allegheny Health Network for the past four years. I’m gonna celebrate my four year anniversary in a month or so, it’s been a great journey over the last several years of my nursing leadership career. I’ve enjoyed many opportunities over the course of my career and assuming this position as vice president of Nursing Education and Professional Practice for Allegheny Health Network has offered me a lot of growth opportunities and it really is a great place to work.

– Talk a little bit if you will, about the path. So the great part about this program is that it goes just beyond nursing. So there’s a lot of people I think who see nursing as a destination, but we wanna get a potential students thinking beyond that. So where did you start and what was attractive to you about taking the path to executive nurse leadership?

– Sure, you know, I graduated probably 33 years ago with my BSN from the University of Pittsburgh. So Pittsburgh sort of my home, if you will. I started my clinical nursing career as an intensive care nurse in the liver transplant ICU at the University of Pittsburgh Medical Center. And then really kept in that acute care nursing world and transitioned to being a bedside nurse. And my first leadership position really was a charge nurse in the emergency room. And then I took on an opportunity and really love the field of transplant nursing and became a heart transplant coordinator at Penn state Hershey Medical Center and was in that role for several years, I wanted to stay in transplant and took the opportunity to move to Charleston, South Carolina, to assume a role as a heart and lung transplant coordinator at the Medical University of South Carolina where I really took the autonomy that nursing provides to coordinate care for a group of transplant patients. I had my first son when I was in Charleston. So he’ll always be a southerner. And I think the best thing for nursing is that it really offers you the ability to blend your professional role as well as with your personal role and family’s really important. So we made the decision to move back to Pennsylvania so we could be near family and took on a position as the clinical head nurse and the general clinical research center back at Hershey Medical Center. So again, I think I’ve always had opportunities in nursing leadership and really took a role of building on each step of my career and assuming those leadership opportunities. A lot of my leadership growth has really come in the form of maybe a non-traditional path, if you will. I’ve been the president of several nursing organizations. I was the 10th president of the International Transplant Nurses Society which is an international nursing organization and really led that organization as president elect, president and president Meredith for a three-year term. I’ve been president of the South Central Organization of Nurse Leaders, as well as the president of the Pennsylvania Organization of Nurse Leaders. And I think that those non traditional leadership roles really give you the opportunity to showcase your strengths and different role outside the scope of a brick and mortar of an organization, if you will and really allows you to build relationship with peers across the country, as well as assumed leadership roles in the acute care setting and all of my experiences in acute care in the hospital, in the setting of the hospital. After leaving Hershey, I took a role as a research and clinical practice leader at Holy spirit Hospital in Camp Hill, Pennsylvania and then moved to WellSpan Health where I was the director of nursing innovation and nursing practice. And then four years ago came here to Allegheny Health Network in my vice president role. Along that journey, I went back to school and got my master’s degree in nursing. And about nine years ago completed my doctorate of nursing practice at your college. So while I was growing in my professional career, I also took that lifelong journey of achieving a terminal degree in the nursing profession. When I graduated from Pitt many years ago, I didn’t think that that would be me, but you know, your life changes and you find yourself in different stages of your career to assume greater leadership opportunities as well as your academic progression as well.

– So obviously with a very impressive resume, it would be very easy to go into kind of a micromanagement role, the thing that we all loathe our workplace, but you talked to me before about the importance of nursing autonomy when you’re looking at the leadership structure about being in touch with what’s happening on the nursing level and not micromanaging. So talk to me about why you think that’s so important for a successful hospital or a successful network.

– You know, I really have had the ability to assume positions where they were new. And so with that, you had the ability to sort of shape it on your own. And I think one of the reasons that I’ve been so successful with that is that I’ve had the benefit of having a lot of great nursing leadership mentors who were not micromanagers, who allowed and let individuals practice with the depth and breadth of their expertise to allow them to do what they were put in the position to do. And I think a lot of that has to come from trust that you’ve built and that you earn with individuals. And so I think, you know, to me not micromanaging allows my staff and the people that work with me to be able to do the best of what they do. And so I think because my role is in professional practice and education, I have a passion for having our nurses live and make decisions about their practice, which is really at the bedside. So we need to be able to bring them to the table to use their professional voice and their own nursing autonomy to make decisions about bedside nursing care and practice. They’re the ones that are doing it every day, and it’s not us in leadership positions. Our job is to be able to remove barriers and support those that are in those roles to be able to do what they need to be able to do whether it’s with resources, whether it’s with equipment, whether it’s making prudent decisions both fiscally and managerially related to staffing to allow them to be able to participate in shared decision-making and shared governance where those councils are. Nurses have a variety of different practice settings to be able to come together to be able to use their voice and make decisions about nursing and patient care.

– Obviously you value the connectivity with the ground floor work, the frontline work and knowing what’s going on with the nurses so that you stay connected, so you’re not out of touch. And, you know, with COVID I think that this is a great example because everyone was learning on the fly. We really were going back to ground zero in the healthcare world and trying to figure out what’s going to work and what’s not going to work and you didn’t stay in your office and let all this happen. You were down on the ground floor even participating in giving vaccinations. Talk about what that was like to be hands-on involved in that once again.

– You know, I think that that was one of the things that I really enjoyed the most when we first were able to get the COVID vaccine and be able to participate in giving vaccines at least first to our frontline healthcare workers. It was just a really empowering, uplifting experience to be able to, you know, have some hope that we’ll be able to get on the other side of this. So my first experience was giving vaccines for our healthcare workers, which allowed me, I think to really have some dialogue with them about how they were doing, what they needed, and I also thought it was a great opportunity to see someone in a senior leadership role giving vaccines. So not only did I promote myself of, you know wanting to do it, it also showed that we weren’t necessarily just asking them to be able to give vaccines, but it was, you know any one of us could step up with a nursing skill to be able to participate in vaccines. You know, most recently at Allegheny Health Network we’ve been doing a lot of community outreach with getting the injection into the arms of our community. And so that gives a different perspective because you know, they’re just so hopeful being able to reunite with family and then sitting alongside some of my other nursing colleagues and participating in those events has just been really, really rewarding.

– So perhaps one of the downsides of COVID for the nursing profession is burnout and turnover. Now there’s already turnover in nursing. I think the stats show about 20% nationally in year one and about 40% by year three. So the question becomes, how do you combat that in your role? I know we talk about the leadership progression but some people may see the skills that they need and the degrees that they need has being very cost prohibitive, and they don’t have access to the type of degrees that we’re talking about here today. So how do you combat that key people in the roles that they’re at while also encouraging them to up-skill?

– You know, I think for us, it’s really just part and parcel to who we are as an organization. So I’m speaking for Allegheny Health Network and I think that, you know, professional development of our employees is really important to them. And again, I think it’s having conversations with them related to what is the barrier for you choosing to be able to go back to school? And some it’s financial, you know, some folks have graduated from a diploma program or an associate’s degree program ’cause that was their entry level into the nursing profession. And so, now they’re at the stage where they would consider to go back to school to get a baccalaureate degree in nursing but now their kids are in school. And so they’re gonna choose their children over themselves to be able to go back to school. So we’ve developed some great partnerships with some organizations to be able to utilize our own tuition reimbursement for our nurses to go back to school so that they don’t have any out-of-pocket expense. That’s a direct bill to the organization utilizing the tuition reimbursement that they would have already had access to but it’s not the shuffle of reimbursement. And so we’ve seen a tremendous amount of our employees take the opportunity to go back to school because they don’t have that financial outlay of dollars from their own pocket were utilizing reimbursement dollars that we would have, sometimes it’s related to finding them in the right place. And so a lot of, you know, entry to practice as a nursing assistant and helping them getting back into nursing schools, that’s their choice. You know, there’s so many entry levels to the nursing profession and we help people where they are and help to remove barriers for, and as I said earlier, that’s the role of a nurse leader. We need to listen to our employees and then create opportunities that give them the ability to either seek a degree path or go back to school to get their master’s degree and and help them where they need to be.

– Of course, on the other side of that, you have some nurses who don’t necessarily wanna go into leadership roles because there’s a lot of money that can be made at the nursing level especially for traveling nurses and something that comes with that is turnover. Turnover costs a lot of money to bring someone else new in and train them and get them acclimated to their new work environment. So with all of those factors at play, what do you do when you have that much turnover? How do you try to keep people in their roles? And do you see this traveling nursing continuing to grow because it is so expensive, both on the front end and the back end?

– Yeah, I think we’ve really seen that more specifically over the last year with COVID. And it is, you know, as I said earlier with nurses having a significant amount of financial debt related to school expenses and school loans and a lot of them are choosing the ability to travel to have a greater wage for those travel assignments and you know, maybe go someplace else in the winter months where it’s warm and and have the ability to do that. You know, one of the things that we need to do as nurse leaders is really to engage our employees and have their experience and our organizations be something that empowers them and want to stay within your organization whether it’s with professional development opportunities, going back to school, achieving certification, enrolling in a clinical ladder that allows them the opportunity to grow professionally. So some of it is on the engagement side related to developing innovative programs or other things that we can do to engage them to the organization and help keep them within our walls. The other thing is, you know, a lot of times, it may be something that they wanna do for a short period of time. So we’ve kept some of our nurses on the casual status that come back and still work with us so that, you know, if they are fine that travel nursing may not necessarily be for them that they have the ability to ease back into the organization, especially those individuals that are strong nurses that we wanna keep and that we wanna keep attracted to our organization.

– Of course, the bottom line is really the bottom line. So if you’re continuing to have that turnover it costs more money which eats into profits which in this day and age it’s unfathomable but it can eventually lead to a reduction in staff. How big of an issue is that not only at Allegheny Health Network, but just nationwide, the idea that because of this type of turnover so much money is being expended on not actually having human beings at the hospital level and then you’re having to look at the budget and say, we’ve got to cut because we don’t have the money to have people in those roles, that has got to be maddening.

– Yeah, yeah. You know, the, the financial expense of really over the last year, specifically with COVID and, you know, I think we’re seeing it in a bit of a different vein right now and that we have the turnover related to travel. We also have the ability to receive vaccine and set up vaccination clinics for our community which a lot of them are staffed by nurses because they have the skill to administer vaccines even though on state to state, there’s some waivers related to other licensed professionals that have the ability to give vaccine. But a lot of times, you know, we feel the weight of that on our shoulders within nursing, to be able to staff those vaccination clinics and then mind the gap as we have certain amount of turnover and also our hospital volumes are getting back to be pre-COVID levels where we are back up to speed with our elective as well as scheduled surgeries. Our hospital volume is manageable related to COVID where we’ve weathered the second, third surge of COVID and now patients that may not have come to the hospital ’cause they were afraid to are now, you know having their surgeries performed and coming into the hospitals with chronic diseases that need to be managed and perhaps were not managed as well as they could have been because of the fear of coming into the hospital or seeking care when they really needed it. So I think right now we’re trying to balance what we need to do on the inpatient side and what we needed to be able to do on the ambulatory side to be able to help support what we know we need to to get ourselves on the other side of the pandemic.

– Switching gears just a bit, I think in any industry communication is key and you’ve talked about it in the past how important it is for you to stay connected on the nursing level. But you also see a little bit of a challenge with nurses that are coming into the field right now, they’re younger, their communication patterns are different instead of the face-to-face interactions that you and I grew up with for so many years, you’ve got more texting and social media, Instagram, and that type of thing, and so some of the interpersonal relationships don’t exist. Some of those skills aren’t there. And then that makes it very difficult for them sometimes to be able to communicate with fellow nurses, with physicians and even leaders like yourself. So how do you break through that barrier when we have a generation now that may not be used to that one-to-one conversation, the ability to have confidence in their communication skills?

– Our new nurses, and I think, perhaps over the last several years have transitioned into like you said, some lack of interpersonal communication skills because of the generation in which they’re living. So our nurse residency program does a lot to be able to help to foster those situations where we do have interprofessional education and have those opportunities for them to practice and learn. You know, we’re really blessed that we have a state-of-the-art simulation center where we can simulate these conversations and a non-acute non-patient setting where sometimes it’s conversations and communication between providers on the healthcare team but sometimes it’s also the communication with the nurse to the patient and the patient’s family. So I think those organizations that have a strong nurse residency program offer an opportunity for those individuals to practice those skills. I also think that one of the things that is really important is that interprofessional communication. And when we look at our data from the nurse residency program, one of the things that is the data point that we constantly look at is that the nurses feeling comfortable communicating with a physician. You know, over the last year, a lot of our nursing students had a significant impact of not being in the hospital to be able to be in clinical that were replaced with simulation for them to be able to successfully meet the curriculum and graduation requirements as well as their individual state board of nursing requirements for their education. And so, we, again not only just what nurse residency but recognize that we need to foster those opportunities with our preceptors in other roles, our leadership, our assistant nurse managers, our charge nurses to be able to mentor and coach those individuals that might not have ever had some of those real-world experiences to sort of let me show you how to communicate. This is the way that you should when you have to call a doctor in the middle of the night, give them those pertinent pieces of information that they need to be able to know, and that you would be able to suggest what you think might be best for the patient and let the physician make the decision. But some of it comes with practice and some folks gain that skill really relatively quickly but then there are others that really need some coaching and mentoring and maybe just someone standing alongside them to coach them along the way. So those are some strategies that I think have been helpful but then also recognizing that is something that we need to tease out and really pay attention to because it’s not necessarily a comfort level of them because of the way that they communicate in their generation now.

– So considering this is all happening, this gap is happening on the education level and you expect that new nursing class to really be meaningful reinforcements. Did that make it difficult to really integrate them into the process during a pandemic when there is that big gap at least the hands-on learning that was not being able to take place because of having to do remote learning?

– You know, I think one of the things that was really successful for us last year is that we made the decision to continue with our nurse extern program. And while it was supposed to be a 12-week program, I made a decision to continue to have that program but truncated a little bit. And because of social distancing, brought a group in every two weeks so we didn’t have everyone in the hospital at the same time but a lot of the feedback that we received, not only from our academic partners, but the students themselves was how beneficial that was to mind the gap for them to feel so much more confident going into their senior year because they got a sense of what the hospital looked like because none of them really knew because they were taken out of the clinical setting when COVID started. So there was, in some cases some trepidation about being in the hospital, where and what are they gonna see and what kind of patients are they gonna be taken care of? And I think that experience was helpful for them to transition to their senior year as well as hired many of them on as nursing assistants so that they could continue to work with us and be able to develop those communication skills, maybe not necessarily as an RN but within the healthcare team they have some additional practice and some real-world scenarios where they were able to practice in a nursing assistant role but have some comfort with the players on the team. All of them would develop trust and respect and dialogue, familiar faces with folks that they in many cases, we hired them as you know, now going into graduation here in a month or so hired them on those units. So they have some comfort level with the physicians that are on those units, the other nurses that they’re gonna be working with. And I think that that has been a very beneficial strategy for us and we’re continuing with that program and we’re gonna be doing it the full 12 weeks over the summer with over 220 nurse externs. I think that was one strategy that proved to be really helpful.

– So transitioning from new nurses to nurses who have been in their role for quite a long time, who maybe looking to advance into executive nurse leadership what advice do you have for them?

– My advice would be to always be real with yourself and know who you are, and that I think one of the things that’s well-documented in the literature from a nursing standpoint is that nurses who are excellent clinicians are often those ones that are tapped on the shoulder to be in a nursing management and leadership role. And one of the greatest and hardest transitions is being a peer with a colleague and then now be their supervisor and their manager. So recognizing that if that is truly your path, your relationships with some of those folks are gonna have to change because that is what leadership means. You need to be consistent. You need to be fair. You need to be equitable and treat everybody the same. So there is gonna be a shift in some personal relationships if you do become the manager of a group of people that used to be your peers. So sometimes I think it’s recognizing what’s gonna be in front of you and if you’re gonna have the ability to know that upfront and have the frank on this conversation with folks that says, I have this in my career path, and just because we were peers at one point our relationship will change. Sometimes it’s just having that open honest dialogue with folks to say, we can be friends but that friendship is gonna be and look a little bit differently as I transition to a different role, and same with nurse managers that might get promoted over another peer into a director role. You know, I think that it’s just recognizing who you are and where your strengths are and where your weaknesses are and help yourself to be able to be well-rounded to you might not necessarily be the expert in everything but that’s where your decisions are with building your team come. So, if you’re weak in an area, find somebody that has a skillset that leverages out your team. So I think one of the things that I would suggest is that don’t realize that you have to be the master of everything. There are some things that you would be really good at that maybe somebody else might not necessarily have as a strength, but that’s how you build a strong balanced team where everybody comes together and leverages their strengths to the best of their ability, and everybody brings that all together.

– So finally, for those considering this role as well, what do you enjoy most? I mean, I hear that you have a lot of things that go on, you have to be a Jack of all trades but I think that there’s gotta be some joy that you find in what you’re doing, because even at your level maybe a little bit removed from the front lines, you really are having a positive impact on what’s happening bedside as well.

– I have never ever regretted the decision to become a nurse. And I think that when you do become a nurse leader, you’re not necessarily considered a nurse per se ’cause you’re not at the bedside. And so to me, what I like the best is, I get to focus on nursing practice and professionalism and to education which allows me to continue to not reinvent the wheel, but, you know, continue to reinvigorate myself with the practice of nursing. And I think that’s why I love my role the most. And I think that one of the greatest joys that I have is thinking about how I can help the other members of my team, and even in my vice president role, when I first came to Allegheny Health Network, we were building our shared decision-making structure and retooling it, if you will. One of the things that I did was, in my vice president role, go to the table of those bedside nurses and help them on that journey and build it back up to where I have had experiences of shared decision-making be a more mature model to where it is today. So I think it’s a lot of those nurses that I had relationships with then, over the course of the last year, as we transitioned back into Zoom meetings was able to reconnect with some of those nurses that were on the shared decision making council and reconnect with them. And seeing them smile and say, hey, how’s it going? It’s been a long time since we’ve seen you , to me, that’s the beauty of our profession. You know, I get to be a leader, but I’m only as good as the people that I’m around and who I can mentor, who I can coach, who I can support in their roles. So to me, that’s, that’s where I get my joy from. You know, I have a great team and I very rarely use the term boss, if you will. Like, we all work together as a team which I think in some respects makes you be a good leader. You need to be humble. You need to be flexible. You need to be strong when you need to be strong and seek support from your colleagues when you’re having a rough day. So, you know, over the course of just last year, we’ve all had the test our own resiliency and our own ability to pull ourselves up by the bootstraps and work from home, work from the hospital, work from someplace else, just worked from anywhere that you have the ability to connect. And so to me, I think that that’s one of the greatest joys that I have. It’s just the connection with our other peers. And like I said earlier, going back and putting on a pair of scrubs and giving vaccines was, some might think it’s just giving an IAM injection in the arm, but to me, it was just so much more than that.

– I can’t thank you enough for really letting us go behind the curtain. It’s been very genuine and we appreciate your candidness. And most importantly, just thanks for sharing your insight. Thanks so much for joining us today.

– Thank you, Ben, it’s all my pleasure. Thank you.

– Duquesne University’s Online Executive Nurse Leadership and Healthcare Management track is offered at various different levels including masters and doctoral degrees and post-master’s certificate. To learn more, you can visit our website to get in contact with our enrollment advisor team today.