Dr. Linda Cronenwett is the Co-Director of the Robert Wood Johnson Foundation’s Executive Nurse Fellows program. She is also Dean Emerita and Professor of the School of Nursing at University of North Carolina at Chapel Hill. She has also previously served as an administrator in the Department of Nursing at Dartmouth-Hitchcock Medical Center where she provided leadership in the nursing professional practice and ran quality improvement initiatives. She has also served on various boards and organizations throughout her career. We are excited to be featuring her today in our Leaders in Nursing Education series.
How did you decide on a career in Nursing and what drew you to Nursing Education?
A neighbor in my rural farming community was a nursing role model for me. She had skills that were valuable, and, during a time when women were culturally constrained to relatively few careers, I wanted to help others, just as she did. I assumed I would attend the nearest hospital training school, but I was elected to Girls’ State my junior year in high school. That early leadership development experience took place on the campus of the University of Michigan in Ann Arbor. I loved it and decided I wanted to attend a university to become a nurse. That path nurtured my love of academic work, which pulled me back from practice roles time and again throughout my career and led, at the end, to my becoming dean of nursing at UNC-Chapel Hill.
You have had a very long career during which you have received numerous honors and awards. You have also served on many organizations. What were the biggest drivers for the success you have experienced in the field of nursing?
I’m not sure it’s possible to clearly pinpoint the answer to this question, no matter what field we pursue. I “came of age” at a time when graduate education in nursing was essentially “free” to anyone capable and eager to pursue it, and I had the benefit of receiving my degrees at institutions that had some of the best faculty in the world. I began writing for publication within my first five years of practice (uncommon) and was prepared well for practice, education, andresearch before I was 40 (also uncommon for nurses). Over time, I led the profession through the strength of my scholarship (editorials, grants, publications, and presentations) and the strength of relationships built through roles across many health care sectors and professional associations. I followed my passion for improvement, regardless of whether I was a volunteer leader, middle manager, or executive leader, and that led to involvement in many of the cutting edge issues of the day. I’ve not always been on the side of the majority in my field, but I am someone who does not shy from asserting a position and letting others decide its merits. I’ve had wonderful mentors, within and outside of nursing, and I am grateful for the opportunities they opened up to me. By showing up, keeping commitments, and being willing to forge partnerships with others, the opportunities to lead just kept coming. It’s been a great career.
What changes do you envision in the roles of nurses as we move forward into the future, especially with the ACA?
We’re already seeing an exponential increase in the opportunities for advanced practice registered nurses (nurse practitioners, nurse anesthetists, nurse midwives, and clinical nurse specialists) as the barriers to APRN practice are eliminated across states and the demand for health care from previously uninsured populations increases. Right now, it appears that there will be new roles for nurses in basic practice outside of the hospital walls, such as, in primary care, care coordination, hospice and palliative care, and the many innovations that will occur to help elders age in place. Public health infrastructures are crumbling throughout the country, but current crises with infectious diseases, such as Ebola, may clarify the need for a public health workforce. We may also need public health nursing expertise in new forms of health care “homes”, as organizations become seek or are forced to become accountable for the health of populations in addition to individual patients.
What are your thoughts on the high turnover rate of nurses and what steps should be taken in helping to fix it?
The graduates of nursing schools over the last few years might argue with your premise of “high turnover, as they had a hard time finding jobs during this last economic slowdown because nurses have been remaining in their positions for longer than expected. Nurses may leave jobs for 1-3 more academic degrees during their lifetime, and because most are female, there is inherent turnover due to childbearing responsibilities. Nursing offers so many career opportunities that turnover also occurs because it is the norm to acquire certain experiences early on in order to prepare for other roles later in one’s career. I wish the turnover statistics accounted for these normative, and somewhat desired, forms of turnover. But it is also true that hospitals and other organizations have not provided the kinds of support for new graduates that are necessary to provide a smooth transition to practice. Nursing desperately needs a universal residency program to reduce the turnover that occurs because new nurses are expected to “sink or swim.” Finally, turnover comes from environments that do not have the characteristics known to enhance nurse satisfaction, namely, structures that engage nurses in accountability for their practice, good physician-nurse communication and teamwork, strong front-line management, and environments free from bullying behaviors and insufficient staffing. Nurse satisfaction and patient satisfaction are highly correlated, so hospitals that attend to the quality of nursing work environments have fewer turnovers, better nurse satisfaction, and better patient satisfaction.
How you do you foresee the relationship between doctors, physician’s assistants, and advanced practice registered nurses changing over the next few years?
The biggest barrier to effective teamwork among these groups of providers is the disagreement between organized medicine and nursing about the roles each is prepared to play, primarily in primary care. Nurse practitioners have achieved full practice authority in 19 states, and the research base now confirms that all groups are effective primary care providers. We are beginning to see the first inter-professional programs that will bring these groups together during their training years, thus further clarifying the competencies each possesses. Once the practice acts have changed throughout the country, the public posturing between medicine and nursing will diminish, and teams of professionals will work together for the good of patients and populations, as they do now in most areas of the country.