Rose M. Rivers, PhD, MSN

Robert Wood Johnson Executive Nurse Fellow, 1997

    • February 2, 2005

Position: Vice President for Nursing and Patient Services
Shands Hospital at the University of Florida
Gainesville, Fla.

Fellowship Goals
Rose Rivers, the 12th of 16 children born into an African-American family in the small Florida town of Reddick, began life—as she puts it—"not expecting much." It was after she left home that she came to realize that one's own expectations are all that limit one's opportunities. Her career is evidence that she never forgot that lesson. Starting at age 16 in a Florida nursing home, Rivers advanced steadily through a series of nursing positions and educational degrees, most of them in Gainesville at the University of Florida and its primary teaching hospital, the 576-bed Shands Hospital at the University of Florida.

In 1997 Rivers became Shands' senior director of nursing and patient services, an advancement that catapulted her into the hospital's executive ranks, a new and not altogether comfortable milieu. Rivers had been responsible for oversight of a set number of units and her boss was a fellow nurse. Suddenly she was responsible for the entire department of nursing and was reporting to the chief operating officer. As she was only too aware, her skills in negotiating and communicating would have a greater impact and scope if they were enhanced. She felt that access to teachers or mentors to facilitate learning leadership skills at the executive level was imperative.

Seated at a table with primarily white males, she says, "I felt the weight of the responsibility to ensure that issues pertinent to nurses, patients and their well-being were on the table, and I realized that enhancing my skills to deal at this level of the organization could make the difference for outcomes related to nurses and patients." In her RWJ Executive Nurse Fellows Program application, Rivers wrote, "My purpose for seeking participation in this program is to develop better ways to manage challenges and keep them from overwhelming my work experience and career development."

Fellowship Experience
The program gave Rivers just what she had hoped for—a supportive environment where she could learn about the subtle intricacies of executive leadership and the need for and uses of politics (with a small "p") to influence policy. As she puts it, "If you look at things only on the surface, you have only a surface understanding." Although some of her colleagues with more executive experience considered the seminars too elementary, Rivers found them valuable, including the sessions on negotiations, communications and executive presence.

"Part of what I learned in the fellowship is that if you want your message to be heard, you have to bring a message that is hearable." Her mentorship with Michael D. Means, CEO of Health First, a Florida hospital organization, was equally rewarding, and the two remained in contact after the fellowship ended. The beauty of the mentoring relationship was that it enabled her to talk to a top health care executive and observe his interactions with colleagues without fear that she herself was being evaluated, says Rivers.

Her fellowship project was to improve the coordination and quality of care for Shands' kidney and liver transplant patients—an area in which she had previous experience as a nurse supervisor. Rivers worked with a transplant surgeon and set up a steering committee representing all facets of the transplant system. They looked for opportunities to improve communications between caregivers and to integrate the various processes involved.

The results, Rivers reported, ranged from improvement in the timeliness and accuracy of lab tests to creation of a room devoted to transplant education materials for patients and their families. Creating a new position of nurse manager for transplants improved overall administration. Although Shands continually seeks quality improvements, an effort of this scale would not have been undertaken without the fellowship and its resources, Rivers said. The funding helped with such aspects as creating the education room, developing new testing protocols and hiring a part-time project coordinator to schedule committee meetings and handle other logistics.

Fellowship Impact
When she became senior director of nursing, Rivers initially intended to keep the position only a year, thinking that she might leave the hospital altogether. However, the fellowship "got me to start looking forward instead of back," and her outlook on her job and its opportunities changed. Later, when she was appointed a vice president as part of a reorganization, Rivers credits the program with giving her the tools to assert herself and her position and to push for what she believes in, including promoting a more collaborative relationship between management and the nurses' union.

Although before she was content "to go with the flow," she now feels accountable for her leadership—making presentations to large groups, and leveraging her position to bring patient care interests to the table. "When you have the tools, you have the ability to take risks," she says.

"I had to un-box myself," she wrote in her final fellowship report. "I didn't realize that I was so bound by traditional ways of doing things and so bound by solid lines of authority. I came to realize that I was the one that I was waiting for."

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