The Nursing Profession: A Platform for Leadership
Mary Wakefield, PhD, RN, is administrator of the Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services.
Most nurses can reflect on their careers and see multiple pivot points—times when decisions were made that directly shaped their professional trajectory. For some, those decisions were carefully planned and executed with an aim of staying in the boundaries of traditional and very meaningful nursing roles.
That, however, wouldn’t characterize my career path. Serendipity, willingness to operate at the edge of one’s comfort zone, seeing the relevance of nursing knowledge in non-nursing settings, and cultivating a mix of expertise and breadth of relationships in and outside of health care were all key to the path I took and most of the positions I’ve held.
Nurses may end up in very different places, but my bet is that we start from similar beginnings. For me, the appeal of nursing took root when I was still in high school, working part time in a small rural hospital and a nursing home in my hometown of Devils Lake, North Dakota. I remember clearly rushing five minutes across town to work occasional back-to-back shifts from evenings at the nursing home to night shifts in the hospital.
From those traditional health care settings, the lessons I learned working alongside nurses were about more than accurately taking an elderly resident’s blood pressure or carefully feeding a newborn. On the Northern Plains of the 1970s, far from the subspecialty expertise and high-tech medicine of today’s major academic medical centers, those nurses coordinated care and found ways to deliver care more efficiently because the circumstances required it. And, important to a young person contemplating a nursing career, the nurses I worked with always stepped in to guide and stepped up to help. From those role models, I learned to view challenges as opportunities to innovate, and I learned what exceptional patient care looked like.
Fast forward to 1987. With a doctoral degree in nursing in hand, I was offered a position as a Legislative Assistant in the Washington, D.C., office of a U.S. Senator. Taking the job meant leaving a tenured faculty position. Not knowing anyone nearby who could give me advice, I cold-called three national nursing organizations in Washington and left messages.
"For many nurses, the pathways that you see will be the pathways that you build."
One person called me back: Polly Bednash, PhD, RN, FAAN, at the American Association of Colleges of Nursing. I don't remember what she said as much as how she said it. “Of course, you should take the job! We need more nurses in all leadership levels in Washington!” As if leaving my home state to go to faraway Capitol Hill was the most obvious thing to do. That conversation was a first step toward becoming the first nurse to lead HRSA.
These early life experiences—and all that followed—brought home four lessons that have served me well over the years.
The first is that nurses need to lean into change.
Whether American nurses are practicing in rural North Dakota or in Capetown, South Africa, we have opportunities to embrace and shape changes in health care. The pace of change is accelerating and much of what is unfolding can provide new opportunities for nurses and leverage the profession’s expertise—if we look for them.
The second lesson is harder. It is to look for opportunities where others see limitations. For example, some 65 years ago my dad, then a fairly young pilot, left a well-established aviation business in Wisconsin to start a new one in North Dakota. Some view North Dakota as an out-of-the-way, flat, plain patch of country. But my dad saw it very differently. From his perspective, the entire state looked like a runway, where he could take off and land just about anywhere.
Nurses have our own special view of health and health care in America, based on education and experience. For nurses who choose to work at the intersection of health policy, health, and patient care, the observations that emerge from our unique vantage point can help shape not just how health care is delivered locally but everywhere. There is a world of opportunity to leverage the profession’s ideas and expertise—particularly if we’re open to innovation in the face of obstacles.
The third lesson is that saying “I can’t” is rarely a good option. If something is truly important, the answer to pursue is “I’ll find a way.” The lesson here is to check in on your attitude, and when necessary, adjust your vocabulary, from “I can’t” to “I can” or, even better, “we can.”
The fourth lesson is to always be ready to lend a hand. And, conversely, don’t hesitate to reach out for help when you need it. Staying in touch with the needs of others is an abiding value of the nursing profession. It reflects who we are, regardless of where our career paths take us.
These are simply stated lessons—but don’t let them fool you. They are far easier to articulate than to apply. Nevertheless, they can help position nurses to take new pathways into leadership. But remember, for many nurses, the pathways that you see will be the pathways that you build.