Position: Director, Office of Public Health Nursing and Professional Development
Division of Public Health
North Carolina Department of Health and Human Services
Joy Reed is passionate about two things—nursing and public health—and from her position in the North Carolina government she has sought to maintain a strong voice for both in state policy. But Reed confronted a number of challenges, including staff reorganization and the march of managed care, and she found it increasingly difficult to remain a forceful advocate for nursing and public health within the state bureaucracy. With a bachelor's in nursing (Duke University), a master's in community health (the University of North Carolina at Chapel Hill) and a doctorate in education (North Carolina State University), Reed had no shortage of formal education. But she believed her leadership skills could be sharpened. If she could improve her abilities to negotiate, persuade and articulate a vision, she reasoned, it would mean a stronger voice for public health nursing at the policy table. "Perhaps the greatest thing I still need to learn is to trust my instincts, take more risks, and have more confidence in my own abilities," she wrote in her RWJ Executive Nurse Fellows Program application.
Reed, the only public health nurse in her fellowship class, had some logistical difficulties early on. Processing of the initial fellowship funds, for example, was delayed because the money did not go through the state's standard grants procedure. Once underway, however, the fellowship proved to be highly valuable—to both Reed and the state's 86 local health departments. Her project focused on helping these local offices revise their billing systems to conform to a new state system for reimbursing services to Medicaid patients. The undertaking—large and complex, both administratively and technically—entailed negotiating new billing codes and rates with the state Medicaid office, educating the local health staffs on using the codes and ensuring necessary changes in the computer program. Reed would have been involved in some aspects anyway but not nearly so extensively had she not taken on the transition as her fellowship project.
Reed says she certainly would not have negotiated the codes and rates, an aspect critical to the local health departments. At stake were millions of dollars in reimbursements. In the first year after the new system's July 2000 startup, the state sent the local departments an extra $12 million as the result of one negotiated provision alone. Reed used some of her fellowship funds to purchase audit tools and manuals for the local health departments and to hire outside experts to provide training. The state would not have covered those expenditures, and it was questionable how many of the local departments would have dipped into their own limited budgets, she said. She also used fellowship money to attend a Harvard workshop on negotiating skills.
Along with the project, she credits the battery of leadership tests and the Core Resource Team coaching as major contributions to her leadership development. Interacting with the other fellows, including members of the 1999 and 2000 cohorts, was another valuable aspect—a network of peers from whom she could learn. Although she was the sole public health nurse in her class, in the 1999 class eight others joined her.
Reed's mentor, assigned by the program staff, was the dean of a school of public health. They had several meetings and she shadowed him for a day. Their styles, however, "were not a good fit," Reed says, and the relationship failed to flourish. The program's mentorship component needs to be more clearly defined, she says.
Reed says the fellowship taught her three main leadership lessons. One is the need to separate business from personal feelings, especially in negotiations. She believes that drawing the line between the two—for example, angrily arguing a point with an adversary at the negotiating table and then going out to lunch together—is harder for women to do than men, but just as necessary. Second is the need for full communication when change is coming to an organization. You can't give people too much information or give it too early, she says. Third is that initiating change and maintaining change each require different skills. The former, she says, demands the ability to articulate a vision, the latter the ability to provide support and encouragement.
During her fellowship—and at least in part because of it—Reed decided to run for the presidency of the Association of State and Territorial Directors of Nursing. She won, and because of that position, became chairperson of a group made up of the heads of four national nursing organizations involved in public health issues. The group—the Quad Council of Public Health Nursing Organizations—is developing a national set of public health nursing competencies as one of its projects.
At the fellowship's conclusion, Reed wrote, "I am much more willing to put what I believe 'ought to be' out there for people to see and then find a way to make it happen."
In June 2008, Reed won the American Nurses Association Pearl McIver Public Health Nurse Award for her significant contributions to public health nursing.