One Nurse’s Leadership Journey
May 10, 2014, 3:00 PM
Cynthia Crone, MNSc, APRN, CPNP, is deputy commissioner of the Arkansas Insurance Department, where she created and now leads the state’s Partnership Health Insurance Marketplace. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program.
Being asked to write a post about nurse leadership for National Nurses Week presents a wonderful opportunity to reflect on my nursing journey and express appreciation for the many nurses and other leaders who have played a supportive role in my development. A career in public health with an emphasis on vulnerable populations, including most recently directing efforts in Arkansas to implement the Health Insurance Marketplace, has reinforced with me the critical role nurse leaders play in the politics and policy of health care and how very important it is to foster and support community involvement and interdisciplinary collaboration by younger nurses.
I started nursing school in the mid-1970s. Nurse practitioners were just coming on the scene. After graduation I obtained certification as a pediatric nurse practitioner and traveled to 10 rural counties to hold “well child clinics.” I learned a lot from the public health nurses. I loved my job. The work helped me better understand the bio-psycho-social-spiritual art and science of nursing and the social determinants of health. Further, through interaction with nurse and other community leaders, I learned that another element—political–can’t be ignored.
During this time, nurse mentors guided me to accept leadership roles in nursing organizations—Sigma Theta Tau, Arkansas NAPNAP, and the Arkansas Nurses Association. I will never forget the grace and wisdom of those amazing nurse leaders and coaches. Working with them, my earliest advocacy was for the Arkansas Advanced Practice Nurse Act and the Arkansas Child Passenger Safety laws. Little did I know that the controversies surrounding automobile safety restraints would mirror the later controversies surrounding the Affordable Care Act. Opponents back then said whether to place a child in a car seat was a “personal rights” decision, not a health or economic decision. Thirty years later, this is an accepted law and part of our culture. Maybe in fewer than 30 years most everyone will support the Affordable Care Act and take advantage of cost effective, consumer-focused preventive services and enhanced chronic disease management. Nurse leaders are vital to this monumental culture change.
As my journey in nursing continued into the ’80s, my pediatric nurse practitioner (PNP) supervisor—also a PNP—encouraged me to accept a position as statewide pediatric nursing consultant and later maternal-child nurse consultant at the Arkansas Department of Health. It became clear to me that healthy children start with healthy mothers, and I began my first educator role as a perinatal outreach nurse with the University of Arkansas for Medical Sciences (UAMS) while I attended graduate school.
'We must continue our work to nurture young nurses and other leaders to be a part of change toward a new culture of health.'
The ‘90s came, and so did the crack cocaine epidemic. In my role as perinatal outreach nurse, I began to get all the referrals of pregnant women with substance use disorders. There were no resources for care. That was not my specialty; I was a maternal-child nurse. But working with a new maternal-fetal medicine physician and networking with others including state and federal agencies, private foundations, community groups, and philanthropists, we obtained funding for a perinatal treatment, prevention, and research program. It was innovative and comprehensive. We treated the mother-child dyad and then the families. We had a health clinic, housing, mental health clinic, and child care center. I served as the inaugural executive director for 15 years and depended on our skilled and dedicated evaluators to help guide data-driven improvements. We had great outcomes and became nationally recognized.
The century changed! Nurse colleagues and mentors encouraged me to apply to the RWJF Executive Nurse Fellows (ENF) program. They supported me, coached me, and even held a mock interview to help me prepare for the finalist interview. I was selected as one of 20 nurses from across the nation to enter the 2001 cohort—a tremendous opportunity to sharpen skills needed to help change the future health care system.
Fast forward to 2007. I was working at UAMS Partners for Inclusive Communities. My leadership role on two start-up projects led me to again partner with another key mentor in my career, a former state legislator who was a health champion and serving as the state’s Behavioral Health Division Director. In 2009, the Governor appointed him as Insurance Commissioner, and the following year he recruited me to lead efforts to establish the Arkansas Health Insurance Marketplace. This provided me an unexpected opportunity to learn more about the payer side of health care and to influence health and health care throughout the state of Arkansas. This leadership role continues to excite me. Like child safety seats, it’s a cause worth fighting for. And it provides a great opportunity for mentoring. In the past year the nurse-led Arkansas Health Connector has hosted students in nursing, public health, law, and public service.
My home is nursing and serving vulnerable populations. My colleagues and mentors have been diverse in their backgrounds. The connections are strong. Yesterday I heard from one of my ENF colleagues—an educator in Texas needing connections for her student. That felt good. We, and others, must continue our work to nurture young nurses and other leaders to be a part of change toward a new culture of health. More than ever, I love being a nurse and seeing positive change come to fruition. Our profession makes a difference. Happy Nurses Week!
This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.