Juliann G. Sebastian, PhD, MSN

    • February 2, 2005

Position: Professor of Nursing and Assistant Dean for Advanced Practice Nursing
College of Nursing
University of Kentucky
Lexington, Ky.

Fellowship Goals
A lifelong Kentuckian from a family deeply rooted in the Blue Grass State, Julie Sebastian had achieved academic and professional prominence early in her career. After earning bachelor's and master's degrees in nursing at the University of Kentucky, she filled positions of increasing responsibility with the University's College of Nursing. She initially served as a supervisor of nursing students doing community health work in rural Appalachia. By 1998, she had become an associate professor as well as assistant dean for advanced practice nursing. The latter put her in charge of the master's and post-master's programs and the academic clinical practice program for faculty members.

Along the way, she earned a PhD in business administration at the University's College of Business and Economics. At age 46, Sebastian looked forward to a continued role of influence in Kentucky nursing.

But there was one thing that she felt was missing from her career: a broader stage. "While my roots in the state provide me with an understanding of its culture, needs and heritage, I find that I need more national involvement in order to make a real difference in the future of health care," she wrote in her application to the RWJ Executive Nurse Fellows Program. "I am particularly interested in seeing how other organizations manage multiple, conflicting pressures and especially those organizations that have made significant progress and are doing innovative work." Her specific goal was to more fully integrate nursing into the clinical enterprise of academic health science centers.

Fellowship Experience
One of the main challenges that Sebastian faced in her job as assistant dean was to work with other faculty members to determine how best to develop and test new health care delivery models. Consequently, she focused much of her fellowship work on developing prototypes of ideal academic clinical practice models. Her project, "Factors Influencing the Viability of Academic Clinical Nursing," included creating a written survey on academic clinical practices, which she fielded to about 600 nursing programs around the country. The goal of the survey was to document the status of academic clinical nursing programs around the country and to identify the variables that have contributed to success. The project also included a six-week visit to the University of Utah to study in detail that institution's academic practice program. The program is extensive and provided a helpful model.

While Sebastian continues work on the survey and related publications, the project has already paid concrete dividends at the College of Nursing. As a result of her work, the college increased its number and types of clinical practice arrangements with faculty. For example, faculty clinical appointments were expanded in acute and primary care, and new clinical contracts were added for family nurse practitioners and psychiatric clinical nurse specialists. Additionally, Sebastian assisted Associate Dean Marcia Stanhope with opening two college-operated, nurse-managed clinics at elementary schools, a third at a middle school, and a fourth at a welfare-to-work program for single parents. These new arrangements have expanded the educational opportunities for nursing students and faculty and the access to health care for underserved populations.

Her $30,000 in fellowship project funding included support for the survey, her Utah visit, a consultant to help plan for billing for faculty practice services at the University of Kentucky, and the purchase of hand-held computers for faculty and staff clinicians to test point-of-care data collection. She used part of her $15,000 in leadership development funds to attend conferences related to one of her main fellowship objectives: better understanding change and how to work with systems undergoing change. Other expenditures included purchase of a laptop computer and travel to visit her mentor, E. Travis York, retired chancellor of the State University System of Florida, who was chosen for her by the National Program Office.

Like herself, nurses tend to be rooted in their communities, Sebastian says, noting that most are women, many married and raising children. For Sebastian, herself the mother of a grown daughter, the seminars provided an opportunity to move out of her community and learn from and share with experts in a broad range of fields from across the country. It was also a chance to interact with other fellows representing a wide geographic and professional span.

Initially Sebastian said the seminar content was too heavily focused on leadership style and not enough on concrete issues. However, she says the program staff reacted quickly to correct the imbalance. Particularly interesting to her was a seminar devoted to gun control, health care and other political issues and another seminar on patient safety and medical error.

Although some fellows complained about their mentorship experiences, Sebastian reports that her experience was an enthusiastically positive one. She visited her mentor twice in Florida, accompanying him to meetings and observing how he dealt with issues and a range of people, including political and community leaders. The resulting relationship remains a warm one. In fact, Sebastian says, "I felt as if I got two mentors instead of one,"—a reference to York's wife, Vam, a successful businesswoman.

In addition to York, Sebastian got help from her designated leadership coach—Robin Morjikian, deputy director of the fellowship program. Sebastian admits to being intimidated by the prospect of the intensive coaching session conducted by members of the Core Resource Team halfway through the three-year program, but the discomfort quickly disappeared. "What a gift," Sebastian says: six people focused for several hours on just one thing—helping her.

Fellowship Impact
Recently promoted to full professor, Sebastian remains at Kentucky's College of Nursing and continues to oversee the academic clinical practice program. In addition, she now co-directs the college's new Doctor of Nursing Practice Program. As a result of her fellowship, she says that she is now more reflective about the leadership decisions and issues that confront her—"much more inclined to analyze a situation from numerous perspectives. I hope I spend more time understanding different points of view."

As part of this deepened appreciation for the dynamics of the leadership process, Sebastian says she has learned the critical effect that communication has on people she deals with—the importance of the words she chooses and when and how she delivers them. "The content of issues will change and I will always be able to learn and be informed. However, it is around the processes of shaping issues and of working with others to do so that I learned so much," she wrote at the fellowship's conclusion.