RWJF Executive Nurse Fellow Moves from Clinical Nursing to Community Health and Health Disparities

    • July 10, 2014

Overview. Cynthia Alee Barnes-Boyd, PhD, RN, FAAN, wanted to improve the health of the residents of Chicago. But as an administrator at the University of Illinois Hospital in Chicago, she realized that her dream required her to move out of the hospital and into the community. Later in her career, she concluded that improving the health of the most vulnerable communities required more than the work of a single institution.

Could Chicago’s academic, housing, medical, and spiritual leaders come together to create a healthier city? She created, and directs, the Healthy City Collaborative to help answer that question.

An early role model. Growing up in suburban Chicago in the late 1960s and early 1970s, Barnes-Boyd does not recall any nurses in her family. Also, no one in her immediate family was ever seriously ill, so her interactions with medical professionals were limited. But she remembers watching an African American role model on an NBC television show called Julia, in which the lead character, played by Diahann Carroll, was a nurse in a doctor’s office.

That led her to join a Future Nurses Club in high school, “and that’s where my understanding of the nurse’s role began,” she recalled. “From a young girl, I wanted to be a nurse.”

Education and early career. Barnes-Boyd started her nursing education in a small, private nursing school in southern Illinois, where students claimed they had only seen Black people on television—an ironic reality, she said, that “shaped the kind of nurse I ultimately became: a strong advocate for ethnic minority populations with a lot of my work concentrated on health disparities.”

Barnes-Boyd soon transferred to a three-year nursing diploma program at Wesley Memorial Hospital, then affiliated with Northwestern University in Chicago. One of only three Black students, she started an association for Black nursing students. “That had an influence on the way I view—even now, as a mentor—how to be successful as the ethnic minority student. I never ever use the term minority, and I am not one.”

Building upon her education, Barnes-Boyd entered the BSN program at the University of Illinois in 1973, working evenings and nights in pediatric nursing at the University of Illinois Medical Center to pay for her degree.

Recognizing an unmet need at the medical center, she and another nurse created the hospital’s first (and unofficial) pediatric intensive care unit, using two rooms on the pediatric floor, with furniture rescued from the basement. That initiative paid off, not only for patients but also for her professional advancement. After graduating in 1975, Barnes-Boyd was named head nurse of the medical center’s now-official pediatric intensive care unit, a role that later expanded to include the neonatal intensive care unit as well.

From clinical care to the community. Barnes-Boyd’s career path took her to seven progressively advanced positions from 1978 to 2014—a path that ultimately allowed her to move from clinical nursing to a career in community health. “I’ve never left a position because I was unhappy,” she explained. “Rather, I had the opportunity to move to the next phase of my career.” Meanwhile, she continued to accumulate nursing degrees, earning an MSN in 1979 and a PhD in 1990, both from the University of Illinois at Chicago. “The first two positions I had were those I applied for as they were. Every other position that followed I have created, taking advantage of circumstances.”

Barnes-Boyd recalls the exact moment that she realized she should get involved with community health initiatives. As a critical care clinical specialist at Wyler’s Children’s Hospital in the late 1970s, she was involved with trying to resuscitate a baby who had drowned in a mop bucket.

“That was the moment I realized I was in the wrong place, that I was on the wrong side of the problem,” said Barnes-Boyd. “This baby should not have drowned in a mop bucket. Something should have been tended to long before this happened.”—Cynthia Alee Barnes-Boyd

From then on, Barnes-Boyd broadened her focus. One of her first efforts involved securing a federal Special Projects of Regional and National Significance grant, which allowed her to evaluate a model in which nurses make home visits to newborns who were healthy when they left the hospital but identified as at risk of dying in their first year of life. The visiting nurse program “followed families up to 14 months and addressed some of the social reasons to explain why babies die.” A second federal grant added community workers to the model, and Barnes-Boyd evaluated the effectiveness of this team in her PhD thesis.

In 1990, she helped reopen a community health center named Mile Square Health Center, which had been providing health care services to Chicago’s public housing residents for more than two decades before closing due to bankruptcy. Mile Square became a part of University of Illinois at Chicago’s health system, with Barnes-Boyd serving as its executive director. Over the next seven years, she expanded it to four different sites before moving on to a position of special assistant to the vice chancellor for community health for the university. By 2014, Mile Square was serving more than 24,000 patients in 14 locations.

In 2000, her next community role was director of the University of Illinois at Chicago (UIC) Great Cities Neighborhood Initiative. “The university was developing its Great Cities program—uniting the health sciences colleges and medical center campus and the liberal arts campus to harness the resources of a university to serve the community,” she said. The Neighborhood Initiative was one of its flagship programs, helping to build partnerships through scholarship, research, and service.

While serving as director of the Neighborhood Initiative, she also held the position of assistant dean for community health initiatives at the University of Illinois at Chicago’s nursing school. In 2012, she was thrilled when the university’s new vice president for health affairs announced he wanted to focus on health disparities. “I said to him, ‘This is the first time our mission of the health science system is aligned with the our mission as a-land grant university and responsive to the needs of the city such that we focus on the people we are supposed to be serving as a state institution.’”

“I’m interested in developing programs where people are—beauty salons, churches, laundromats.”—Cynthia Alee Barnes-Boyd

Connecting with RWJF. As an executive, Barnes-Boyd sometimes felt isolated, “like I didn’t have a peer,” she recalled. “I was a nurse in a senior-level university position, in the midst of all the boys in suits. When I accepted one of my position, the director got up and said, ‘We have a twofer—a woman and a person of color.’ At the time, I didn’t know what to say. We had a good relationship and maybe he felt like it was okay to say that in my presence. But... I was offended by it.”

In 2006, Barnes-Boyd was accepted into Robert Wood Johnson Foundation Executive Nurse Fellows, a three-year advanced leadership program to address the needs, opportunities, and challenges of registered nurses in senior leadership roles. Through coaching, education, group training, and individual initiatives, the fellowship builds capacity among nurses to help transform health care at the local and national levels. It enrolled its first cohort of nurses in 1998; its final cohort starts in 2014. For more information, read the Program Results Report.

“I knew that what I needed was a place to talk freely about what was challenging in my career,” she said. Ultimately, she found in the program “the mentoring I had been craving.”

“I was not in a traditional nursing role, and people often asked, ‘What made you leave nursing?’ But I didn’t leave nursing. I’m a nurse in a unique position.”—Cynthia Alee Barnes-Boyd

Healthy City Collaborative. As part of the RWJF Executive Nurse Fellows program, Barnes-Boyd received funding to develop a leadership project based on a community problem. She didn’t hesitate, having long recognized that improving the health of Chicago’s citizens meant cooperating with Chicago’s academic, housing, medical, and spiritual leaders.

When Barnes-Boyd presented her business plan for a healthier city to a member of the faculty, “he initially said a lot of nice things, but he said it was too big of a plan,” she remembered. “And I thought, ‘Who is he to put boundaries on what I can do?’”

Characteristically, Barnes-Boyd plunged in, creating the Healthy City Collaborative. The multidisciplinary workgroup engages university researchers, external partners, and community leadership in conversations and research to benefit the health of Chicago. Its research agenda reflects “the broadest definition of health, which acknowledges interrelationships among individual, social, environmental, political, and economic contributors to the health of the city,” says Barnes-Boyd.

Barnes-Boyd has directed the collaborative since 2006. It is still thriving in 2014, and she acknowledged, “I am proud that I was able to accomplish what I set out to accomplish.”

Ties among the Executive Nurse Fellows also endure through social media and personal contacts. “Within my cohort, we all brought different gifts,” she concluded. “One of the gifts I contribute is thinking big and bold, and then assuming you’re capable of doing it. You can’t put restrictions on yourself due to the profession you are in. And I often think nurses do that because no one tells them to think about doing it differently.”

RWJF perspective. The RWJF Executive Nurse Fellows program was created in 1997 to capitalize on the profession's strengths and build the leadership capacity of nurses. The leadership development program was designed to prepare a select cadre of registered nurses in leadership positions for influential roles in shaping the U.S. health care system of the future.

“Because of their front-line experience with patients and families, nurses bring a unique and valuable perspective to local and national efforts to transform our health care system,” says Maryjoan D. Ladden, PhD, RN, FAAN, RWJF senior program officer and program alum. “The Executive Nurse Fellows program has part of the Foundation's building human capital strategy to develop a diverse and well-prepared workforce and leadership.”