Advice on advancing into leadership, educating the next generation and improving working conditions from Chief Nursing Executive Peggy Norton-Rosko, DNP ’18.
Tell us about your role as a system-wide chief nursing executive.
I have oversight for nursing practice throughout the University of Maryland Medical System. We have 13 hospitals and 150 sites across Maryland. We provide 25% of the hospital care in Maryland. It’s an exciting time because we are moving toward functioning as an integrated academic health system rather than as several different member organizations. I started in May 2024 and have been involved in integration for clinical practice, standardization of nursing practice and standardization approaches for operating procedures across the system.
You started your nursing career in cardiac surgery and critical care. What did you envision for your nursing career, and how did you get interested in leadership?
Early in my career, I hadn’t really thought of an official leadership role. I loved being a clinical nurse at the bedside and an advanced practice nurse with a group of cardiac surgeons. After about 15 years as a clinical nurse, an intensive care unit manager position opened with a group of nurses I knew and trusted. I loved that role. From there, I was able to get progressive promotions into larger roles. I started to realize that I could have an even broader impact on not only patient care and outcomes, but also on nurses and nursing practice. I could support nurses in caring for patients, making sure that we could move barriers out of their way.
What advice do you have for nurses who aspire to leadership positions?
I’ve told nurses over the years, if you still think you have a desire to be hands on in clinical settings with patients, do that for as long as you want. You can always move into a line leadership role and get additional education and mentoring, but you can’t always go back to a clinical setting if you’ve totally focused your formal education on management. We all go into healthcare because we have a passion for taking care of patients and for partnering with other team members. Stay at the bedside for as long as that still drives your passion and then make your move to leadership.
How did earning a Doctor of Nursing Practice (DNP) from Chamberlain University fit into your career progression?
My first chief nursing officer role was a great motivator for me to get my doctorate. My role was more about creating the vision and guiding its implementation than hands-on doing. I needed additional education and training on how to take what we know is the best evidence and translate it into how we do our work. Chamberlain’s DNP program helped my transition into that next level of leadership.
What was your experience like in Chamberlain’s doctoral program?
Support from faculty and students was the most valuable part of the program. It was interesting to get the perspective of what was happening in places other than the Chicago market, which is where I’ve spent most of my career. Once it was all done, I missed coming home from work and doing papers and online chats with the class. I lean on what I learned every day. It still helps me as we look at big organizational problems.
You’ve said that expanding the nursing workforce is job No 1. What do you see as effective ways to do that?
One of the things we’re doing at the University of Maryland Medical System, that I inherited from my predecessor, Dr. Lisa Rowan, is partnering in a different way with schools of nursing across Maryland to provide clinical instruction to students. Our nurses are acting as the instructors for undergraduate students who are coming through our organizations to do their clinical rotations in our Academy of Clinical Essentials (ACE) program.
For example, if I’m one of the University of Maryland Medical System nurses who’s acting as the clinical instructor, I’m the nurse of record for my patients on that clinical day. The same four students come to work with me every week on the same day to take care of my clinical assignment. They’re with me the whole 12-hour shift fully immersed in the clinical experience.
Our nurses who sign on to be clinical instructors love it. They feel like they’re advancing, while being able to stay at the bedside. Many of them want to teach, but they don’t necessarily want to go back to school. The student feedback is even more positive. They tell us they feel like they know what it’s going to be like to be a nurse.
Bringing in more practice-ready nurses is one challenge, but there’s also the continuing issue of burnout and retention. How are you addressing it?
One thing we focus on is nurse manager burnout, because they are so key to the success of every nurse in their department and the patient care that gets provided. There is some research in the medical literature that shows when physicians in training have had a specific educational intervention around improving their emotional intelligence, they have a higher level of resiliency and satisfaction with their own practice, and their patients have a higher level of satisfaction with their physician as well. We’re interested in finding out if we can do a similar educational intervention with our nurse managers. Will they have less burnout? Will they have longer tenure and be more effective in supporting their staff? Could that translate into lower turnover rates?
How do new technologies and innovations fit into your efforts to expand the nurse workforce and reduce nurse burnout?
One thing we have implemented across our system is virtual nursing. It’s having an impact on nursing workload at the bedside because we’re able to give some important tasks like patient teaching and family care coordination to virtual nurses. Sometimes they do virtual rounding when the physician is there and the bedside nurse is pulled away with another patient. We’re starting to explore how we could use virtual nursing for our higher-risk patients once they’re discharged to help prevent readmissions.
We’re also using a precision staffing tool to help us identify the workload intensity of each individual patient. As we’re making patient care assignments, we can identify if somebody’s workload is too high per shift. This helps with nursing workload and the perception of fairness on the units. If a nurse seems to be struggling, we can ask, “What did their last several shifts look like? Was their workload too high? Do they need a different level of assignment?” It’s a way for us to help match the nurse’s skill set with the acuity of the patient, which is as important as it’s ever been, especially given the relative inexperience of the nursing workforce across the country.
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