David R. Marshall, JD, DNP, RN, CENP, NEA-BC

Abstract

David R. Marshall, JD, DNP, RN, CENP, NEA-BC, is vice president and chief nursing & patient care services officer at the University of Texas Medical Branch (UTMB) in Galveston, Texas. David R. Marshall, JD, DNP, RN, CENP, NEA-BC, is vice president and chief nursing & patient care services officer at the University of Texas Medical Branch (UTMB) in Galveston, Texas. LBB: Nurse leader roles have become very complex over the decades. Each of us is challenged to maintain our commitment. What are your leadership challenges and what sage advice do you have for our readers? DRM: Like many of the nurse executives I know, several challenges immediately come to mind. I think one of the foremost challenges involves thinking strategically about the workforce requirements necessary to achieve satisfactory outcomes for those we serve. In hospitals, one of the related challenges involves attracting and retaining experienced, talented nurses. The competition for these resources is stiff in my area of the country, and there seems to be a growing shortage. This increases the reliance on newly licensed nurses, and places a greater emphasis on preparing them to transition into fully independent practice in the shortest possible timeframe. One of the resulting challenges is not overburdening those responsible for serving as preceptors. I think we have to look for ways to allow those nurses considering a well-deserved retirement to continue to contribute through roles aimed at sharing their experience and knowledge. Advice: Know your frontline staff and the issues they face. Shadow them to understand the conditions and issues that they deal with on a daily basis. LBB: What drove you to choose nursing and to focus your career on nursing leadership? DRM: I took an emergency medical technician (EMT) basic course during the summer between high school and college. During that training experience, I had the chance to work with incredible nurse role models who created environments where patients received great care. That summer was very important to me and led me to choose a career in nursing. I observed nurses in critical care units, an emergency department, and in an operating room. I saw their work to keep patients and their families informed. I observed their interactions with physicians one minute, a patient and their family the next, and nursing assistants supporting care the next. Their adept ability to communicate their knowledge to all of those recipients was inspiring to me. Like other nurse leaders, my first leadership role in nursing was as a charge nurse. Somewhere along my journey, someone saw something in me and asked me to step into a more formal management role. That first management role was as an assistant nurse manager on the 3 to 11 shift on a medical floor. I was responsible for scheduling on my shift and ensuring things ran smoothly on the shift. I am not certain that I knew I wanted to be an executive nurse leader during that first management role, but along the way, with experience, I gained the trust of the staff and my peers on the other shifts. I think part of it was competitive: wanting to be the best, or get the best for the patients. Somewhere in there, I became aware of my ability to get incredibly talented people to accomplish great things on a shift. Then it was for a unit, and then it was for a department. It was ultimately for more than 1000 nurses for a health system. I sought education and advice from those more experienced, and I honed my skills as a leader. In the language that Kouzes and Posner use, I was good at encouraging the heart. LBB: What was your first job in nursing and describe how it influenced your nursing career? DRM: My first job was as a nursing assistant while in nursing school. I worked the night shift as a nursing assistant in a small hospital in my hometown, Pittsburg, Texas. In a small town environment like that, you take care of people you have known all of your life. Working as a nursing assistant gave me the experience of working in a team to provide care. I wasn't always sure why the nurse I was supporting asked me to do something or to do something in a certain way, so I think that led me to spend a little extra time explaining to nursing assistants I worked with when I became a RN, the why behind what I asked them to do. LBB : When did you graduate from nursing school, and what was your first job as an RN? DRM: I graduated from nursing school in December 1982. My first job in nursing was as a nurse resident; the residents rotated through different areas at UTMB. The residency program helped me to become a better nurse. I gained experiences that shaped my career. In the residency; I rotated through all of the internal medicine services in an academic medical center (e.g., coronary care, general medicine, medical intensive care, oncology, nephrology, and transplant). That was an intense first year, but it exposed me to a diversity of leadership styles and different unit microcultures. I saw the best and the worst, and I wanted to be a part of the best. I also thought I could help improve the best. LBB: When did you decide to move from a clinical role to nursing leadership? DRM: A nurse manager saw something in me, and I became a charge nurse, on the 3–11 shift. The following year, I became assistant nurse manager on the same unit. I learned the basics of scheduling and staffing from someone who had been doing it for years. The nurse manager took me under her wing, and I learned a lot about the importance of standard processes and holding people accountable. She encouraged me to be active in local professional organizations and to seek advanced education. She taught me the importance of setting a standard, making certain that everyone on the team knew what the standard was, and then following up to ensure when the standard was not met. LBB: How was the transition with staff from a peer clinician to leader? Please describe that transition and your recommendations from others considering a nursing leadership role. DRM: Tough. People who were my peers, I became their supervisor. I've always created an environment where their voices can be heard. I had to reintroduce myself to the people I worked with, the staff I had been peers with, the physicians I had been on rounds with as a staff nurse, and other members of the interprofessional team. It was hard not to be the rescuer when there was a tough clinical problem. I could give advice, but I really wanted those staff nurses who knew the patients the best to provide the solutions. LBB: What has been your passion, your true north as a nurse leader? DRM: My true north is the opportunity to work with really incredible people. The things we do in health care are difficult, and as leaders, we must create environments where staff can do their very best. I think back to my beginning when I was working as an EMT and the nurses who helped me. I bonded with patients and the nurses who cared for them. We need to create an environment for our employees and patients. LBB: Looking back over your career, what lessons have you learned that you are willing to share with our readers. DRM: I have learned that it is important not to take myself too seriously and that work isn't the most important thing. After I had been a nurse for about 10 years, I went to law school and kept a part-time job as a house supervisor. I also worked as a law clerk. I focused on work instead of trying to be a better brother, son, and active in my family life. I had been a nurse for 10 years and thought law would be something I could do as I got older. I got the law degree, passed the bar, and worked as an associate in a law firm for 3 years. It wasn't for me. I went back to the hospital full time and knew that nursing is where I should always be. Law helped me as an executive to appreciate the value of holding different perspectives. Nursing helped me to connect with people and that is most valuable to me. LBB: Share some highlights from your career with us. DRM: One of my first accomplishments as a nursing leader was serving as the lead for developing a tiered supplemental staffing model for the hospital. The first tier was for those staff who wanted full-time or part-time employment with benefits. The second tier was for those staff who wanted full-time or part-time employment with benefits, but who opted for additional pay for the willingness to float to similar units on a regular basis—a float pool of sorts. The third tier was for those staff who wanted more flexibility without a full-time or part-time commitment. For them, we created an internal agency, and those staff received premium pay in lieu of benefits. We created flexibility for staff while simultaneously meeting the workforce needs of the hospital. After September 11, 2001, I decided to explore disaster nursing. I came across an online disaster course offered by Sigma Theta Tau. The course mentioned disaster medical assistance teams. I did a web search and found that there was one based in my community, and I joined. My first deployment was to Florida in 2004. I was assigned to work the night shift in a special needs shelter in the Orange County Convention Center. I took care of one patient who was in the shelter with his mother. He was about my age, blind, and had some developmental delays. We bonded over the short few nights I was assigned to the shelter. At the end of my last shift in the shelter, he told me he adored me. I was flooded with emotion as I remembered why I became a nurse—to provide care, comfort, and safety to those who need it. Another more recent accomplishment has been opening the nation's first Maker Health Space in a hospital. “Making” is one aspect of a broader effort to create a culture of creativity and innovation. A Makerspace is a unique type of ideation and fabrication environment with an open ethos. Unlike traditional innovation centers where the focus is on generating ideas and methods that will later be produced, a Makerspace is equipped with tools, materials, and equipment to bring ideas into a live prototyping environment. The goal is to generate fast prototypes of ideas in an affordable manner. Similar to an open corporate gym, it promotes a culture—a prototyping and an ideation culture. The space has been open since September 2015. In that time, more than 200 nurses and healthcare professionals have visited the space. Through a part-time, interdisciplinary academic partnership with maker experts in another state, health care professionals are offered rapid courses in making. Four nurses have conceptualized and prototyped an innovation directly related to improving and delivering patient care in areas ranging from burn intensive care units to a correctional hospital. True north—it's what is really important to you. For me, it's family. I lost a parent early in my life. Now, I'm better at my connection to family. I recently did a course with Marshall Goldsmith who challenged me to ask my daughter how I can be a better dad. I've used it with my direct reports: What can I do to be a better supervisor for you? What have you learned? There are other things in life besides work. I sacrificed personal relationships by staying at work too long or getting too much education. LBB: What are you most passionate about? DRM: Creating environments where incredibly talented people can do good work. Hearing patient's talk about the care received. I like to make daily rounds to remind me of why we are here. LBB: David, what's on your top 10 list for nurses? DRM: My top 10: 1You can live by values and principles until you're tested. To be the best leader, you need to experience leading and failing. Both are important.2Be aware of self. Be cognizant of who you are and what you want to achieve in society.3Listen to people. Let them know you have heard their voice. Everyone wants to be heard. You need to know who haven't you heard from before making decisions.4Be the role model you want to see in others. If you want the team to have higher education, you must obtain higher education. I don't expect more of them than I do of myself.5Set a vision and help others to see that vision as a guiding light.6Connect staff back to purpose. Helping humans get back to health is my purpose. We must stay connected to why we became nurses.7Achieve more balance. Leadership takes so much energy. We need to maintain our energy level. We need to sustain our environments.8Nurse leaders must remember that it is all about the patients.9Remind staff about the work they do is very important.10Involvement is one of my values. Professional involvement. We have a duty to ourselves and to our profession to contribute and give back to the profession. LBB: What do you do for fun? DRM: I fish. I live in a waterfront house on an island. I like to fish. It is the fishing, not the catching, that is important. Baiting the hook, feeling the tug on the line, and ultimately catching the fish. It's good therapy. LBB: What else would you like the readers to know about you? What are you excited about now? DRM: Health care is at the point that interprofessional teams are really important. Nurse leaders can and will be leaders of those teams working together to improve their health. The care continuum is our next frontier. Things have come full circle. We are back to where nursing started: working in the community to get and keep people healthy. LBB: Thank you, David, for your contributions to nursing and society. Your leadership and advice are truly appreciated! DRM: My executive coach had me write my eulogy. It reads, “David loved his family and they loved him back.” LBB: I would add, David loves nursing and the profession, and patients have loved him back! Name: David MarshallHometown: Pittsburg, Texas (Pop. 4580)Current job: Chief nursing & patient care services officer for the University of Texas Medical Branch Health SystemEducation: BSN, University of Texas; MSN, University of Texas Medical Branch; JD, South Texas College of Law; DNP, Texas Tech University Health Sciences CenterFirst job in nursing: Staff nurse, internal medicine internship, University of Texas Medical Branch.Being in a leadership position gives me the opportunity to: Set a bold vision and work with incredible people to achieve extraordinary things.Most people don't know that I: Worked as a peach picker in my first job.My best advice to aspiring leaders: Find a way to serve. Martin Luther King Jr. once said, “Everyone has the power for greatness—not for fame, but greatness—because greatness is determined by service.” As leaders in the most trusted profession, I think we have a duty to give back.One thing I want to learn: How to play the guitar.One word to describe me: Enthusiastic. Name: David Marshall Hometown: Pittsburg, Texas (Pop. 4580) Current job: Chief nursing & patient care services officer for the University of Texas Medical Branch Health System Education: BSN, University of Texas; MSN, University of Texas Medical Branch; JD, South Texas College of Law; DNP, Texas Tech University Health Sciences Center First job in nursing: Staff nurse, internal medicine internship, University of Texas Medical Branch. Being in a leadership position gives me the opportunity to: Set a bold vision and work with incredible people to achieve extraordinary things. Most people don't know that I: Worked as a peach picker in my first job. My best advice to aspiring leaders: Find a way to serve. Martin Luther King Jr. once said, “Everyone has the power for greatness—not for fame, but greatness—because greatness is determined by service.” As leaders in the most trusted profession, I think we have a duty to give back. One thing I want to learn: How to play the guitar. One word to describe me: Enthusiastic.