Joan Shinkus Clark, DNP, RN, NEA-BC, CENP, FACHE, FAAN

Abstract

Dr. Joan Shinkus Clark is the senior vice president and system chief nursing officer for Texas Health Resources (THR) headquartered in Arlington, Texas. Dr. Clark joined the THR leadership team in 2008, assuming overall responsibility for the nursing enterprise across the THR system. THR has 25 acute care and short-stay hospitals that are owned, operated, joint-ventured, or affiliated with the system, representing more than 3,800 licensed beds. THR has more than 21,100 employees at fully owned and operated facilities plus 1,400 employees of consolidated joint ventures and more than 5,500 physicians with active staff privileges. In her system role, Dr. Clark has responsibility for advancing strategic nursing initiatives and represents nursing at the senior executive level.Dr. Clark has also been a member of AONE for 25 years and has served AONE and chapter affiliates in Texas, Florida, and Georgia on numerous committees and in multiple elected positions, including 2 terms: 1 as Region 4 and as Region 7 AONE board director. Dr. Joan Shinkus Clark is the senior vice president and system chief nursing officer for Texas Health Resources (THR) headquartered in Arlington, Texas. Dr. Clark joined the THR leadership team in 2008, assuming overall responsibility for the nursing enterprise across the THR system. THR has 25 acute care and short-stay hospitals that are owned, operated, joint-ventured, or affiliated with the system, representing more than 3,800 licensed beds. THR has more than 21,100 employees at fully owned and operated facilities plus 1,400 employees of consolidated joint ventures and more than 5,500 physicians with active staff privileges. In her system role, Dr. Clark has responsibility for advancing strategic nursing initiatives and represents nursing at the senior executive level. Dr. Clark has also been a member of AONE for 25 years and has served AONE and chapter affiliates in Texas, Florida, and Georgia on numerous committees and in multiple elected positions, including 2 terms: 1 as Region 4 and as Region 7 AONE board director. KK: What attracted you to nursing, and what were your early experiences in the field? JC: I grew up with 3 sisters in Pittsburgh, Pennsylvania, where my father was a community doctor. My father's office was in our home, and my mother assisted him in his practice. Watching my father practice, I saw the close connection he developed with his patients as he cared for them many times, not just during one episode of care. That is what convinced me to go into healthcare, but it was my older sister who convinced me to go into nursing. My sister now practices as a psychiatric nurse, and I followed in her footsteps but went into critical care nursing. I started in a community hospital ICU (intensive care unit), and after 1 year, transitioned to academic critical care nursing at Shands Hospital at the University of Florida. I was hooked on critical care because of the cutting-edge work being done to treat ARDS (acute respiratory distress syndrome) and cardiac surgery at the time. KK: Were there early mentors and role models who influenced you and shaped who you are today? JC: I have been very fortunate to have strong supervisors who have encouraged me to learn, grow, and take on greater responsibility. While I have thoroughly enjoyed my nursing leadership roles, I have to admit I it took some convincing to get me to go in this direction. When my first manager job presented itself, I didn't seek it out. I wanted to stay at the bedside, but my supervisor convinced me to step in because I was the better of two choices among my peers. It was a difficult transition, but I continued to be encouraged and supported by my supervisors. A few years into my manager role, a new CNO (chief nursing officer) was hired who took an interest in me as a person and as a leader. I soon began to aspire to being the same type of leader as this CNO and took on progressively more responsible leadership positions. That taught me the importance of identifying and mentoring potential leaders in the ranks. They may not see what you see in them, but you can influence them and help them to realize their full potential. After completing my graduate work at the University of Florida and a short tenure in informatics and education, I worked in an AVP (assistant vice president) role under the leadership of a supportive CNO. I took my first CNO position in 1995 at Floyd Medical Center in Rome, Georgia, and over the years, my CEOs (chief executive officers) have also been great partners and supported my growth as a leader. KK: What do you consider to be the major challenges for nurses in healthcare leadership positions today? JC: The major challenge is a dramatically changing healthcare environment and the transformation of nursing to professionals practicing at the top of their license and competency. Nurses are just beginning to evolve and understand their role within the continuum of care but ultimately I believe this will significantly change the profession in the future. Nurses have always been an important part of team partnerships around the care of patients, but the team boundaries are expanding, and nurse partnerships will expand as the boundaries blend to the right and left of the acute care hospital. KK: Does your role as a system chief nursing officer require a different set of skills and competencies than when you were accountable for one hospital? JC: Very much so. The skills and competencies for this role have been an ongoing discussion of AONE and some of my counterparts over the last couple of years. We have been working on revisions to the nurse executive competencies for the system CNE (chief nursing executive), as well as the tools and resources needed to assist new system CNEs transition into their roles. The board of directors created a forum, the AONE System CNE Task Force, for sharing best practices as we move towards standardization and alignment of nursing practice across multiple hospitals and settings. We have held sessions at the AONE annual conference over the last 3 years and plan a preconference session for 2015. We held a system CNE meeting in Chicago in 2013 to share best practices and learn from one another. We are developing tools and resources for system CNEs available through the AONE Web site and conducted, analyzed, and disseminated surveys of system CNEs over the past 3 years. We have put together a strategic plan of activities for the next 4 years to assure that this growing group of CNEs can access the tools and resources that will help them in their work. KK: What brings you joy in your work? JC: The ability to devote more time to strategy and mentorship while helping aspiring nurse leaders to gain the experience and confidence to become effective nursing leaders. I like to help my nurse leaders to stretch themselves in new ways, which often leads to fun and interesting challenges that may innocently begin as a “double dog dare.” KK: What is an example of a “double dog dare?” JC: One example is when I have “double dog dared” my nurse leaders to publish or do presentations. I generally do that when I want them to set goals, and it has been quite effective. KK: Our younger nurses worry about work-life balance. How do you achieve that in your busy life? JC: I am not sure that I am the role model here, but I feel that balance is something that you must insist on for your staff. I believe activities that promote health and well-being are a must in everyone's life. I try to get to my home on the water in Florida as often as possible since that is where I have the most balance in my life. My husband, who is a retired hospice nurse, stays at our home in Florida and cares for his 96-year-old mother. I try to be with them as often as possible, but that isn't always easy. KK: What contribution to nursing are you most proud of? JC: I am most proud of the work I have done in a couple of settings around creating new models of care. I was fortunate to have the support to grow a new role, the clinical nurse leader (CNL), over the past 10 years. This new role prepares nurses to lead clinically in complex environments and assist patients in experiencing a coordinated approach to care. I was successful in implementing the CNL model at one entire hospital, and now I'm deploying it across all hospitals in the THR system. In this model, CNLs lead and coordinate clinical care in microsystems of 12 to 16 patients. This role is an anchor stone that will allow us to be creative in envisioning how other roles in the microsystem will best facilitate the most reliable and effective patient care. I have also worked to standardize and align nursing practice across the many hospitals and settings in our system. We have changed our leadership model enterprise wide to engage more clinicians in top leadership. At our entities, the CNO role is now an important member of a leadership triad (CNO, CMO [chief medical officer], and president), all with equal authority and accountability for the top leadership of their entity. In the last year, I am also very proud of how our nurses at Texas Health Presbyterian Hospital of Dallas handled the diagnosis and care of the first ebola patient to be diagnosed in the United States. They were courageous and stepped up to put their patients first in this unprecedented situation! KK: Has the CNL role added costs to your organizations, and if so, how is that justified? JC: This role is part of a whole-system change, and it does cost money, but ultimately, we believe the CNL and care teams will identify ways to avoid cost and take costs out of the system. Once fully deployed at the end of 2014, we will begin redesigning our acute care delivery model around the role of the CNL. KK: How do nurses prepare for the CNL role? JC: CNLs hold a master's degree, but at THR, they start at the BSN level as patient care facilitators. Right now we have 80 patient care facilitators and 25 CNLs across our system. This has also led to the development of a program that allows nurses to choose career tracks in nursing. We have a program called “My Nursing Journey,” and it has 4 tracks: a clinical track, which includes the patient care facilitator and clinical leader; a management track; an education track; and an informatics track for nurses. KK: How do nurses decide which track to take, and how do they prepare for the different roles? JC: This is a self-selection process that occurs as part of the annual evaluation process for nurses. It creates an opportunity for discussing interests and setting goals between the nurse and the nurse manager, and they work together to set goals for specific career tracks. We have also created a learning management system that provides resources for each track. KK: It seems to me that having a system the size of Texas Health Resources provides a sort of laboratory for nursing innovation. Are there other innovative programs that you have put in place? JC: Yes, and one in particular has saved the organization significant money. That is an enterprise-wide central staffing office to deploy safe and effective resources to cover both planned and unplanned staffing needs. This started as a joint venture with an outside staffing company and involved bringing in a chief nurse from the agency industry to centralize and create a single source for staffing. Initially, THR owned 51% and the staffing company 49%, but the joint venture has since been dissolved, and the centralized staffing office (CSO) is wholly owned by THR. In 2009, the first year of this program, we reduced our spending on nurse contract labor. Over the last 4 years expenses were reduced from $28 million to $7 million, and the CSO is now providing an average of 198 FTEs system-wide of noncontract nonovertime labor. This program started with providing nursing resources, but it has grown to cover other professional, technical, and administrative staff across the system with great success. KK: What piece of wisdom can you share about implementing change? JC: Change is inevitable, and it is also a process of building trust and engaging individuals in adapting to new models and ways of thinking. The best wisdom I can share on this topic is to engage those who will need to change in the process, listen to their ideas, and help them to find ways to achieve those ideas. Your most important role is helping them to think flexibly and provide a supportive environment that encourages people to look for the right path to achieving that change. KK: Relationships are so critical to your role. Can you identify one relationship in your current role that has been most critical to your success? JC: The relationships with the CNOs has been critically important to the work of standardization and alignment of nursing across the system. Without a common sense of purpose, it would be so much more difficult to be effective in our relationships with other executives, our staff, our physicians, and our patients. KK: In 2012, you served as co-chairperson of the AONE Health Care Reform Task Force. What are a couple of the key outcomes of this work? JC: I co-chaired this task force along with Sharon Gale, AONE Region 1 board member and CEO of the Organization of Nurse Leaders for Massachusetts and Rhode Island. We looked at healthcare reform rules and regulations and developed a communication plan that included some publications in Nurse Leader magazine over the 2012 and 2013 time frame. In addition, the task force looked at the work of the Future of Patient Care Delivery committee during the preceding years and developed a crosswalk article with the IOM (Institute of Medicine) report. The task force also provided advisement to the AONE board on the role AONE should play in healthcare reform implementation. KK: You are a fellow in the American College of Healthcare Executives. Why did you pursue this designation and do you think it has been helpful in your current role? JC: I pursued this credential because it is a common credential among healthcare executives and validates common competencies with other leaders in the environment. It also provides opportunities to grow and gain new ideas within a broader range of healthcare executive contacts. KK: You have been an ANCC Magnet Recognition® appraiser since 2006. What advice or encouragement do you have for others considering that role? JC: I believe that being a Magnet appraiser has been an excellent opportunity for me to learn from other organizations about how they face the challenges of building nursing excellence in different environments. It is a time commitment, but the payoff is immense, and I know of no better way to give back to my profession than supporting a recognition program that has been so significant in helping organizations take the journey towards defined nursing excellence. KK: What advice do you have for current and aspiring nurse leaders? JC: Leadership in nursing is noble and it is exciting, and we should actively help those in, and aspiring to, these roles to get and stay engaged in that quest. Nursing is essential to the future of healthcare, and nursing leaders will be essential to partnering to shape that future, however, it happens at the entity, the local, and the national level. Don't be afraid to take on more education and opportunities to be exposed to others outside your organization as these experiences will be most helpful in stretching and growing your thinking as a leader. KK: What advice do you have for AONE members in how they can best contribute to the organization? JC: Don't just hold membership to round out your resume. Do something with it! Use the many resources and programs available as part of your membership, and don't keep trying to re-invent the wheel. Take advantage of the experiences offered to learn and grow, whether through the fellowship programs, the certification preparation and testing, or the meetings and social networking available through the AONE Web site. Get involved in a local chapter, or if you don't have one, start one! Use your state chapter to get involved in state policy and to share and highlight the best practices in your setting. Get involved nationally with the many committees, surveys, and meetings sponsored by AONE. Passively waiting for AONE to meet your expectations will not work; you need to contribute and use AONE resources when and how they can best meet your needs. Hometown:Pittsburgh, Pennsylvania.Education:Diploma in nursing from Montefiore Hospital School of Nursing, Pittsburgh, Pennsylvania, BS in healthcare administration from St. Joseph's College in Maine, an MSN from the University of Florida, and a DNP from Texas Christian University. Dr. Clark has also completed the Johnson & Johnson Wharton Fellowship at the University of Pennsylvania in Philadelphia, Pennsylvania.Current job:Senior vice president and system chief nursing officer for Texas Health Resources (THR) headquartered in Arlington, Texas.First job in nursing:ICU nurse in a community hospital.Best advice to aspiring nurse leaders:Don't be afraid to take on more education and opportunities to be exposed to others outside your organization; these experiences will be most helpful in stretching and growing your thinking as a leader.Most people don't know that:I had a short-lived stint as a singer in a rock and roll band while in high school, called the Purple Passion.One thing I want to learn:I would like to learn how to paint and do more than doodle. My children and my ancestors were artists, and I figure there must be some talent hiding in there that I haven't realized yet.One word to summarize me:Genuine. Hometown: Pittsburgh, Pennsylvania. Education: Diploma in nursing from Montefiore Hospital School of Nursing, Pittsburgh, Pennsylvania, BS in healthcare administration from St. Joseph's College in Maine, an MSN from the University of Florida, and a DNP from Texas Christian University. Dr. Clark has also completed the Johnson & Johnson Wharton Fellowship at the University of Pennsylvania in Philadelphia, Pennsylvania. Current job: Senior vice president and system chief nursing officer for Texas Health Resources (THR) headquartered in Arlington, Texas. First job in nursing: ICU nurse in a community hospital. Best advice to aspiring nurse leaders: Don't be afraid to take on more education and opportunities to be exposed to others outside your organization; these experiences will be most helpful in stretching and growing your thinking as a leader. Most people don't know that: I had a short-lived stint as a singer in a rock and roll band while in high school, called the Purple Passion. One thing I want to learn: I would like to learn how to paint and do more than doodle. My children and my ancestors were artists, and I figure there must be some talent hiding in there that I haven't realized yet. One word to summarize me: Genuine.