Abstract
This column is focused on life after a deanship. For many deans who transition, the change may come as a surprise. Certainly that was the case for Dr. Garner and me. This column tells the important story of one dean’s evolution. Dr. Garner and I met in the Robert Wood Johnson (RWJ) Executive Nurse Fellows program and I heard her speak recently at one of the RWJ alumni programs on the powerful experience of her transition.
Dr. Catherine Garner is a Professor of Nursing and lead faculty in the Doctorate of Nursing Practice (DNP) in the Executive Leadership Program at the Medical University of South Carolina. Prior to joining the Medical University, she served as the Executive Director for Nursing and Academics for the eight-hospital Greenville Health System. She has extensive healthcare leadership experience spanning home care, ambulatory care, and served in a position as Vice President of Clinical Operations for one of the country’s first Medicare Managed Care Organizations. She has held senior leadership positions in education, as Dean of Health Sciences and Nursing at the University of Phoenix and as the Provost/ Dean of the International University of Nursing in the West Indies.
Dr. Garner, to begin could you describe the circumstances that stimulated your transition out of your deanship?
My transition from my last dean position was unfortunate, but probably not as traumatic as some others experience. I joined a start-up online university and was able to assemble a stellar faculty and very quickly establish and get accreditation for a RN to MSN program, five MSN specialties and two Doctor of Nursing Practice (DNP) programs, in executive leadership and in educational leadership. The nursing program grew from 60 students to over 2000 in just three years. Unfortunately, the more successful the nursing programs, the more uncomfortable the workplace became. Upon reflection, I realized I could have claimed a hostile work environment, one of the conditions of workplace harassment under Title VII of the 1964 Civil Rights Act, but sometimes when the work environment begins to affect one’s mental and physical health, it is time to move on.
Sudden unexpected transitions can be difficult to integrate. What did the sudden transition mean for you as a professional?
The trauma for me was in my last six months when the daily harassment escalated, and I began to have nausea before each teleconference and visit to the headquarters. Sometimes you have to realize that you have little control over the environment where you work and you make hard decisions. I had a choice as to whether to continue in that environment or leave. As much as I loved my job, the team, and the students, when things finally came to a head, I was as relieved as I was hurt and the decision was made to leave in order to preserve my professional integrity.
In my experience I found I had renewed insight into organization dynamics because of the transition. What are the insights or “lessons learned” that you share with emerging leaders or future deans?
Lessons learned: Keep your networks alive and know your worth in many different areas of the healthcare and education systems. “Bad” bosses are everywhere, and it’s not your fault if you need to leave to save your sanity. As I have shared my story, I have met many successful leaders who relate a similar experience in both practice and the academy. It is unfortunate that many leaders, both male and female, are uncomfortable with strong and effective leaders in subordinate positions. Corporate culture and the managerial mindset have been described as consisting of obscured and undisclosed assumptions (Canyon, 2014). This is the antithesis of transformational leadership, but typical of the dominant culture in healthcare organizations.
One of the issues critical to good leadership is succession planning. In my situation the abruptness of the transition forestalled my planning efforts. Had you thought about a transition to the next leader?
While the team I had put into place (associate and assistant deans, lead faculty, and program assistants) was quite able to manage the succession, I had no say over my successor. The next year proved very difficult and the entire senior team departed. Unfortunately, it was the students who suffered. Particularly the doctoral students struggled as the atmosphere changed from the capstone being a mentored experience to an adversarial “prove yourself” model. To see what I had built compromised by someone who followed simply compounded the grief. Yet, as my grandmother used to say “it is always darkest before the dawn.”
How did the transition from being a dean impact your plans for the future?
My career has not been traditional. My first 20 years were spent as a nurse practitioner and then administrator in ambulatory care, home care, and managed care. I always taught part-time to keep my love of teaching alive and did research and published from the practice side. I had my own consulting business during this time and was the president of a national nursing organization. My first dean position was at the University of Phoenix, a non-traditional model that suited me very well. During this time, I had the opportunity to participate in the Robert Wood Johnson Executive Leadership program, opening up an extensive network.
As I looked around at possibilities and worked my network, one of my former doctoral students reached out and asked me to consult with an eight-hospital integrated delivery system on bridging academics and practice competencies for nurses. This touched a personal passion for making education relevant in transforming healthcare. The hospital had just become a BSN preferred hospital, and I counseled many of the staff nurses and young managers on choosing educational programs. I served as a mentor to several master’s capstone projects and doctoral dissertations of staff nurses and managers.
The work with a large hospital system led to creation of a competency-based model for all nurses, from staff nurse to executive that was shared among the healthcare system and seven schools that rotated students through the system. Twice a year, groups met for a formal summit on this topic, leading to many positive changes in clinical rotations and a revised orientation / residency program for new graduates. This initial consulting work led to two years of full-time employment in the system – gratifying work with lots of organizational political mazes and grueling hours.
What are you doing currently?
During this past year, I also experienced the loss of my mother and younger sister, so there are personal events that caused me to reflect on what I valued most in my life. While I truly enjoyed being back on the practice side and effecting positive change toward quality outcomes, the best part of that role was mentoring individual nurses who were pursuing additional education. My transition to a “retirement plan” had always been to go back to teaching.
Recently, I attended a Robert Wood Johnson Nurse Executive event in Arizona where the focus of the meeting was transitions. As I spent quality time with my colleagues exploring my own personal desires and “what next?” one can say I put my thoughts and desires out into the “universe.” Serendipitously, three weeks later I got a call from a former RWJ fellow about an opening in her college.
Now I am back in the academic environment as a professor with the Medical University of South Carolina’s online DNP in Executive Leadership program. I am doing what I love; mentoring and developing leaders from home in my “jammies” between residences in Charleston, South Carolina. I am thrilled to be surrounded by colleagues who are innovative and have a deep sense of respect for and commitment to students.
What special advice do you have for others in their leadership roles?
I tell people to always remember it’s a journey. Leaders often do not appreciate the variety of talents they have developed as deans: organizational skills, leadership and mentorship, accreditation, curriculum development and evaluation, fund-raising, community development work, grant writing, and policy skills. These are all skills that can be marketed in a variety of environments. What I learned being back in the practice arena during this major healthcare transition, is that there is a very real need for creative thinking, understanding how to apply research rigor to practice improvement initiatives, innovative staffing models, and new role development for nurses (nurse navigators, transitional care, and case management). The Harvard Business Review has begun sponsoring forums to bring together healthcare leaders from varying disciplines with academic researchers and thought leaders, as well as businesspersons from other industries to address some of the key challenges. Small (2015) explained that the focus of the effort is on understanding why innovation in healthcare is so slow (http://projects.iq.harvard.edu/forum-on-healthcare-innovation/).
Many organizations do not have the internal infrastructure for education, as resources have been increasingly focused on direct care and population management. An excellent reference on opportunities in population management is a recent Advisory Board Company Research Paper: Three Key Elements for Successful Population Management (https://www.advisory.com/research/health-care-advisory-board/studies/2013/three-elements-for-successful-population-health-management).
Those with leadership experience at the dean level and above have tremendous talents, and there are many organizations that would be very grateful to have them. I advise those making a transition to consider non-profits with fund development and grant writing, as well as healthcare systems that may have poorly developed educational development organizations. I was opened to the ideas of consulting, writing, and mentoring young faculty. There are infinite possibilities for those with passion and confidence in their leadership and development skills.
You have described yourself as a transformational leader. Could you elaborate?
An editorial in Strategic Direction described transformational leaders as “facilitators who act as role models to other team members and use innovative problem-solving approaches. Transformational leaders adopt a mentoring role with their followers, encouraging self-development and increased responsibility within the organization” (Strategic Direction, 2008). Early in my career, I realized that I am most effective in a start-up and turn-around roles. As a leader, I am very comfortable with ambiguity and confusion. It is an opportunity to create a vision and a strategic pathway toward defined outcomes that align with organizational success. Then my role is to mentor, coach, and develop others into the roles that will create the environment that will enable continuing success – for leaders, staff, patients, and families. In my view, good managers work themselves out of a job. If I did my job well as a leader, once the organization reached maintenance stage, it was easy to hand off the job to the identified successor. Then I could move onto greater challenges. While I did the same in this particular position and had a team that was quite capable of assuming leadership without missing a beat, the organizational leader chose to bring in someone from the outside. My interpretation was that this leader needed his “own person,” not an uncommon move in corporate America. Unfortunately, that type of change has the potential for significant disruption if those individuals also want to assemble their own team. This type of disruption does set an organization back in terms of forward progress, but may be appropriate for the culture of the organization. As the former leader, it just plain hurts to see what could have been your legacy be repudiated in any fashion.