In the late nineteenth century, a hospital’s superintendent of nurses had a big job. She was often responsible for educating students in the in-hospital schools that emerged around that time, and more. “She was also in charge of the day-to-day running of the hospital: dietary, housekeeping, supplies, sterilization, managing flow of patients in and out of ORs,” said Patricia D'Antonio, PhD, RN, the Carol E. Ware Professor of Psychiatric Nursing and director of the Barbara Bates Center for the Study of the History of Nursing at the University of Pennsylvania School of Nursing.
But, as hospitals expanded and became more complex — and running them required more than just medical knowledge — hospital administration became its own specialized profession, she said. The number of nurses —and women — in leadership roles decreased dramatically.
But, over the last several decades, the pendulum has swung back. With the move towards nurses earning advanced practice degrees and moving into specialty clinical roles — and health care’s increasingly supportive environments — nurses have demonstrated their expertise in managing day-to-day activities in complex institutions. “What we’re seeing is nurses having increased recognition of their central role and knowledge of how the hospital enterprise works,” D’Antonio said. In a sense, “it’s a return to nursing’s original role.”
As nurses began expanding into formerly uncharted areas, new opportunities opened that allowed them to put their clinical knowledge to use in new and different ways and take top leadership posts within large hospitals and health systems. This shift can be found throughout Penn Medicine. Two prominent examples are Regina Cunningham, PhD, RN, HUP’s chief executive officer, and Patricia Sullivan, PhD, the Health System’s chief quality officer.
Below read about three nurses and the unique career paths they chose.
Trading a Stethoscope for a Hard Hat
As clinical liaison for HUP East, Kathy Gallager’s experience as a nurse on a patient care unit has made her an integral part of the project from the start.
In 1982 — newly graduated from nursing school — Kathy Gallagher, MS, BSN, began work on a med/surg unit at HUP. Over the next 30+ years, she progressed to a surgical ICU and also helped to open a vascular and thoracic surgical progressive care unit (a step-down from an ICU) on Rhoads 1. She eventually became its nurse manager.
During her time as nurse manager, she received her master’s in Strategic and Organizational Leadership and “I began thinking about what else I would like to do,” she said. Then, in 2015, the answer appeared in an email announcing the creation of a new role: clinical liaison for the new patient pavilion (HUP East) project. The position needed someone with “in the trenches” experience, i.e., working with staff and physicians, managing equipment, and understanding patient issues, with good collaboration and communication skills. She threw in her hat and got the job.
“I was there from the beginning, collaborating with architects, engineers, construction workers and project managers,” she said. Her input — as well as that of many other clinical and non-clinical staff and patient advisors — resulted in many changes, some of them significant. For example, feedback from a life-size mock-up of a patient unit not only led to changes to clinical spaces but also in the shape of the entire building!
Gallagher is now part of the team planning the transition to the new building. Since “trading her stethoscope and scrubs for a hard hat and safety vest,” Gallagher has gained a tremendous amount of knowledge — about construction and design but also about working collaboratively with the multidisciplinary team of experts. “How many nurses can say they helped build a hospital!” she said, laughing.
But even more important is her ability to still make a difference in patients’ lives. “As a clinical nurse, you could look back on your shift and know you helped someone that day,” she said. With her input on HUP East, there’s not a daily “reward” but her clinical knowledge and experience “will make a difference for patients and families and clinical staff for many years to come. The whole goal of the project is about improving the human experience in health care.”
Gallagher isn’t sure what the next chapter of her life will hold once HUP East is up and running. But she knows one thing: With a career in nursing, many opportunities are out there for her.
Technology + Nursing: Impacting Thousands of Patients
As head of LG Health’s ACO, Kevin Bogari uses his clinical knowledge to impact the care of
thousands of patients in the community.
Two things from Kevin Bogari’s childhood dictated his career path: an interest in becoming a paramedic from his family’s involvement as volunteer firefighters and a knowledge of technology stemming from his father’s job at IBM. “We had a PC from the time I was in eighth grade,” said Bogari, BSN, MS, executive director of LG Health’s Accountable Care Organization.
Bogari ultimately pursued a career in health care by choosing to become a nurse, earning a diploma from the Lancaster General Hospital School of Nursing. Working on intensive care units at LGH, he honed skills caring for a variety of critically ill patients on both medical and surgical ICUs. Along the way he received his BSN and completed courses that would allow him to function as a paramedic. “I thought about becoming a flight nurse.”
When management positions that required a strong clinical background took him away from the bedside, his other interest came into play: technology. When he was director of Clinical Infomatics at LGH, “I was able to straddle two worlds: clinicians and IT personnel,” he said. Bridging that gap, he interpreted needs on both sides of the fence to design clinical processes and work through problems “when one person didn’t know what the other was talking about.” That included work on EPIC, Penn Medicine’s electronic health record.
Now, he uses his strengths to improve quality of care and provide value-based care leading LG Health’s ACO (An ACO comprises health care providers , both employed and independent clinicians and hospitals, who voluntarily come together to deliver high quality and highly coordinated care that results in more efficient health care spending where patients safely get the right care, at the right time, in the right setting.) “I have an understanding of clinical quality measures as it relates to what the ACO is responsible for and how we’re responding,” he said. It’s not needing to know the latest treatments but “having experience and appreciation for the entire care delivery model — from wellness to post acute care — that’s important.”
Does he miss caring for individual patients? “There is certainly a lot of professional satisfaction in taking care of a patient and the immediacy to see the results of these actions,” he said, adding wryly, “In the administrative role, things don’t happen fast.”
But as an administrator, “I’ve had the opportunity to potentially have an impact on thousands of patients,” he said. “There is a lot of satisfaction to be gained from helping a team revise or implement processes or technology that has an impact on improving patient and community outcomes.”
Keeping a Close Watch on Patients, From Afar
With the help of multiple monitors, computers and a camera, Susan Sparling provides an additional layer of expert medical and nursing support for critically ill patients.
Although Susan Sparling, BSN, staff nurse at the Center for Connected Care's Penn E-lert, toyed with the idea of becoming a veterinarian when she was young, her thoughts turned to nursing when she was in high school. She worked as a nursing assistant in a nursing home while in high school and then held that position at Penn Presbyterian Medical Center, while attending the Presbyterian School of Nursing. “I worked on every unit and got so much experience,” she said. “I loved it.”
After graduating in 1976, Sparling started work on a surgical floor at PPMC. Looking back, she marvels how different health care is today. For example, nurses never wore gloves at the bedside, she said. In fact, “it was insulting to use gloves when we bathed a patient,” she said. “Sterile gloves were worn for sterile procedures, such as dressing changes but not for routine care.” Before Ambu bags — self-inflating resuscitators — were in every ICU room, nurses performed “mouth to mouth” with CPR until the code cart arrived. And timing IV drips was done using a second hand on a watch and counting the drips per minute. Perhaps most indicative of the times: Doctors and nurses smoked in the hospital, including at the nurses’ station. Even patients smoked, in their rooms.
The president of Presbyterian Medical Center at the time she began working there was Carl Mosher, who had started his career as a nurse. Sparling said that had a major impact on the way nurses were viewed. “Nurses were respected and empowered there,” she said. “PPMC was unique.”
Over the next several years, Sparling worked on many patient care units, primarily intensive care units. Gaining the knowledge and expertise of a critical care nurse would serve her well in the future. “My first love was being at the bedside and taking care of patients,” she said.
But lifting patients — before ceiling lifts were installed in every patient room — was taking a toll on her and on her back. “Nursing is a physical job and we had only one nursing assistant on the floor and many sick patients.” She suffered four herniated discs… but didn’t want to leave nursing.
Penn E-lert — a state-of-the-art electronic intensive care unit that provides remote monitoring as an additional layer of expert medical and nursing support for critically ill patients — provided an alternative. She initially did per diem work and thought “this would be a good thing for the future.” And then, in 2014, she made the transition, which she found easy. “I had already worked with several of the staff,” she said, adding that with five monitors, computers and a camera to follow what was going on, “I could see patients and still have input.” Indeed, over the years she has seen — and helped to prevent — many potentially serious events, such as a patient who had pulled out an endotracheal tube or an oxygen level alert.
“Initially I didn’t want to go. I loved working with patients and the staff,” she said, but then she discovered that she could still contribute and make a difference. “It was a very good move.”