Five female leaders at Edison, N.J.-based Hackensack Meridian Health started their careers tending to patients at the bedside. But somewhere along their career tracks, all five set their sights on the top of the leadership ladder.
Today, all five women are C-suite leaders throughout the HMH system. They have many things in common: they are highly compassionate and dedicated individuals; they are able to see the 30,000-foot view, even when in the weeds in the hospital boardroom; and they are fervent believers that with a nurse mindset, the sky's the limit.
Patricia Carroll, MSN, describes her career transition to leadership as a "progressive journey." She was a bedside nurse for 14 years and spent another 12 years in various nurse leadership roles before becoming president and chief health executive at Raritan Bay Medical Center in Perth Amboy, N.J., and Old Bridge (N.J.) Medical Center in 2022.
Regina Foley, PhD, RN, took on the role of executive vice president and chief transformation officer and interim chief nursing officer at Hackensack Meridian in April 2022. She began her career at the bedside but within five years was a nurse leader.
Lisa Iachetti, BSN, RN, began her career as a bedside nurse in 1982 but wanted to move up the ladder. She did just that, moving from one nursing leadership role to another. Fast-forward 40 years and Ms. Iachetti became the president and chief hospital executive officer at North Bergen-N.J. Hackensack Meridian Palisades Medical Center in July 2022.
Caitlin Miller, BSN, RN, quickly transitioned from being a bedside nurse to a leadership role as an assistant nurse manager for one year, and two more years as nurse manager at Bayshore Medical Center in Holmdel, N.J. She took on the role of interim president in 2022 and became the permanent president and chief hospital executive of Bayshore Medical in February 2023.
Michele Morrison, RN, tended to patients at the bedside for 20 months before turning her attention toward leadership. After serving in several roles — risk management, performance improvement, operations at another New Jersey hospital, she took on the role as interim hospital president and chief hospital executive in 2019 at Southern Ocean Medical Center in Stafford Township, N.J. Six months later, she became the president and chief hospital executive.
Becker's spoke with these leaders to find out what spurred them to switch from the clinical team to administration, how they empower nurses in their hospitals and what they are doing to attract and retain quality nurses.
Editor's note: Responses have been edited lightly for clarity and brevity.
Question: What prompted you to move from the bedside to the "corner office"?
Patricia Carroll: My experience as a nursing leader was a progressive journey, and at each step I was given expanded opportunities and span of control. I became inspired to become a hospital leader and be part of a greater chance to positively influence patient care.
Dr. Regina Foley: With so many years at the bedside, I knew what the patients needed and saw myriad opportunities to improve areas such as patient experience, quality and cost. I had the confidence and knowledge to pursue my passion, which is to build a better healthcare system for patients.
This isn't a job to me, it's like my fourth child (I am a proud mother of three). I always want to "keep getting better" — which happens to be HMH's motto — for the patients we serve.
Lisa Iachetti: I have had many great mentors who have provided me with tremendous opportunities. I left the bedside to become a hospital leader because I wanted to make a larger impact on the lives of the patients and family members."
Caitlin Miller: I began to think more expansively about how the hospital was run and how all departments affected the patient and team member experience. I loved doing direct patient care and talking to patients and their families. I enjoyed having a checklist of things to do each day for my assignment of patients and the feeling of accomplishment at the end of my shift.
To take care of a person during their time of weakness and vulnerability has always felt like a true privilege. The idea of being a hospital leader was always appealing to me because I felt like I could have greater influence and impact.
Michele Morrison: Prior to nursing [I] worked as a paralegal and was in college pursuing my degree in criminal justice when my younger brother suffered from a preventable medical error. That sparked my interest in healthcare and I pursued a degree in nursing. Once a bedside nurse, it was an easy transition to risk management since it combined my medical degree and background in the legal field. It also provided the opportunity for me to make a difference away from direct patient care to prevent medical errors.
Q: How do you encourage nurses to take on leadership roles in your hospital?
PC: I absolutely encourage nurses to take the step out of their "comfort" zone. I lean on my own experience and career path to encourage and support nurses to seek out new opportunities. Nurses learn to be in charge of their patient care, adapt and pivot when required. They work effectively in a team and take the lead to ensure safe patient care. The skills of communication and relationship building are successfully translated to be a hospital leader.
RF: Bedside nurses can pursue roles such as charge nurse, resource nurse and/or assistant nurse manager, which give them exposure to issues (payroll, staffing, contract negotiations) that they would need to tackle as leaders. If a nurse speaks up and expresses an interest in leadership, they will immediately get on my radar for opportunities to lead.
We also have a shadow leadership program where nurses can shadow leaders such as chief nursing officers to get the exposure and experience necessary to become leaders.
Within HMH, we grow our own. We want nurses to remain here for the duration of their career. We have a nursing leadership development program that's structured to cultivate the next generation of nursing leaders.
LI: Nurses make great leaders. I see things from a human perspective, as do my nurse colleagues. I stay connected to my roots by rounding regularly, particularly in the emergency department. I love participating in the patient healing process and connecting with our patients as much as I love participating in successful initiatives — such as mentoring leaders and the team. The team spirit here is inspirational. Seeing it firsthand allows me to better understand and advocate for the hospital's patients and team members.
CM: A nurse's expertise and vantage point is extremely important in helping a hospital run effectively. We are patient-focused, collaborative and compassionate.
Providing development opportunities and mentoring is critical. If it wasn't for the leaders who took an interest in me, recognized my potential and gave me growth opportunities, I would not be in my position today. I feel a tremendous responsibility to pay that forward. Helping team members see their potential and gaining confidence in their abilities is a joy for me.
MM: I love to encourage nurses to have a seat at the administrative table. My team is entirely healthcare providers: a physician, pharmacist and four RNs. Having a team that understands the clinical impact on decisions and operations is very important to me. It provides a foundation for connecting with our team members and physicians on every level and gives us credibility in the healthcare arena.
Q: What particular characteristics do female hospital leaders need to be successful?
PC: I have always believed that everyone should be judged on their work, not on their gender. I am grateful for every opportunity that I have had and work to earn the respect of my leaders and colleagues. As a woman leader, I have learned to pivot and adapt to not only provide for my family but to meet every expectation in my work and career.
From my own experience, female hospital leaders need to remember to stay strong in their beliefs, to remember their viewpoint is a valuable contribution and to provide a role model to the women behind them. When I look back in history, I am in awe of what women have done to give me this opportunity, we must continue to go forward and show examples that women leaders can successfully rise to a position of influence.
RF: We need humility, [the ability to] keep our ego in check, resilience and be grounded in the present moment.
LI: Confidence — having the feeling that you can trust, believe in and be sure about your abilities. Courage — the ability to do something that may frighten you at first. It is all about being brave and demonstrating your strengths while emulating empathy.
CM: There is an added level of persistence and resilience needed as a female leader. I think women have to work harder to show we can handle tough conversations and situations, and make difficult decisions.
I have noticed that female leaders, at times, are not allowed to simply be competent and effective. I've personally gotten feedback on occasions, from men, about my facial expressions and seriousness. Women are expected to be comforting, happy and smiling. It's an expectation only placed on women.
MM: Female leaders more quickly pivot with change. Perhaps this is mirrored from the many changes females experience during life with body changes, hormonal changes, childbearing and being care providers and moms. We are agile in the ever-changing landscape of healthcare, all while maintaining composure and leading our teams forward despite barriers. And we do it with compassion for patients, our team and the communities we serve.
As a nurse myself, I understand how patient care works and is delivered at the bedside. This gives me the opportunity to discuss operations on a different level with leaders and engage with our front-line team members.
Q: Can you describe a nursing initiative at your hospital that has really moved the needle toward improvement?
PC: We have focused on three areas: quality improvement, patient experience and reducing hospital-acquired infections. In my career, quality initiatives have been pivotal in "the moving the needle" for patient safety and quality.
RF: Nurses move fast and are adaptable. I think about the saying that's associated with the U.S. Marines: "Improvise, Adapt and Overcome."
We used a nurse's work ethic and culture of collaboration and operational excellence to help the state of New Jersey, New Jersey State Police and the National Guard to stand up the COVID vaccine megasite at the Meadowlands (Rutherford, N.J.). We did it in just four weeks. We also scaled that operation to 34 other locations across New Jersey. We managed product storage, transportation, safety and logistics. We did it safely and without incident.
Nurses were the backbone of this operation and administered 800,000 vaccinations. It is one of the greatest success stories of the pandemic.
LI: As part of the HMH Palisades Medical Center reimagining plan and with the addition of the new executive team, we continue to remain laser focused on maintaining our commitment to providing a thriving and prosperous community hospital. Our priority is making sure we have highly trained nurses in place to care for patients throughout the hospital.
CM: Throughout my time in healthcare, I have been committed to creating a welcoming culture where team members have the opportunity and ability to implement their ideas. Our "Think Tank Committee" at Bayshore Medical Center is a monthly open roundtable discussion where team members can bring culture ideas, patient safety and experience recommendations and projects that will improve the experience for our team members and patients.
When team members have an open line of communication to administration, it empowers them to build their leadership skills and create a healthy workplace environment. Having an "open door" policy is not just a talking point for me, it is a way of leadership for me.
I have a passion for planning and organizing events that bring our team together. We hold countless events throughout the year that promote inclusion, engagement and connection.
MM: While most emergency departments exercise the use of "pull to full," last summer we implemented "pull to infinity." This essentially means that we don't use the waiting room any longer. We bring every patient to a room and if the rooms are full, we pull them to our infinite triage area. This allows our team to get started with advanced nursing initiatives (a set of pre-approved protocols that jump start treatment). We let patients know that we are starting their treatment immediately.
This process has expedited our time to medical screening exams, test results and disposition. Patient experience has also soared with this new model. For patients getting admitted, we have also implemented a new process for nursing handoff and transfer to expedite getting the patient moved to their inpatient unit within 30 minutes. This makes for a great first impression, improved patient experience and alleviates boarding time in the emergency department.
Q: What are you doing to help your hospital attract and retain quality clinicians?
PC: This is a network-wide initiative: We create an environment that supports a culture that recognizes everyone is human and, when conflict occurs, we support open discussion and resolution and not retaliation — at all levels. We spend more time with each other than our own families and so, as leaders, we should work to create that space that allows us to give one another "grace" in times of conflict.
RF: To retain them, we're creating an environment and culture that allows them to practice at their best. To attract them, we are continually focusing on creating a high-quality, compassionate environment that yields the best outcomes for our patients. Outcomes attract talent. In addition, the Hackensack Meridian School of Medicine is training the next generation of clinicians and encouraging them to practice right here in New Jersey. We also have tremendous partnerships with three schools of nursing to attract the best and brightest to our network.
LI: We conduct salary reviews and make market adjustments when needed. We have created focus groups to foster a more cohesive and trusting, collaborative relationship within the nursing teams. Nurses meet with executive leadership monthly in an effort to share for improvement as well as share what is working well. We also support the shared governance model.
CM: We need to understand that the mentality has changed, especially in a post-COVID world. There are team members who want more work/life balance, more flexibility, quality of life, and a positive work environment. That requires that we put an emphasis on fostering a strong, supportive work culture. Every leader has to buy in to creating an environment that is welcome, inclusive and supportive.
With new nurses, it is important we recognize that and give them the support they need so that we retain them and they remain committed and loyal to the organization. This requires continuing education opportunities, leadership development and mentorship programs, engagement events with family integration and recognition programs and scholarships.
MM: Like many organizations, we have implemented retention bonuses for our team members as one strategy. More importantly, we have maintained a culture of collaboration throughout Hackensack Meridian Health and Southern Ocean Medical Center. A great example of this is when we are in "red" census, you will often find me and my executive team transporting patients, rounding in all departments, providing snack carts for our team members, answering call bells and assisting in any way possible.
Patient care is my priority and anytime I can assist my front-line team in this capacity, I jump right in. I make sure I'm present and available to my team with frequent and scheduled rounding throughout the hospital including at least once a month on the night shift.
We have some great formal programs for team member wellness, and stress.
Lastly, we always make sure to have some fun whenever we can, celebrating milestones, participating in a Super Bowl party, March Madness and other monthly events to keep our team members feeling energized and part of a great team.