'If there isn't a seat at the table, bring your own chair': How IU Health is giving nurses a voice in leadership decisions

Michelle Janney, PhD, RN, serves as executive vice president, COO and interim chief nurse executive of Indianapolis-based Indiana University Health.

Here, Dr. Janney shares how IU Health is working to promote nurse resilience, discusses why the media's portrayal of nurses is often problematic, and offers important advice for new nurse leaders.

Editor's note: Responses have been lightly edited for length and clarity.

Question: What is the greatest challenge you're facing in your current role, and how are you working to tackle these issues?

Dr. Michelle Janney: I don't believe we've adequately created an environment for our caregivers to feel safe and supported. We put nurses in humanity's hardest moments. Their physical health and emotional well-being are often adversely affected by their work. Nurses are 23 percent more likely to commit suicide than women in general. They're also four times more likely to commit suicide than people working outside of healthcare. I don't think this is a well-known fact among nurses and nurse leaders. The other issue is workplace violence. The Occupational Safety and Health Administration reports 25,000 workplace assaults annually, and 75 percent of those occur in healthcare and social service settings.

We're trying to bring this suicide risk to light and begin some important conversations around it. In the last five years, we've spent a lot of time looking at physician burnout. Now, the suicide rate for physicians is actually declining nationwide. We think it's related to the implementation of aggressive support systems and the reconstruction of work-life balance. I believe that's an important challenge for us to do with nurses, as well. To address workplace violence, we implemented the RISE program, which stands for "Resilience in Stressful Events." The program offers a peer support team and emotional first aid through self-referral and a phone call. The overall goal is to lift up the voices of our nurses. We need to work through these issues together, support each other, and create safe places for us to practice and resume our resilience.

Q: What is one initiative or project that you're most excited about right now?

MJ: We're experiencing a surge of growth and development among our clinical bedside nurses. We believe it's a direct result of creating an environment that embraces professional engagement through shared leadership. We implemented a systemwide shared leadership initiative about three years ago. The initiative unites clinical nurses from every one of our facilities, including ambulatory areas, who sit on different committees. The nurses work together to create a charter every year that focuses on advancing our system nursing strategic initiatives. They meet monthly and go back to their own facilities to share what they've learned with site-specific committees.

The initiative has been a catalyst for nurse promotions into leadership positions. It helps nurses see that being part of this profession means continuing your education and participating in professional organizations. It also gives them a voice in decisions that will guide the future of nursing at IU Health. That has really resonated with them. 

Q: What do you think is misunderstood about nursing today?

MJ: Stereotypical images of nurses in the media can lead the public to misunderstand nurses' role as technical experts or assistants to physicians. It goes all the way back to Nurse Ratched from One Flew Over the Cuckoo's Nest, Margaret Houlihan on M.A.S.H. and the Nurse Jackie series. Those portrayals of nurses in the media don't help us. I can't blame it all on the media, though. Historically, nurses have done a lot to perpetuate their self-image. Even today, many nurses think that if they can do a difficult IV start, then they're the best. I keep reminding them that very soon, robots will be doing that for us. Where will their self-identity be then? 

We reinvented our onboarding program about a year ago to help with this. We removed the reteaching and competency checklists, except those required by regulatory bodies. The program now focuses on nurses doing a self-assessment and having ownership of their orientation progress. Our learning is very individualized based on what they need. We also changed our orientation validation tool to really focus on application of the nursing process to patient care and not just the tasks. 

Q: What advice do you have for chief nurse executives stepping into their role for the first time?

MJ: In nursing, we talk about Benner's concept of "novice to expert." Someone I recently hired on my team said it was really hard, both personally and professionally, to go from being an expert in her previous role to a novice in her new one. As nurses come into new leadership roles, we talk a lot about that transition. I remind them that every expert was once a beginner. It's about realizing that you're at a new place in your career, and it's a great place.

The other thing we're focusing on with our new leaders is how to own their voice at the leadership table. We're trying to change the language from "nurse leader" to "healthcare leader." Chief nurse executives must be able to translate their unique knowledge and skills into a much broader leadership lens. They have to frame their ideas within the delivery of healthcare, rather than just the delivery of nursing. So that's something we talk about a lot. I always say if there isn't a seat at the table, bring your own chair.

Editor's note: This article was updated Oct. 28 at 2:25 p.m.

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