Joyce E. Johnson assumed the role of Senior Vice President for Nursing at Georgetown University Hospital in July 2000 when Georgetown was days away from closing its doors. The hospital had failed in its attempt to "shrink into prosperity" and the morale and trust of the nursing division was at an all time low. Her first strategic plan was rolled out within 2 weeks and included a commitment to rebuilding a strong Nursing Division through aggressive recruitment (100 Nurses in a Hundred Days); supporting clinical nursing at point of service; a promise to return Georgetown Nursing to national preeminence; rebuilding shared governance; and positioning Georgetown to achieve Magnet(R) recognition within 3 years. This represented a quantum change from the survival mode of the immediate past, and is a testament to her ability to establish trust, educate, and inspire an entire workforce to significantly change corporate culture. Since that time, the nursing division has developed and flourished, with a significant milestone reached in Magnet designation in 2004 and 2008.
Inherent in all aspects of her plans is support of nursing at the bedside. Nurses learned the seriousness of her advocacy early on. Salaries had been completely stagnant for the years leading up to Joyce's arrival. Two substantial raises for staff nurses only were implemented within the first 2 months, and since then there have been seven increases. Base salaries have risen 160% and other financial benefits (differentials, on call pay, preceptor, charge nurse, and so on) have also substantially increased. Not long ago, a group of p.r.n nurses cowrote a memo asking for a raise because they had not been included in the previous adjustment. She considered its reasonableness and implemented it immediately. She developed Nursing Education from three educators to the current 19. She obtained funds (~$400,000/year) for the tax-free nursing scholarship for Georgetown nurses at Georgetown University at a time when the hospital was still losing millions of dollars. National certification of everyone eligible became Joyce's goal for nurses throughout the organization, and she advocated and obtained financial support for review courses, exams, celebration, and bonuses for nurses aspiring to this. Of course, she immediately modeled the expectation by sitting for the Nurse Executive, Advanced exam.
Realizing the need for all of us to understand the greater purpose of our profession and work life, she transparently role models the mission, vision, and values of Georgetown in every aspect of her public and personal persona. She rarely speaks to internal or external groups about our experience without referencing our Jesuit heritage. Altruism, "men and women in the service of others" and cura personalis (caring for the whole person) are values of all nursing, nursing at Georgetown, and the institution itself. Joyce embodies this mission. Regardless of the discipline or the level in the organization, everyone acknowledges that Joyce Johnson makes every decision based on what is best for the patient. Not incidentally, it turns out that the decision is also best for nursing as well as the institution.
Nursing leaders at all levels of the division are committed to a participative management style, believing that optimal job satisfaction and creativity will result from free exchange of disciplined ideas and efforts. The practice environment that has emerged offers our staff and patients the opportunity to experience the benefits of continually improving nursing care and concomitant outcomes.
Dr. Johnson is the heart of this thriving system. Envisioning a patient-care system fully staffed by clinical nurses who are leaders, she outlined her expectations of reestablishing Georgetown's place as one of the preeminent hospitals and nursing divisions in the country. Her plans are clearly articulated to nursing managers, councils, task forces, and in her meetings with staff nurses. By thoroughly supporting a majority BSN nursing workforce, she expected and received ready compliance with her demands for a compassionate, skilled, and intellectually active approach to patient care. Staff nurses were given the tools and expected to draft the second divisional strategic plan. Setting high standards and expectations is clearly seen as the first step in developing leaders at every level.
Horizontal and vertical communication channels were established and continue to grow. Channels are redundant, maximizing the chances that information reaches all nurses. Numerous verbal and written modalities are used from one-on-one to groups in scheduled and nonscheduled meetings, phone/group phone messages, e-mail, memos, newsletters, and websites. It is possible for individuals to miss information-but it's not easy. Such active communication fosters the benefit of a high degree of responsiveness. Council minutes reflect prompt response by management to issues raised at the staff nurse level.
Nursing leadership at all levels recognizes the importance of visibility and accessibility and are on the patient-care units every day. Both directors and managers have personal and first name relationships with their entire staff. The corporate ethic is one of accessibility by all leaders from council members to the CNO. Joyce certainly sets the standard for that. Perhaps the most humorous example of this happened following her welcome remarks to the Summer Nurse Tech class in 2007. As always, she emphasized her accessibility, assuring them that her door was always open, often without an appointment. Two hours later, some 12 techs found a little unscheduled time and arrived at her office to hang out!! True to her word, she welcomed them and spent the next half hour talking about nursing.
Nurses at all levels are enfranchised and expected to participate in the success of the Georgetown Division of Nursing. Over the years, it has become clear to nurses at all levels that Joyce is interested in every aspect of patient care and is particularly committed to providing a safe environment for both nurses and patients. She follows and monitors each occurrence report daily and monitors all outcomes closely. She demands accountability and explanations regarding any outcomes that temporarily trend downward, not only from managers. Staff nurses have been called to both explain process problems and help brainstorm ways to avoid repetition when performance improvement approaches fall short. Conversely, she expects to be held to a similar high standard. She takes responsibility for providing her staff with the resources as well as physical, emotional, and organizational support to practice nursing safely and confidently.
Joyce was initially regarded with some degree of apprehension by her direct reports because it was clear that her standards and expectations were high, and accountability was nonnegotiable. Since then, her relationships with both managers and staff have grown to one of deep respect and fondness. Recently, a staff nurse was relating her experience listening to a motivational speaker at a state Association of Women's Health, Obstetric and Neonatal Nurses meeting. She revealed that she was both inspired and moved to tears by the personal passion of this woman. Her next comment was, "The first thing I thought of was that she was SO great...She's just like Joyce!! We should bring her to Georgetown so the two could give a conference together!!" (Outcome: the speaker was engaged to present the keynote in the Education Council's next regional conference.) Joyce has inspired and mentored staff at all levels and is trusted to represent and advocate for broad divisional initiatives and for the projects and the needs and ideas of individual patient-care units and nurses.
Dr. Johnson has had a long-term affinity for developing leaders. She strongly believes in modeling the behavior she expects, giving managers and staff the tools to do their jobs, supporting their ongoing education and certification, and expecting the very best. From her first Georgetown strategic plan, she articulated the goal of promoting Georgetown nurses at the regional and national levels. She personally set an example for Georgetown nurses by leading and participating in numerous professional nursing organizations and professional activities. Involvement in professional organizations is a part of the culture throughout nursing departments as evidenced by the considerable list of hundreds of nurse memberships in these entities.
To support staff nurse and manager visibility, she has made good on her pledge to enable participation at regional and national meetings and has heavily supported those speaking or presenting posters. (Expenses for all presenters are covered for any national meeting.) Joyce is looked to with admiration, as nurses at all levels recognize her leadership in national and regional organizations, her prolific authorship that influences the profession in so many ways, and her ability to galvanize professional audiences at home and across the country. She is frequently asked to represent nursing at national events such as receptions, healthcare bill signings, and hearings on Capitol Hill. She often agrees only if she can bring staff nurses to experience the excitement of policy making at the national level. Another legend arose from the year she took the entire New Grad class to watch the First Kennedy appropriations bill signed into law. Advocacy for the profession is now a part of nursing culture at all levels at Georgetown.
From a nadir of nearly total absence in professional circles, Georgetown nurses now see themselves as leaders in the profession.
It is not unusual for managers to feel comfortable approaching the CNO; however, Joyce has fostered a reputation that encourages nurses at all levels to use the "open door" policy. One of the more legendary events happened when a payroll glitch left a newly employed nurse without an initial paycheck. This was discovered after the business office was closed for the weekend. Distraught, she came to Joyce for direction. Joyce immediately opened her purse and wrote out a personal check for the entire amount of the 2 weeks' salary.
A discussion of the cultural changes planned and implemented through Joyce Johnson's leadership would be incomplete without recognizing the quantum leap in the area of research. After patient care and the nursing population had been stabilized, Joyce mandated that an institutional review board-approved research project emanate from each nursing unit with a nurse as the principal investigator. To facilitate this, she created the position of Director of Nursing Research. In the intervening 5 years, the research program at Georgetown has grown to over 30 nurse-led projects, many of which have been presented nationally. The expectation of nursing research has been enculturated.
And no discussion of the changes in the Georgetown practice environment would be complete without mention of the famous Georgetown Nurses Lounge. Dr. Johnson long recognized the contradiction in providing a well-appointed Physicians Lounge without a similarly appointed Nurses Lounge. She identified two adjoining offices and began finding relocation space for the current occupants. She supervised the renovation and personally undertook the decoration, right down to actually making the drapes. The nurses of Georgetown now have a spacious place to check e-mail or relax, watch the big-screen TV, and enjoy a cappuccino from the complimentary coffeemaker. The adjoining room features reclining chairs with massage inserts, low lights, and new-age music. The environment truly demonstrates the regard and esteem for nurses held by the institution, and Joyce Johnson is responsible.
She has touched every aspect of nursing-care delivery in this institution. Joyce Johnson is truly the heart and soul of nursing at Georgetown.