ADAMS: Dr Friese, thank you for speaking with me today. Can you share a little about yourself, your career development and expertise?

FRIESE: Jeff, thank you, it is my pleasure to speak with you. I completed my bachelor of science in nursing (BSN) at the University of Pennsylvania's in 1993, and there was a clear expectation that every student would go on to pursue graduate school and assume leadership. Early in my 1st year at Penn, I met Linda Aiken, PhD, RN, FAAN. I volunteered in her research center and as an undergraduate coauthored an article on nursing workforce policy. After graduation, I worked as a staff nurse on the leukemia intensive care unit at Johns Hopkins Hospital. I then returned to Penn as the 1st BSN-PhD student where I applied much of the extant work linking organizational features of nursing care to outcomes for patients with cancer. I completed a 3-year postdoctoral fellowship at Dana-Farber Cancer Institute and Harvard School of Public Health focusing on cancer-related health services research. I was recruited to the University of Michigan, School of Nursing, in 2008. The goal of my research program is to evaluate the quality of care delivery to improve outcomes for patients and providers.

ADAMS: What is your proudest accomplishment to date?

FRIESE: I can share 3 brief ones crossing personal and professional thresholds. First, our 2008 paper in Health Services Research1 was cited by the IOM Future of Nursing report2 in the recommendation to increase the proportion of RNs who hold a BSN. This work was also cited by 2 state boards of nursing as they drafted strategic plans to strengthen nursing education. Second is my 2012 induction into the American Academy of Nursing as a fellow, and 3rd, 13 years later, I'm still able to meet a former patient of mine for lunch a few times a year. She survived both acute leukemia and critical illness, in her words, "because of the nurses. They made it all happen."

ADAMS: You have carved out a unique role in nursing leadership and research. Can you speak to the relationship between your practice and your current research? Why is that of particular importance to nursing leadership?

FRIESE: My best questions have come from my clinical practice. One day, I told a patient about my study linking nurse practice environments to surgical patient outcomes and he said, "go study the (outpatient) clinic. That's the wild, wild west." And thus, my current research emphasizes the outpatient setting. I have shifted my focus to ambulatory oncology settings, where 80% of cancer care is delivered in the United States with very little infrastructure or accountability for quality. We have identified serious gaps in nursing practice environments, uneven workloads, and adverse events for nurses and patients. We hope to translate these findings into interventions that can improve the environments and strengthen the safety net for these vulnerable patients. As we shift more care to ambulatory settings, it's important for nursing leaders to measure and improve these environments so we don't repeat past mistakes from hospital units.

ADAMS: What do you feel is the greatest challenge/opportunity to healthcare leaders over the next decade?

FRIESE: The key will be delivering value for healthcare services. Payers and purchasers have placed providers on notice: deliver value, or else. Organizations must optimize value through reduced costs and increased efficiency. This is incredibly complex in healthcare organizations that require tremendous human and capital investments to deliver excellent care. Leaders will need to sift through the maze and achieve optimal outcomes at a reasonable price point.

ADAMS: How does that challenge influence you?

FRIESE: The challenge to demonstrate value is one I am keen to address. To demonstrate nursing's value in our healthcare system, we must (1) conduct interdisciplinary science, (2) use novel measures and methods, (3) advocate for better data across healthcare systems, and (4) translate our findings for the corporate and policy communities. As 1 example, Clay Christensen identified advanced practice nurses as a disruptive innovation in healthcare.3 Have we as a community embraced this opportunity and developed innovations to deliver safe, value-added care?

ADAMS: What is something that the majority of nurse leader readers of JONA might not know?

FRIESE: Clinicians are inundated with leaders' messages to adhere to policies and guidelines. Walk through a medication room on an inpatient unit and count the number of laminated signs to remind nurses what to do; it's fatiguing. We have to condense these messages and focus clinicians on the key practice issues and develop backroom solutions for the rest.

ADAMS: Dr Friese, I really appreciate you speaking with me today, we look forward to the advancement of your work and the impact you will continue to have on patient care.

FRIESE: Thank you for allowing me to share, and I look forward to the advancements we will all make together.

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