J.M.A.: Dr McHugh, thank you for speaking with me today.
Dr McHugh: It is my pleasure. I am looking forward to the discussion.
J.M.A.: Can you talk a little about yourself, your career, and influence trajectory?
Dr McHugh: My mother inspired me to be a nurse. While I was growing up, I watched as she put herself through school, first as a nurse's aide and then began training as a licensed practical nurse. She aspired to be an RN but died of cancer before she could. She had the heart of a nurse, and her perseverance and dedication to care for others made me proud of nursing. I attended Gwynedd-Mercy College as an undergraduate. I received my associate's degree and worked in a small community hospital while getting my bachelor's degree. This was one of the most valuable experiences in my career. I experienced the ups and the downs of nursing, at the individual and system level. I began to observe how system-level decisions could facilitate or obstruct the ability of nurses to do their jobs. I saw the value of leadership and what it could do to create an environment where nurses could thrive or be demoralized. During this time, I was enrolled and graduated from Penn's MSN family nurse practitioner (NP) and psychiatric clinical nurse specialist program. Throughout my studies, I had doctorally prepared professors who opened my eyes to the potential that a doctoral education could offer. While pursuing my PhD at Penn, I worked as a family NP at a residential treatment center for women with eating disorders. This experience planted the seeds of interest in policy as a tool to improve health. I watched desperate families spend their life savings in an effort to save their daughters in treatment for anorexia, bulimia, and other related mental health disorders. I saw law and policy as a means to improve processes more globally than 1 patient at a time. Simultaneously, my doctoral supervisor, Dr Margaret Cotroneo, included me in her work with the World Health Organization (WHO). Later I received a Fulbright Scholarship working with the WHO in Copenhagen in the development and evaluation of curriculum for nurses to get additional training to work as family health nurses-1st-line primary care providers. When I returned to the United States, I completed my PhD and pursued additional training at the Harvard School of Public Health. While there, my work focused on states' efforts to reduce racial and ethnic health disparities. I continued this work as a law student at the Northeastern University School of Law where I was a research fellow at the Institute on Urban Health Research with Dr Hortensia Amaro. We worked with the Mayor of Boston and the Boston Public Health Commission to develop the city's Blueprint for Reducing Racial and Ethnic Health Disparities (http://www.bphc.org/chesj/resources/Documents/Reports/Mayor's%20Task%20Force%20B). When I graduated law school, I returned to Penn as a postdoctoral fellow training with Dr Linda Aiken at the Center for Health Outcomes and Policy Research. This experience consolidated all of my training and experience as a clinical nurse and a nurse researcher focusing on systems and policy.
J.M.A.: You are tremendously accomplished. What has driven you conceptually?
Dr McHugh: There are 2 things: (1) the experiences I have had-from nurses' aide through NP. I am proud of the days when I would drive home from work-tired-but knowing I made a difference. Making sure someone had ice chips for a dry mouth, taking the time to sit and talk with a patient who needed to talk, recognizing and responding to changes in patient condition, and making sure no patient was alone, especially at the end of life. The 2nd is a direct extension of the 1st-the research I do that is aimed at understanding and ensuring that the nurses' workplace(s) and the policies that influence nursing practice allow nurses to use all their knowledge and skill. I enjoy taking the issues of the day and reminding people what patients and nurses already know-nursing is the heart of healthcare, and they can make or break outcomes. Take, for example, the outcomes tied to payment incentives that are getting so much attention such as patient satisfaction and readmissions. Work we've done demonstrates that nursing is 1 of the largest determinants of how well a hospital performs and patient outcomes.
J.M.A.: What would you say is the most critical issue for nurse administrators in the future?
Dr McHugh: The health system is going through tremendous changes following the passage of the Affordable Care Act.1 The challenge will be to keep a focus on fundamentals and questioning changes that are not patient-centric or evidence-based. Our research focuses on fundamental principles; if you make sure that the best trained and knowledgeable people are at the bedside, and they have the support of administration and a well-organized system, the patients will receive good care. It is easy to focus on the promises of technology or targeted initiatives, but the success or failure of these is ultimately dependent on people-and in healthcare, this means nurses. I think that an informed, confident, and empowered nursing workforce is the key to patient care success in the new healthcare system.
J.M.A.: How can we best prepare nurses the next generation of nurses to lead and advance the profession?
Dr McHugh: The most influential factor in my trajectory was mentorship. I had a mentor at every stage. Another commonality among my own mentors was constant scholarly inquiry and challenging status quo. Cultivating a culture that empowers nurses to question why things are done the way they are and how they could be better is what leads to improvements at the bedside, in research, in the boardroom, and in policy making. I aspire to provide this kind of mentorship to others. I believe every expert nurse and nurse scientist has an obligation to give back to the profession through mentorship. I also support the importance of continued education as embodied in the Institute of Medicine's recommendation for a minimum BSN for entry into practice. To advance the profession, we must have a highly educated workforce.
It is essential for nurses to take the lead in clinical reform and not wait to be invited. Nursing has a unique perspective because we are involved in every care setting and across the lifespan. Nurses are present at critical junctures in people's lives. This is the power of our profession. I hate to hear-"I am just the nurse."
J.M.A.: Thank you for accepting our invitation today. It is exciting to hear of your advocacy and leadership for our profession.
Dr McHugh: Jeff, I appreciate the chance to speak with you and the readers of JONA.
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