E. Mary Johnson's passion and experience is in ambulatory nursing leadership: helping develop individual nurse leaders to better understand ambulatory systems and operational flow. Her experience includes President and Board of Directors member of American Academy of Ambulatory Care Nursing (AAACN); Nursing Standards chairperson; educator for Ambulatory Care Certification Review Course; frequent lecturer of leadership issues; published chapter in Core Curriculum for Ambulatory Nursing text, and publisher in Viewpoint; appointment to Joint P-TAC-JC committee for Ambulatory Care; appointment to ACNN Content Expert Panel on Nursing Leadership; and Developed Career Coach for Nurses program for Cleveland Clinic Health System.

1. What are the significant professional milestones in your nursing professional development (NPD) journey/career?

E. M. J.: As a new Director of Nursing, I was mentored by a lay administrator in ambulatory care. That experience allowed me to understand early on the need for collaboration among the many disciplines delivering ambulatory patient care. In time, I became a better "team player"-able to help other disciplines understand nursing's impact on both the journey of patients/families and on operational flow.

For example, early on in my career, I co-led a team of professionals who developed and implemented the Nurse on Call program. Our initial goal was to offer a free consumer health information and telephone triage line to consumers. Its success was immediate, and has evolved over time to being a central and valued service to patients/families from all over the country and to the organization. RNs telephone triage clients, help educate them and family members, and possibly access them for care if necessary. It has remained a free, accessible service to anyone who chooses to use it. Health care is confusing, complicated, and often difficult to navigate. This service provides patients/families with needed education to make informed decisions.

Being an active and ongoing involved member of AAACN has provided me with many professional opportunities. I regard my long association with AAACN colleagues creating deep and lasting networking and friendship opportunities as a significant outcome of my professional development. These nurse colleagues helped make me a more effective leader, and even today, I continue to learn, laugh, and share a passion for nursing with them. They are a resource like no other-willing to help, offer an opinion, support an effort, and to be honest.

I've come full circle in my professional career-from being mentored to being able to "mentor" nurses. I started a program called Career Coach for Nursing at Cleveland Clinic with a primary goal of nurse retention. I often referred to this work as "CPR for my Nursing Soul" because it allowed me to "cheerlead" nurses, often when they were challenged and confused about how to survive and thrive to be successful. I learn so much about how much nurses care about patients and the teams they are part of-about how difficult the "bureaucracy " sometimes can be. What a privilege it is to be trusted as a colleague on the journey. I continue doing this work to this day-and love celebrating the success individuals have. I've learned that one person cheerleading you is sometimes all you need.

2. How have you seen the specialty of NPD grow/evolve/change during your career?

E. M. J.: In the past, ambulatory care was often viewed as "it's only a physician's office mentality" in the delivery of care. Today, ambulatory care is considered an essential and critical "lynch pin" in patient care delivery. Ambulatory care nurses have always understood the importance of engaging the patient/family in their care-precisely because they return to their home environments, and are responsible for their care between visits. Ambulatory nurses view this process as a primary goal of nursing care.

Current practice involves understanding and implementing "transitional care and coordinated care" management "across the continuum in the health care system we are all part of." The focus on patient engagement in understanding their diagnoses and how to manage their care at home is paramount-resulting in better outcomes for the patient. An added benefit of patient engagement is decreased acute care admissions resulting in cost saving benefit for the patient and the healthcare system.

3. What do you see as significant trends or gaps in NPD practice, from your perspective as an expert in nursing leadership ambulatory care?

E. M. J.: Clearly, individuals and organizations recognize and support the need to increase the professional education and development of their staff. The incorporation of evidenced-based practice in the last decade has been phenomenal. The 2010 Institute of Medicine report on the "The Future of Nursing; Leading Change, Advancing Health" presents a compelling case and road map for the leadership development of nurses in all arenas. Leadership development begins with knowledge. Implementing institutional policy of hiring only BSN staff and/or requiring obtaining a BSN within an identified period of time for continued employment are examples of organizational recognition of the importance of nursing knowledge and practice. Magnet(R), Pathways to Excellence, and Certification designations are other visible signs of investment in the professional development of the nursing team. The opportunity for all nurses advocate, educated, translate, coordinate, and deliver care exist and will continue in the future.

A concern I frequently observe is a reluctance of nursing leaders to value and collaborate more fully with each other and other disciplines involved in healthcare delivery. Successful nurse leaders recognize and include the many other disciplines and are essential to care delivery systems. The silo mentality is alive but not well for future success. I believe this cultural change most effectively begins with "networking." Networking is not about how many people you have in your rolodex or on your smart phone. Networking is about developing trusting relationships over time and effort by the individual nurse. Real change and progress happens when professional relationships value and share in the delivery of coordinated care and agreed outcomes.

4. What insights can you share related to the value of NPD in healthcare organizations now and in the future?

E. M. J.: It's such an exciting time in health care and nursing practice overall! New discoveries about diseases, the entry of high-tech procedures, understanding and applying "gene " therapy are just a smattering of what's to come. The increasing, evolving healthcare delivery is becoming more complex and confusing-from the Accountable Care Organization mergers/acquisitions, the Affordable Care Act implications, accessing the millions of Americans who will all need care at some point. Advanced practice nurses will play an increasingly important role in accessing and providing care to patients now and in the future.

That's exactly my point; the changing landscape makes the case for how important nursing is and will continue to be. Most persons agree that the healthcare system is very complex and difficult to navigate. Nurses are effective and trusted advocates for patients/families and for physician staff-precisely because they understand and can translate the language of healthcare delivery to both groups. I often say, "No one can live without nurses! Physicians need nurses to implement the plan of care and patients need nurses to implement the plan of care." This has never been truer than in today's world.

5. What advice do you have for NPD specialists in the context of today's healthcare and learning environments?

E. M. J.: It's critical that everyone recognize that the evaluation of health care now and in the future will be on the evaluation of only three metrics-patient safety, patient satisfaction, and patient outcomes of care. To meet these metrics, it matters that a shared, collaborated, and respectful attitude for all contributing disciplines (including community services offered) be adapted to meet patient goals and outcomes. Ethics and advocacy remain the critical backbone of nursing leadership and are the responsibility of every nurse in practice.

In my opinion, there are only two professions that make significant difference every day-in every way! That's educators and nurses-because they directly influence, touch, and care for human lives every day. What could possibly be more important to your professional nursing life?

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