Nursing Administration Quarterly (NAQ) was first published in 1976. Vol 1. No.1/Fall, 1976, was titled Leadership in Nursing Administration. Barbara J. Brown, EdD, RN, CNAA, FNAP, FAAN, who is definitely a leader in nursing administration served as the initial editor in chief, a position she held for 37 years. Current editor, Kathleen Sanford, interviewed Barbara, now Editor Emerita, for this 40th anniversary year of NAQ.
Sanford:Barbara, nursing leaders and other readers of NAQ can't think of this journal without bringing your face to mind. You have been associated with this publication from the very beginning. Tell us about the early days of NAQ.
Brown:Well, it all started in 1975, when I was at an National League for Nursing convention. At the time, I was the nursing administrator at family hospital and nursing home in Milwaukee while I was teaching nursing administration courses at Marquette University. I was also president for the National Society for Nursing Administrators (NSNA, the original name of AONE). I had been contacted by publishers to consider writing a book for nursing administration. I met with 5 different publishers and explained to the first 4 that I had 6 children at home and 2 jobs, so I didn't have time to write a book. However, when I met Aspen Publishers, I said: "For you I can do a book, as long as I'm provided with a ski chalet in Aspen, Colorado so my children and husband can ski while I write. I should be able to take a sabbatical from work."Of course, they informed me that they were in Gaithersburg, Maryland, so I let them know I couldn't do the book! Undeterred, they asked me what our profession needed from a publisher, and I suggested that we could use a quarterly, topical journal, something like the Harvard Business Review, or Administrative Science Quarterly. When the publisher stated that there probably wasn't sufficient subject matter for nurse leaders for a topical journal, I listed numerous subjects such as leadership, primary nursing, quality care, research, nursing finance, organizational development, and so forth ... and discussed what the content of each topical journal could include.As a result, they invited me to start a journal. I wrote up a proposal and within 6 weeks I had a contract to start Aspen's first nursing publication, NAQ, which I named. Later, Aspen Publishers, Inc. published several other quarterly journals, but I think it's quite humorous that they thought there were not enough topics about nursing administration to interest readers. Of course, back then we weren't acknowledged as a specialty by our national nursing organizations.
Sanford:In spite of how busy you were, you managed to get this long-lasting periodical off the ground!
Brown:Yes, but during that time I wasn't able to take office as the NSNA president, mostly because in those days, the president had to be a sitting nursing administrator. I relocated to Seattle, where I was teaching at the University of Washington and didn't go back to administration until a year later, when I accepted the chief nursing officer position at Virginia Mason Medical Center. It worked out because, while I regret missing that opportunity, I had the good fortune to be part of the committees (at NSNA and the ANA) who documented the early standards for nursing administration. I was able to recruit major nursing leaders from both operations and academia as editorial board members and included nursing forums for subjects like: "What is needed in Nursing Administration?" Many nationally known nursing leaders welcomed the opportunity to express their views. Luther Christman was our early book columnist, and many of our articles were the basis for Aspen published books. These included: Nurse Staffing: A Practical Guide, edited by Barbara Brown, 1980; Nursing Education: Practical Methods and Models, edited by Barbara Brown and Peggy Chin, 1982; and Perspectives in Primary Nursing: Professional Practice Environments, edited by Barbara Brown in 1982.I didn't start using guest editors until 1987 when I went to Saudi Arabia as associate executive director of King Faisal Specialist Hospital and Research Center. I had thought that I would need to give up my editorship, but the NAQ editorial board volunteered to be responsible for topical issues and to contact potential authors. Hospital Corporation of America overnighted pouches of manuscripts to me in Saudi, so I was able to maintain my editing duties. My youngest daughter also took care of correspondence from my home in Denver, Colorado, where she and her husband lived.
Sanford:Aspen isn't the current publisher of NAQ. When did that change?
Brown:Aspen published the journal for its first 25 years. Lippincott (now Wolters Kluwer) took over in 2002, with volume 26. Their first edition was Twenty First Century Nursing: the New Practice Environment.
Sanford:What do you recall about the environment for nursing leaders 40 years ago?
Brown:Well, I remember that NAQ was so successful, because, at that time, Supervisor Nurse was the only other journal for nursing managers. Dorothy Kelly was the editor. That publication (Supervisor Nurse) was filled with practical nursing advice and was sent in bulk to hospitals, because it was supported by advertisements. It met a need, but we also needed something to support the emerging role of nurse leaders in this country. Nursing administration was becoming more involved in finance and economics. Chief nursing officers were becoming a stronger voice in the executive boardroom. Also, at that time, primary nursing was on the rise as a new model. It was a very innovative time (just as today is) and we had a lot that we were able to share with each other.The physician and nurse relationship was just coming out of the "nurse as handmaiden era." I will never forget the 2 physicians at the board table who were so upset to see me, the nurse leader, enter the inner sanctum of the executive suite. We were just gaining strength to be partners in health care leadership. That was a good thing-at that time many nurses were leaving nursing because of how badly they felt they were treated by physicians.We were beginning to set up collaborative practice committees. We were at the start of the era of joint academic appointments for nursing clinical specialists. Advanced education for nurses specializing in administration was new. We initiated multidisciplinary quality assurance committees, and a few of us had responsibility for all of patient care, not only nursing.
Sanford:Given all of that, how did the nurse executive population respond to this new journal (NAQ)?
Brown:It was very favorably received. It didn't take long before both academic and practicing nursing administrators subscribed and contributed to the journal. Both areas were represented on the NAQ editorial board. As a nurse executive who also served as an educator, and belonged to both NSNA and the Counsel for Graduate Education in Administration of Nursing, I knew that this was important.Luther Christman, dean at the College of Nursing at Rush University, was our thought-provoking and humorous book reviewer. His early reviews included titles such as Key to the Executive Head, Managerial Psychology, and First Line Patient Care Management by Barbara Stevens.Our early forums were popular because different nursing leaders contributed thoughts to each topic.
Sanford:In your 4 decades with NAQ (now serving as Editor Emerita) what would you say are the major changes you've seen in nursing leadership?
Brown:There have been several, but the dominant change is the positioning of nurse executives at higher levels in organizations. Today many of the nursing leaders are system chief nurses. A major change has been nurse executives' strong relationships with boards and whole systems, including continuums of care. In addition, nurse leaders are more involved with the community and political system. Leadership skills are now recognized and developed throughout nursing divisions, not just in nursing administration.The emergence of shared governance has been wonderful. By the way, when I first went to Virginia Mason Medical Center, I found the first shared governance bylaws I had ever seen. These had been written by the nurse leader who preceded me. She wrote those in the 1960's. We've been preceded by far thinking leaders!The education for nurse executives is much higher than it was in the past. Since about 1987, I've seen a broadening of nursing leadership internationally with stronger emphasis on our financial skills. Organizations such as Robert Wood Johnson and Wharton School of Business have recognized and supported the need for business preparation of nurses in executive positions.The emergence of men in nursing has been a great change for us. I remember when faculty used to stress over "What shall we do with the male students in OB?" (I told them, "What do we do with the male MD's?") Of course, it was that evolution that led to us doing away with the nursing caps and capping ceremonies! I have to say it's interesting that my cap, cape, pin, and Nightingale lamp are now historical items, which I have donated to the Marquette University College of Nursing where I graduated in 1955.
Sanford:Is there anything that you think has not really changed in nursing leadership over time?
Brown:I am hoping that the sense of being "one" with the staff nurse has not really changed. I know that there is so much for our executives to do, and it is not possible to be physically present with all of the nurses, but it is so important that we support the work that they do.
Sanford:You have been an icon in nursing journalism, which I consider another specialty. Can you give some thoughts on how that has evolved, along with professional nursing scholarship?
Brown:As you probably know, nursing wasn't always scholarly. In fact, there was a longtime schism between academics and practice. To those of us in operations, it seemed that academic research was done mostly for subjects without any meaningful application to patient care. Nursing Administration Quarterly was part of the journey to changing that. "Research: Impact on Patient Care," NAQ, Vol 2, No. 4, Summer, 1978, began the inclusion of research for nurse executives. We've become a profession where much of our research has practical applications that can actually help individuals and communities change on the basis of research findings that result in improved nursing care.Because of my dual roles, I was fortunate to become a member of the American Academy of Nursing in its second year (1977) through invitation. Today, nurse leaders are sponsored and apply for membership, and there are more nurse leaders in operations involved than previously. Bringing the 2 areas together has been essential for increasing the science of nursing.I was one of the journalists who helped start the International Association of Nursing Editors, fondly known as INANE. Our first international meeting was in 1982 at the Royal College of Nursing in London. Thelma Schorr, Editor in Chief, American Journal of Nursing, was the journalist who initiated INANE and gave the name to our organization of nursing editors. There are way too many outstanding nurse journalists and nurse researchers who have contributed to nursing scholarship for me to list them all. Some of the great journalists who come to mind include Thelma Schorr of the American Journal of Nursing; Leah Curtin, who transformed Supervisor Nurse; and Connie Curran, who brought us Nursing Economics. Barbara Stevens was a great writer; Diana Mason, also of American Journal of Nursing, was on the cutting edge of research and publishing. Norma Lang was an outstanding researcher for quality. Linda Aiken and Peter Buerhaus have made tremendous impacts on practice environments with significant database findings. And of course, we cannot forget Tim Porter-O'Grady, who has been a leader in shared governance and the publishing world.
Sanford:Technology is changing how we communicate. At the INANE conference this summer, there was discussion about print journals still being popular and used by nurses. What are your thoughts about technology for nursing and nursing journals for the future?
Brown:Technology has impacted the practice and education of nursing beyond that envisioned 40 years ago. Of course, the use of innovative tools such as automated staffing and scheduling is not new to nurses. When I was in Saudi Arabia, we were using the electronic staff scheduling system, which was used at Virginia Mason Medical Center when I left in 1987. It was great that we had this because when Desert Storm occurred, we had a crisis with a nursing shortage. Many international nurses chose not to practice in Saudi at that time. The electronic system really saved us because we had information at our fingertips about individual nurses and what their backgrounds were. For example, when we didn't have enough OB nurses, we were able to determine quickly which bone marrow transplant nurses had previously worked in OB and assigned them to obstetrics. I mention this because it's an example of how technology has been able to enhance organizational efficiency for quite a while.A point I like to make to nurses about technology is that while it changes how we do things, it can free us to do things better. Before electronic staffing systems became common, front line nurse leaders spent an inordinate amount of time writing out schedules and managing daily staffing manually. Their paperwork didn't allow them to practice nursing leadership at the level it was needed. As other technologies are developed and implemented, we need to use them to make us better practitioners and leaders. The same thing holds true in nurse journalism. Print is wonderful, and new communication technologies will increase our ability to share information so that we can better do what needs to be done for patients and communities.
Sanford:Dr Brown, are there other things you would like NAQ readers to think about for the future?
Brown:Yes. No matter what change comes, we must be about the very best patient- and family-centered care. I hear from so many people that recent patient experiences have been less than stellar. They complain that physicians have no bedside manner and that they don't truly feel cared about by other team members. I've been told stories that illustrate this in both major university and community hospitals.If nursing doesn't hold it together, that is, remains patient centered, we will lose our very essence. We need to still pay attention to staffing and quality while we are concerned with finances. At the same time, it's important that nurse leaders pay attention to the needs of the staff and patient care.We've always been innovative. I remember doing research and setting up a sexual assault treatment center. We also had a childcare center and breast-feeding rooms for staff at about the same time. Then, that was considered innovative. Now, we need to continue taking care of the nursing staff so that they can take care of patients. Leaders need to find ways that nurses aren't consumed with nonclinical decision nursing activities. Nursing is a wonderful profession. Nursing, nursing leadership, and nursing journalism have all been my passion. I know that there are other passionate leaders who stay informed about practice, care about both staff and patients, and embrace innovation as we prepare for the next decades. It makes me proud that NAQ is still here to help them with their journey.
-Kathleen D. Sanford, DBA, RN, FACHE, FAAN
Editor-in-Chief
Nursing Administration Quarterly