As the nurse manager of a 44-bed oncology/telemetry unit at Paoli Hospital-Main Line Health, a Magnet(R) recognized, 231-bed, acute care, Level II trauma center in the suburbs of Philadelphia, Pa., Debra Ruddy oversees 55 full-time equivalents and a total of 75 staff members. When Debra began her present assignment, she made an assessment of the unit to identify critical needs. As a result, a mandatory oncology competency was developed, leading to 92% of staff members becoming certified in chemotherapy administration and biotherapy functions, and improving nurse-patient and nurse-physician relationships, as well as safe, efficacious care. Debra fully integrated herself into the leadership team, gaining the respect of the medical staff, which resulted in a reduction in patient transfers to inner city oncology units. Physicians have commented to senior leadership about the improvement in staff competency, patient safety, and satisfaction.
Transformational leadership
The key to Debra's exceptional success within the organization is transformational leadership. She has standardized a care delivery model, placing the patient at its core via increased transparency in the continuum of care. A partnership was developed with the Outpatient Cancer Center to fulfill this mission. This has resulted in initiatives to improve patient outcomes and patient and staff satisfaction. The unit has had zero hospital-acquired pressure ulcers in 18 months and no catheter-associated urinary tract infections or bloodstream infections for 12 months.
Debra makes a point to meet with each employee quarterly, helping identify his or her strengths and opportunities for improvement. This initiative has transformed the unit into one with an admirable employee engagement score and total dedication to supporting the mission of superior patient care. As a result, specialty certification has increased 10% and staff members are completing BSN, MSN, and NP programs.
As a respected member of the leadership team, Debra's peers regularly seek her advice on dealing with difficult employee situations. The passion she exhibits is unmatched; her drive for superior patient outcomes is equaled by the desire to develop competent, satisfied staff. Her team development strategies have increased unit employee engagement survey scores 13% over the last 18 months.
Debra joined the American Organization of Nurse Executives (AONE) Care, Innovation, and Transformation initiative to redesign patient care and the environment. She has partnered with staff members to develop tests of change, resulting in the implementation of 16 new initiatives. This process is instrumental in the development of nurse change agents.
Currently enrolled in a DNP program, Debra is a member of the Oncology Nursing Society, Pennsylvania Organization of Nurse Leaders, and AONE. She has served the community as an American Cancer Society Relay for Life committee volunteer for over 10 years and a Leukemia and Lymphoma Society Light the Night Walk volunteer. She has also adopted families in need during the holidays and participated in the American Heart Association's Go Red for Women Campaign to promote awareness of women's heart disease.
Debra views effective financial management as essential to the delivery of superior patient care, as well as maintaining a satisfied staff. She's cognizant of the interplay between costs and outcomes, teaching staff members how to translate the unit's mission into desired outcomes through weekly budget reviews. Debra has also mentored peers in the realm of financial management.
Clinical practice
Debra's clinical practice is exemplified by her involvement in the system's Oncology Affinity Group, standardizing chemotherapy orders and practice to positively influence patient safety and staff satisfaction. As one nurse stated, "I believe Debra exemplifies superior service with a focus on chemotherapy administration and the care of oncology patients. Safety is her priority for her patients and staff." Believing in the concept that every patient has the right to an individualized care plan, Debra has worked in a seamless fashion to improve quality and consistency on the unit. This has resulted in scores in the 98th percentile in the skill of the nurse category.
Utilizing a holistic approach, Debra rounds to gather information regarding patient and staff engagement. She demonstrates excellent communication skills to elicit information and put into action approaches to care that have value and meaning to members of her team-linking the art of nursing with science. Her passion for the profession is evident to all who interact with her. One colleague stated, "She's a nurse's nurse."
Mentorship
One of Debra's strengths is mentoring staff. In addition to the majority of staff members becoming certified in chemotherapy administration, oncology certification on the unit has improved 36%, with a BSN rate of over 90%. Clearly these results display Debra's passion to motivate staff in the arena of responsibilities to improve satisfaction and patient outcomes.
Debra was instrumental in helping the unit council develop an education team committed to assessing staff needs, having regular journal reviews, and identifying appropriate methods of communication to disseminate their findings to all staff members. This is illustrated by a 100% score in the teamwork category of the Advisory Board Company's staff survey. She also instituted a unit mentorship program in which new staff members are assigned to a mentor for 3-month increments. The mentor doesn't precept, but acts as a professional advisor to assist with the transition to a new organization and unit. This has resulted in improved RN satisfaction and decreased turnover.
Florence Nightingale wrote, "Never lose an opportunity of urging a practical beginning, however small, for it is wonderful how often in such matters the mustard-seed germinates and roots itself." Debra seizes every opportunity to put this quote into practice. She actively mentors staff on the unit to reach higher, learn further, and become more engaged. This, in turn, has led to enhanced staff satisfaction and improved patient satisfaction and safety. Debra's efforts have resulted in two clinical nurses becoming board certified in pain management, and several others are studying to obtain this credential.
Debra has served as an adjunct faculty member for the accelerated RN-to-BSN program at Immaculata (Pa.) University. As an adjunct, she shares leadership attributes with the students to support personal growth and a commitment to the nursing profession at large. Through her interactions with students, she imbues in them the desire to see the profession flourish. Debra also teaches classes within the organization, such as "Culture of Safety" and "I am the Patient Experience." Her students have commented that "she's a positive influence," providing them with a source of inspiration. She envisions the nursing landscape to "be all that it can be," reaching far and wide in this new decade of healthcare reform.
Employee engagement
Debra promotes staff recognition, communication, and autonomy. She consistently recognizes staff members through verbal and written notes, small gifts, and participating in the employee of the season award nominations. She authors a weekly communication newsletter to staff members, noting the accomplishments of the previous week. With her encouragement, staff members have created a sunshine fund to recognize each other on special occasions and plan social events to build team collegiality. They also created posters with pictures of colleagues and their families to share with everyone on the unit.
Debra promotes regular, timely feedback regarding concerns and diligently follows up with staff members, partnering with them to obtain a solution. She works tirelessly to improve the working environment, chairing the systemwide healthy work environment council and sitting on the nurse executive council. She was influential in creating the hospital's "oasis room," which is dedicated to providing a quiet, soothing environment for nurses to relax in during breaks.
Aware of staff members' disenfranchisement regarding unit staffing, Debra empowered staff and the unit council to develop an acuity tool so that assignments can be made based on acuity, not geographic location. After implementation, staff members were surveyed regarding patient safety, satisfaction, and assignment. The results demonstrated greater satisfaction with assignments; improved patient outcomes, morale, staff collaboration, and teamwork; and reduced patient care delays. She also encouraged staff members to adopt self-scheduling; they then elected a staffing committee to have oversight. Debra validated that staff members can find effective solutions for providing better patient care.
With Debra's assistance, the organization has been recognized as an Employer of Choice for several years in both the Philadelphia area and the state of Pennsylvania. Practicing within a holistic framework, she's engaged in caring for every nurse on her unit. This is exemplified in her approach to assisting a team member with a diagnosis of a life-altering disease. Debra challenged staff members to work together to support a wellness journey for their colleague. This truly emphasizes her belief in the art of nursing practice.
Staff feedback about Debra was elicited after her first year. Feedback included a sense of improvement in manager support, respectfulness, relationships, and shared leadership, and increased appreciation and recognition regarding acknowledgment of staff member achievements, as well as listening to their ideas and concerns. Staff members also commented on Debra's continuous encouragement to expand both personally and professionally, such as attending local and national conferences and participating in professional organizations. Their words were truly inspiring to hear.
A journey to excellence
Debra leads her team in the exemplary, holistic practice of treating young teens with a devastating cancer diagnosis. These families seek care in a family-oriented community hospital setting following treatment at large health centers. Debra's team collaborates with the patients and families, inquiring about their personal preferences and developing a group of primary nurses to deliver care within a healing framework. An attending physician wrote a letter stating, "The nursing care has been exemplary in sometimes quite difficult circumstances. The dedication, hard work, and care...made this experience as positive as it could be. My sentiments come from the heart and are shared by this family and their friends."
Author David Hagberg writes, "The leadership journey is a matter of the soul and that is where the energy and the focus have to be." Debra S. Ruddy is on this journey-facing fear, letting go of control, gaining self-worth and inner strength, finding freedom and moral passion, and truly exhibiting transformational leadership on a daily basis.