Dr. Regina Cunningham, PhD, RN, NEA-BC, FAAN, is an accomplished nurse executive, scientist, and educator who has made impactful contributions to advancing nurse practice and clinical care. In 2017, Dr. Cunningham was named Chief Executive Officer at the Hospital of the University of Pennsylvania and currently serves as Adjunct Professor and Assistant Dean for Clinical Practice at the University of Pennsylvania, School of Nursing. She previously served as Chief Nursing Executive and Senior Vice President of the University of Pennsylvania Health System and Chief Nursing Executive and Associate Executive Director at the Hospital of the University of Pennsylvania. She has extensive experience in the organization and delivery of nursing service across the care continuum, with particular expertise in the utilization of nursing resources in care delivery systems. Her research interests include the effect of nursing on outcomes, clinical trials, and innovative models of care delivery. Dr. Cunningham received a baccalaureate degree from the College of Mount St. Vincent, a Master of Arts in the Delivery of Nursing Service from New York University, and a Doctor of Philosophy from the University of Pennsylvania and then completed a postdoctoral fellowship at Yale University. She was selected as a Robert Wood Johnson Executive Nurse Fellow in 2006 and was inducted as a Fellow of the American Academy of Nursing in 2014.
1. What are the significant professional milestones in your career journey?
RC: Several milestones come to mind for different reasons. I think the first time I was promoted was important. I was working for about 2 years on a surgical intensive care unit at a hospital in New York City when I was approached by my Nurse Manager about going into a higher level staff nurse role. In those days, there were no clinical advancement systems, but the promotion allowed me to take on more responsibilities, such as being in charge of the unit and using my clinical knowledge to influence others; it taught me some very fundamental lessons about leadership. Another milestone was my first Chief Nursing Officer role. I was selected to serve in this capacity at a small free-standing cancer center. Although I had a very solid background in cancer nursing administration at the time, I was only 35 years old and really had so much to learn. I was fortunate in that people were willing to provide tremendous support during those formative years as a nurse executive. Completing my doctoral work at the University of Pennsylvania School of Nursing was another significant milestone in my career. Having formal training as a scientist had put me in the same league with other scientists working at the cancer center. This changed the way I thought about the world and sharpened my skills in data and analytics tremendously. After completing my doctoral work, I became more involved in helping shape some of the scientific strategy at the cancer center; this afforded me the opportunity to see things through a different lens and positioned me for a broader role in a larger academic medical center. In this broader role, I had responsibilities that went beyond nursing into areas of operations and finance. This opportunity allowed me to see the bigger picture, work across boundaries, and develop much broader leadership competencies. A final milestone that I will share was when I transitioned into my current role as CEO. Again, there was a tremendous amount to learn about the role and expectations, but there was also a great opportunity to leverage clinical and administrative knowledge to benefit patients, staff, physicians, and the organization. The scope of influence in this role is substantial, and it has been a powerful platform for driving positive change.
2. How have you seen the specialty of nursing professional development (NPD) change during your career?
RC: I have seen the NPD specialist role change over the many years of my career. One of the key changes I have noted is related to the NPD specialist's use of evidence to guide practice changes and ultimately drive quality. As we continue to move to ensuring an evidentiary basis for practice, NPD specialists have become increasingly important translators of this information into the practice setting. As practice evolves and changes, their role is critical to ensuring competency among nursing staff. Another change that I have seen is an increase in the need for the NPD specialist's role beyond the acute care setting. The focus on decreasing healthcare expenses has increasingly driven care to the ambulatory setting. This has led to the delivery of more complex care in outpatient environments with the need for more nursing education and support in this arena. NPD specialists have the opportunity to support the advancement of nursing practice in the ambulatory and postacute environments.
3. From your perspective, what do you see as significant trends or gaps in nursing practice that NPD specialists could address?
RC: I think there are two important areas where NPD specialists could expand their influence; the first is related to driving value, and the second is in population management. In the value-based healthcare world, we are increasingly accountable to provide care for extended time periods-often for 30 or 60 days following an "anchor" admission. Payments are increasingly "bundled" for specific periods of time that extend beyond the acute care or inpatient stay. This means we will be accountable for care delivered beyond the walls of the hospital. Given this trend, nursing care in the postacute and ambulatory arenas has become a critical part of the equation, and we have to shift our thinking to incorporate this change. Historically, NPD specialists have played less of a role in these settings, so this will create new opportunities for them. Coordinating care for patients as they move across settings to their next level of care will be a critical competency. Nurses have many of the skills required to do this effectively, but they will need to use them in a different way. They will need to anticipate patient care needs at the next level of care and ensure that appropriate resources are coordinated to serve the patient and their family. They will increasingly need to communicate with other professionals across traditional boundaries. Nurses will need to think about patient needs in a broader way. NPD specialists can help to lead the way in this area. Understanding these changes and supporting nurses in developing the skills to do this effectively is an important area of focus.
The second area of opportunity is the need to develop expertise in the management of populations. You hear a lot about population health, and this can be defined in many ways, but for the purposes of this discussion, I am referring to clinical populations, such as patients with diabetes or cardiac disease. Patients seek healthcare services based on these needs. Many complex clinical conditions, such as cancer and advanced heart failure, have now become chronic illnesses, and patients with these diagnoses are managed over long periods of time. Nurses need to develop expertise in the management of specific clinical populations. Understanding this puts nurses in a position of driving care efficiencies and overall quality. NPD specialists should be in the vanguard in supporting nurses to develop knowledge and expertise in the management of clinical populations.
4. What insights can you share related to the value of the NPD specialist in healthcare organizations now and in the future?
RC: One way to define value in health care is outcomes that matter to patients over the cost of delivering those outcomes. Nurses can play a tremendous role in driving value within healthcare systems. They are at the front lines; as such, they are making key decisions that influence patient outcomes every day. Nurses conduct ongoing assessments to identify changes in patient status, acting swiftly upon clinical changes to safeguard patients. NPD specialists are critical to ensuring that nurses have the proper education, skills, and competency to be able to perform their roles effectively. In doing so, they have a profound influence on the overall quality of care delivered to patients. The NPD specialist plays an essential role in helping nurses to effectively transition into their roles in specific practice settings and supporting nurses in maintaining competency over time as practice evolves.
5. What advice do you have for the NPD practitioner in the context of today's health care and learning environment?
RC: I think it is critical for professionals to be relentless learners. We should constantly challenge ourselves and the status quo. Science and technology are driving advancements at a rapid pace. These changes often lead to increased complexity in care delivery. NPD specialists need to constantly remain abreast of these changes so they can support nurses delivering advanced care on the front lines. We have tremendous opportunities in our practice settings to gain meaningful experiential knowledge. I always encourage people to raise their hands when they see an opportunity that stimulates their interest. I think it is important to volunteer for stretch assignments. Have the courage to take risks in areas where you might not be that familiar or skilled. We learn from all professional experiences, even those that don't work out as well as we might have anticipated. Take advantage of learning opportunities. I think it is also important for NPD specialists to develop themselves as leaders. This can be done through formal leadership development programs or more informally. Identifying role models and mentors can be very helpful. It is also good to think about paying it forward and helping others to grow.
6. Other comments you would like to share.
RC: NPD specialists are in a pivotal role. Through their knowledge and skill, they have the opportunity to drive excellence in practice, impact the quality of care delivered, and influence the overall value in healthcare delivery.