Leading Change -- A Profile of Dr. Paulette Burns

Fort Worth, TX

12/11/2008

In 2005, Dr. Paulette Burns, Dean of Harris College of Nursing and Health Sciences, was selected as one of twenty Robert Wood Johnson Executive Nurse Fellows. The Robert Wood Johnson Executive Nurse Fellows Program is a three-year program designed to advance leadership for nurses in senior executive roles who can help to lead and shape the US healthcare system for the future. Each year, the fellowship program accepts equal members from academia, hospitals and public health. The program is designed around five leadership competencies – self-knowledge, strategic vision, risk taking and creativity, interpersonal and communication effectiveness and inspiring and leading change – that prepare executive-level nurses to lead and shape healthcare. During the course of the program, each fellow completes seven leadership seminars, a leadership project at the home institution and a mentor experience.

Why is there such a great need for leadership and change in the current US healthcare system? And in nursing specifically?
The Institute of Medicine has issued numerous national reports since 1998 detailing problems in the US health care system and sounding the clarion call for change in the system. Issues surrounding patient safety, quality care, financing, accessibility, and workforce sufficiency demand system change. Health care in the United States is excellent on some measures such as acute care, but on many other measures we are behind other industrialized countries, such as infant mortality rates. Nursing is the major component of the health care workforce with over three million nurses. Because nurses have a broad educational background in promoting health as well as managing illness and disease, they are uniquely prepared to address many of our current issues. Nursing roles permeate all areas of health care in our society-hospitals, public health agencies, schools, prisons, businesses, mental health facilities, long-term care facilities, and many others.

How does the Robert Wood Johnson Executive Nurse Fellows Program help influence change in nursing and nursing education?
The program focuses on leadership development and support among decision-makers in nursing and nursing education or those who can make the needed changes. Changing nursing and nursing education provides the opportunity to change the health care system. Bold and innovative change led by nurse executives can make a difference.

From you experience in the program, what did you discover about yourself as a leader in nursing education?
I discovered that leadership is a journey, not a destination (Hesselbein, 2008). I learned that much of leadership is knowing deeply who I am as a person and as a leader and then using my strengths collaboratively with others. There were many components to the program such as seminars, the leadership project and the mentoring programs. Which was your favorite? Each seminar highlighted a national leader through a session called “Leadership Lessons Learned”. Leaders in Nursing and other fields shared their leadership stories. Each one was fantastic, but a particularly memorable presenter was Donna Shalala, President of the University of Miami and US Secretary of Health and Human Services during the Clinton administration.

Who was your mentor, and how did he/she help you throughout the program?
My mentor holds a vice- presidential position in an international technology corporation. She was helpful in many ways. She shared her experiences in the executive arena, strategies for managing difficult situations and decisions, strategic planning for the company, negotiating career challenges, and ways to focus on maintaining balance among life and work demands.

Who were some of the seminar speakers that stood out in your mind? Why?
Frances Hesselbein, current Chairman of the Board of Governors of the Leader to Leader Institute and its founding President, and CEO of Girl Scouts of the U.S.A. from 1976-1990 was another favorite. Her transformation of the Girl Scouts from an almost defunct organization when she was named its new leader to the thriving, vibrant organization it is today was an inspiring and informative example of great leadership.

What was your leadership project?
My leadership project was development of a new degree program at TCU, the Doctorate of Nursing Practice (DNP).

How did you come to decide to create the Doctoral Nursing Program (DNP) as your project?
The degree is a practice doctorate as differentiated from a research doctorate (PhD). Many other health professions have moved their degree programs to the doctoral level, such as the PharmD, to keep pace with the knowledge explosion. TCU prepares two of the four advanced practice nursing roles, Certified Registered Nurse Anesthetists and Adult and Pediatric Clinical Nurse Specialists. It is important for TCU to prepare students for the highest level of clinical leadership.

What was the process in creating the program?
Any change requires helping people see the vision of what can be and a safe road to get there. Nursing and Nurse Anesthesia, even though they have the same roots in Nursing, have very different histories, accrediting bodies, and professional organizations as advanced practice disciplines. Collaborating on development of one degree program required creating a strategic vision, negotiating to create the new curriculum and shepherding it through the approval processes, and fostering interdisciplinary understanding.

The DNP has grown exceedingly since fall 2007 when it was established. What do you hope to see in its future?
All advanced practice nursing master’s programs have been mandated by the American Association of Colleges of Nursing to transition to the DNP by 2015. TCU is the first university in Texas to offer the degree for all advanced practice nursing roles. The degree is currently offered as a post-master’s DNP only. In the next few years we will transition our Clinical Nurse Specialist and Nurse Anesthesia programs totally to the DNP. We are also creating an executive track in the DNP to prepare nurses as executive nurse leaders.

Why is it so vital that universities begin to establish doctoral programs similar to the one at Harris College? The knowledge explosion and complexity of care and organizations demands additional preparation of our graduates so they are able to function at the highest clinical level.

Since completing the program, have you taken a different approach to your position than before? One of my lessons learned through the fellowship is the importance of systemic change, not just change. The fellowship has taught me to evaluate everything the Harris College is doing in light of the needed health care system changes. Our students must be prepared to be leaders and change agents in the system.

What changes do you hope to see in leadership in nursing and nursing education at TCU as a result of the program and DNP?
Academic and clinical nursing is very much a part of the graying of America. New and emerging leaders are needed now to fill administrative, faculty, and clinical positions. So, leadership development among faculty and students is a major priority over the next several years. The unrelenting demand for additional nurses and other health care providers in the workforce requires academia to revolutionize our educational programs and approaches. TCU will continue to lead by seeking innovative solutions, increasing student capacity, and creating new opportunities for making a difference through education, scholarship and service.