key: cord-0051653-uyrowz7n
authors: Shinkus Clark, Joan
title: Jacqueline Herd DNP, RN, NEA-BC
date: 2020-10-16
journal: Nurse Lead
DOI: 10.1016/j.mnl.2020.09.003
sha: c62c96021da2fa581b1889b46729e3fd127c1595
doc_id: 51653
cord_uid: uyrowz7n

Jacqueline Herd, DNP, MSN, RN, NEA-BC is the Executive Vice President and Chief Nursing Officer (CNO) at Grady Health System in Atlanta, Georgia. She is a California native and moved to Georgia in 2009 as the chief nursing officer at Grady Health Care in Atlanta (Tenet Health Care). With over 20 years’ experience as a nurse executive, her passion is inspiring and empowering nurses to lead. Before moving to Georgia, she was a member of the Association of California Nurse Leaders (ACNL), and since moving to Georgia, she is a member of the Georgia Nurses Association, American Nurses Association, and an active member of Georgia Organization of Nurse Leaders (GONL). She has served as a member at large, president elect, president and immediate past president on the GONL State Board. She is an active member of American Organization of Nurse Leaders (AONL), has volunteered on the by-laws committee and the publication committee for the “Voice of Nursing Leadership,” and is current AONL board member elected to represent Region 4. She is a strong advocate for the March of Dimes (MOD) and has served on the MOD Atlanta Planning Committee and the Nurse of the Year nominating committee. She has also served on the Georgia State Community Advisory Board and is currently on the Emory University Nell Hodgson Woodruff School of Nursing DNP Community Advisory Board. She is married with 3 children and 7 grandchildren.

JH: While in high school, I completed certification as a medical assistant. My future plans were to work in a physician's office. I had enough credits to graduate from high school early and landed my first full-time job working in a physician's office as a medical assistant at 18 years of age. I quickly realized not only did this job not provide medical insurance, it did not pay enough money to support my family. Working in a physician's office provided me a glimpse into health care and supported my decision to become a physician. However, as a single parent, I realized I needed to work, so I decided to go to nursing school to support my family and allow me to attend medical school. I enrolled in Compton Community College in the nursing program. During my training, I worked 2 jobs: 1 full-time night as a registration clerk in the emergency department (ED); and the other part-time during the day in a physician's office as a medical assistant. Working 2 jobs was challenging, I was an early adopter of power naps-when in class, I would opt to take a nap at break versus eating a snack. After a 10-to 15-minute nap, I was rested and ready to continue onto the next task. I remember several of my instructors telling me I could not continue to work and go to nursing school. With the grace of God and support from my mother and stepfather, I was able to graduate from nursing school as scheduled and pass my nursing boards on the first attempt.

My early experience in the field began in the same emergency department where I worked night shift as a registration clerk. After about 6 months, I resigned and accepted a job in a larger, busier ED with a robust onboarding program for new graduates. I worked the night shift in the emergency department at Martin Luther King Jr. (later renamed King Drew Medical Center). I remember as a new graduate, I loved working as a nurse; and for me, the concept of teamwork was natural. I worked hard as a nurse and harder as a team member, regardless of whose job it was. I helped nurses, clerks, emergency medical technicians, and the interns and residents. I found that my goals around becoming a physician were fading away, as I loved the nursing role. Within about 6 months, I found myself in charge when the fulltime charge nurse was off. I believe this was due to my work ethic and belief in the concept of teamwork. While I probably did not realize this at the time, because it was who I was, this was the beginning of my early experience in leadership. As a 23-year-old new graduate, I was in charge of staff who were old enough to be my mother and with many more years of experience than I. As a nurse, I have never looked back. There are so many opportunities as a nurse, and I realized that there were many ways that I could add value. The leadership role was a place where I felt comfortable and confident, and since my beginnings as a charge nurse, I have continued to pursue positions that have allowed me to develop my expertise as a leader.

JSC: How did your experience in the field prepare you for the leadership challenges nurse executives have faced during 2020?

JH: The challenges for nurse executive are usually around staffing, resources, doing more with less, while ensuring quality outcomes, staff retention, patient satisfaction, and financial stewardship. Those challenges are always with us, but when you add a pandemic to the equation, it has greatly intensified. My career as a CNO began in a small community hospital near Los Angeles. I had worked at this organization for over 15 years. When the CNO resigned, I was the most senior nurse leader and was asked to fill in as the Interim CNO. At the time, I was close to completing my MSN as a family practice advanced practice nurse. When I completed my degree, I was asked to apply for the CNO position. Within the first 6 months of being a new CNO, I underwent 2 union organizing campaigns and a successful Joint Commission (TJC) survey without an established nursing leadership team. When the previous CNO left, she took the entire nursing leadership team with her. I went into the TJC survey with an interim director of the ICU, ED, medicalsurgical, and subacute. We had just remodeled and opened obstetrical services, and a new director's first day was on day 1 of the survey. As a previous emergency department nurse, I quickly become versed in labor and delivery and in subacute regulations. I believe this experience created the foundation on which I would continue to grow and learn the importance of flexibility, thinking outside the box, and back to basics.

In the late eighties and in the nineties, many hospitals in California were either closing their doors or being acquired by larger health systems. This included my hospital, which was sold several times, and then closed its doors due to the complexities in the health care environment. In another role, I had the opportunity to close services on one campus and transfer the services to its sister hospital, less than 5 miles away. These 2 hospitals had a long history of competing for the same patients and medical staff before the same owner brought them. The 2 hospitals were well-known in the community, but the cultures were very different. We transferred entire units to maintain the culture, and as we transferred the last patient, the historical inpatient rehabilitation unit was transitioned to a standalone with a 24-hour emergency department. This ED, once known as a level II trauma center in the early eighties, became a walk-in urgent care.

Experiences such as these as a CNO were life changing, and I was forced to dig deep before I felt prepared. I think the most important takeaway was knowing that regardless of how difficult the situation, I was capable of getting through it. These experiences taught me flexibility and resiliency. I also learned not to sweat the small stuff. This was the foundation on which I continue to grow and learn and prepare me for future challenges. There will always be challenges and in those that have occurred in 2020, the key is having the flexibility and resiliency to get through it.

JSC: Considering the extraordinary nature of dealing with preparedness during a pandemic, what wisdom can you share from this experience?

JH: My career began in the emergency department. As an ED nurse and nurse leader, we were accustomed to disaster drills, whether natural or acts of violence. In my experience, the problem I encountered with other leaders and staff is their belief that disaster preparation is for the ED. Last year, Grady Hospital participated in a disaster drill. The director of emergency management and SVP [senior vice president] of clinical operations insisted the entire organization, including medical staff, participate in the drill and the debriefing. We utilized a modified hospital incident command system (HICS). About 2 to 3 weeks later, Grady had a major flood. When the team realized this was a major disaster, they were able to quickly stand up the incident command structure. The disaster resulted in the loss of 3 patient care floors (230 beds), evacuation of patients, damage to 75% of our elevators, loss of power in a patient tower for 6 weeks, and complete hospital diversion for 14 days. By the time we began to see COVID-19 patients, we were very well prepared in response to disasters. The incident command structure managed human and financial resources including personal protective equipment (PPE), supplies, staffing, COVID-19-unit activations, surge capacity, communication, and psychological support. The wisdom I share is to always ensure everyone in your organization participates in disaster drills and remains continuously ready for disasters, no matter the form or the scope.

JSC: As you look towards the future, what advice would you provide leaders who are dealing with a "new normal" in nursing practice brought on by the impact of the pandemic?

JH: During my career as a nurse, I have seen several "new normals." I think the most dramatic new normal we have seen in health care before COVID-19 was universal precautions. I recall working in the ED as a trauma nurse in the early eighties and not wearing gloves. The honor of an ED nurse was going home with blood on your uniform-IVs and blood draws were done without wearing gloves, especially since it was sometimes challenging to feel the vein. This was before a new unknown disease began to wreak havoc. This mystery disease soon to be named acquired immune deficiency syndrome (AIDS) resulted in patients wasting away and dying from opportunistic disease, creating fear within the health care community. The COVID-19 pandemic reminds me very much of AIDS epidemic, where I saw health care professionals afraid to provide care for human immunodeficiency virus (HIV)-positive or AIDS patients. I was working as a charge nurse in the emergency department, and as a leader in the ED, if nurses were fearful of taking care of an HIV-positive or AIDS patient, I would take the assignment and support them in their understanding. Today, my role as a CNO is different. My role is to support the hundreds of nurses that are on the frontline providing care for our patients, and assure that they have proper PPE, so that they don't endanger themselves or their loved ones. My role is to be visible, answer questions, and ensure ongoing communication. I have found that no matter how often I rounded, I would continue to answer some of the same questions, as well as dispel rumors. My advice to leaders is frequent rounding, frequent huddles with frontline staff, frequent communication in different modalities, active listening, and honesty. Also, it is critical to ensure that staff have the resources, emotional, and physical support they need.

With COVID-19, the effect on staff is magnified because of the of the spread of the disease. Even when COVID-19 is contained, there will always be something new that will challenge leadership, and being a resilient leader, use your past experience to help craft new ways of dealing with the situation. Regardless of the challenge, the leader's role does not change-support and communication and assuring staff safety are the most important things.

JSC: What one thing do nurse leaders need to do to best cope with change in difficult and new circumstances? JH: Develop a foundation of flexibility and resiliency, and rely on other phenomenal nurse leaders. Having access to several nurse leader listservs has been invaluable to me. I can send out questions and within minutes, someone is responding. We are all going through the same thing, and the support and camaraderie is invaluable. With COVID-19, I found this especially true, and the multiple resources provided through professional organizations have been very helpful.

JSC: What contribution to nursing are you most proud of? JH: As nurse leaders I believe that our contribution to the nursing profession is to ensure development of the future nursing work force. The contribution I am most proud of is making an investment in the development of future nurse leaders. My experience as a new nurse leader was feeling under-prepared in early leadership roles. Preparing frontline nurses for leadership roles frequently begins in the academic phase of their training but does not always get continued in early practice roles, leaving the same fate for them when they find themselves chosen for leadership. I have always believed in and have promoted the engagement and early development of frontline staff through professional empowerment in shared decision-making. Leaders must mentor new leaders and "pay it forward" through proactive succession planning and strategic approaches that empower staff to take charge of their practice. JSC: You have been a long-time member of AONL and taken advantage of opportunities to be involved, currently serving as the AONL Region 4 board member. How have your membership and access to resources affected your practice, and what advice would you give to leaders interested in AONL leadership? JH: Membership in professional organizations has provided me the opportunity to collaborate and network with others. As a long-time member of AONL, I have had the opportunity to volunteer for various projects and committees. Each time I have the opportunity to connect with others, it broadens my network of colleagues and access to information and opportunities. The educational opportunities that are geared toward the nurse leaders at all levels have been invaluable in supporting my life-long journey of leadership development. The ability to access other nurse leaders through listservs, the publications, and the networking opportunities that start at the local level through the AONL affiliate chapters at the state level have been so important for enhancing my personal leadership journey.

I encourage all nurses to become involved in a professional organization. As a nurse leader, I became involved in my state organization. First as a member, then board member and as elected officer (vice president, president). Being involved in a professional organization gives you the opportunity to network, collaborate, and meet other nurse leaders that are experiencing some of the same struggles you are going through as a nurse leader. I was a member of AONL, and once I gained confidence at the state level, volunteered as a member of the AONL Publication Committee. At first, I did not know what to expect or how valuable my input would be. From there, I have looked for opportunities to contribute more, and as Region 4 board member, my ability to understand professional issues on a national scale has really enhanced my personal leadership practice. I would highly recommend that nurse leaders volunteer for opportunities to serve, which I learned of through regularly reading their publications, and attending the AONL annual conference.

JSC: Your beginnings were challenging, growing up in Compton, California, becoming a mother at an early age, yet you have become a highly educated and accomplished nurse leader. What has been the secret to your success?

JH: Resilience and never letting someone tell you can't. As a young mother, I realized that I had a responsibility to provide a safe environment for my child and ensure he would grow up to be a successful young man. I had the psychological support from my mother and stepfather, and worked 2 jobs to provide financial support. I was young and determined to be successful. Was it easy, absolutely no, but I never lost faith that I would be successful. I was the first college graduate and the first nurse in our family. My message to anyone young or old is to never give up on your dreams-hard work, faith, and determination go a long way. JSC: After originally pursuing a pre-med track, you became a nurse and decided to pursue higher education in nursing, becoming a certified family nurse practitioner. You have chosen professional roles that have been focused in underserved communities. How has this shaped your nursing leadership practice and what are your aspirations for your future?

JH: While I grew up in an underserved community, at the time, I did not grasp how the lack of access to social and economic opportunities could negatively influence health outcomes. Working as an emergency department nurse in Compton, Watts, and Inglewood, I saw the impact violence, chronic disease, obesity, trust, and lack of understating had on the community. As an African American, I could relate and have those real conversations with patients about their disease, diet, and outcomes. I recall having a conversation with a young black male at triage regarding not taking his blood pressure medication. We were close in age, which made the conversation even more real as we talked about the path he was on, one that could ultimately result in him have a stroke, requiring someone to feed and take care of him. This and some personal experiences with friends and family have shaped the importance of my leadership in the underserved community, because this is the community where I was raised and still have family members who seek their care at the Grady's of the world. I do for our patients what I would want done for my family members.

JSC: What advice do you have for nurse leaders in how to foster an engaged nurse practice environment in the midst of constant changes in health care? JH: Visibility. In the midst of a crisis, leaders often find themselves at the table collaborating with other leaders. The most important task for nurse leaders is to represent their constituents at the highest level and to be visible, transparent, and overwhelming communicative with frontline staff. Rounding on the staff during COVID-19, has provided me the opportunity to engage with the staff and dispel rumors. When we make them a priority, listen, and encourage them to ask questions, it helps to relieve anxiety and concerns. Be transparent, elicit their input for solutions, be honest, and tell them you do not know, but will get back with them. These are big responsibilities, and it is even more important to remember you are human. Take time for yourself and make sure your caring and support starts first with yourself.

She can be reached at jcgator@bellsouth.net. 1541-4612/2020/$ See front matter Copyright 2020 by

Family: Married to Charles for 28 years; 3 children (Elvis, Kia, and Cameron), and 6 grandchildren

Executive vice president, chief nursing officer, Grady Health System, Atlanta Georgia.First job ever: Baby-sitting younger cousins.First job in nursing: Emergency department nurse.Being a leader gives me the opportunity to: Develop the next generation of nurses.My best advice for aspiring leaders: Always ask the "why," and always put the patient and their family at the center of all decisions; treat them as how you would want your precious loved ones treated.My favorite leadership book recommendation: "The 21 Irrefutable Laws of Leadership." This book was an important foundational reference for me on leadership. One thing I took away was the importance of the responsibility that goes along with being a leader.Most people don't know that I: have three sets of twins in my immediate family. I have a twin sister who still lives in Compton; a set of twin brothers; and we are all the same age for 1 week. My youngest siblings are twins and are the same age for a week with a single birth. I have triplet grandsons and a great niece and nephew who are twins. My dad was a twin, and my mother had brothers who were twins.One thing I want to do: Work with inter-city schools to expose elementary grade students to health care careers.One word to summarize me: Blessed.