Linda Knodel first realized she wanted to become a

Leader to Honor Linda Jane Knodel, MSN, MHA, NE-BC, CPQH, FACHE Tim Porter-O Grady, DM, EdD, ScD(h), APRN, FAAN, FACCWS Linda Knodel first realized she wanted to become a nurse when she was in the fourth grade that s when she had an opportunity to be a candy striper in her hometown hospital, and where she also discovered her inspiration and passion for nursing. One of the reasons she enjoyed working in the hospital was the opportunity to observe the caring and compassionate work of the nurses. They intrigued and inspired her, and she eagerly took every opportunity to assist. One day, Linda was able to convince a 103-year-old patient to eat for her. The elderly woman was a challenging patient and ate for very few of the nursing staff. Linda counted this as a blessing and an opportunity. Day after day, she returned, visiting the woman and other patients to serve as she was able. That passion to serve stayed with her throughout her formative years. Following the advice of her high school guidance counselor, Linda enrolled in a nursing school in Fargo, North Dakota. This local school gave her many patient care experiences, which validated her early passion for and commitment to nursing as a career choice. She has never looked back. Linda s career path has led her into the highest echelons of leadership. Along that path, she was fortunate to have many nursing mentors and leaders who inspired her also to lead, not only at the local, state, and regional levels, but now at the national level. This brings us to this brief interview with Linda Knodel, now at the forefront of her profession as she assumes the presidency of the American Organization of Nurse Executives (AONE). As Linda prepares to be sworn in at this year s annual meeting, we asked her to share how nursing has brought her to this place in her career. TPOG: Linda, tell us about your leadership trajectory over the course of your nursing career. LJK: My leadership career really began when a supervisor asked if I would assume a charge position on the unit of my local hospital. I didn t feel particularly prepared or directed to assume that role, but in those days, when your supervisor asked you to do something, you just did it without question. On reflection, I know her choice demonstrated that she believed in me because she saw signs of a burgeoning leader in me and was willing to take a risk on my behalf. In fact, she became one of my earliest mentors, encouraging me in the face of www.nurseleader.com Nurse Leader 19

that new challenge and in many subsequent challenges. In those days, it was assumed that clinical excellence and performing at a high level of clinical competence was sufficient to prepare anyone for a leadership role and would form a firm foundation for their performance. Certainly, I wasn t long in the leadership role before I realized that simply wasn t true. In fact, I realized that leadership is a skill set of its own that requires particular competencies not necessarily obtained through excellent clinical practice. Through it all, my supervisor was there for me, encouraging me, developing me, helping me grow in my leadership confidence and competence. I think this notion of good mentorship was one of the early gifts that has helped guide me throughout my career. In every nursing role I ve had from charge nurse to assistant director to director and ultimately to chief nursing officer I have had great mentors and leaders who have supported me and provided many opportunities to develop and grow at every juncture and intersection along my career path. 20 Nurse Leader For example, as a young director, I noticed that we had a lot of patients who had to drive from outlying regions in order to receive treatment at our dialysis center. They had to travel up to 500 miles 3 times a week for their treatments. As a nurse leader, this was a real concern to me. I thought it would be much wiser and serve our patients better to place dialysis clinics in local community settings that were closer to our patient populations in order to provide shorter distances and easier opportunities for them to receive dialysis. I shared this with our CEO [chief executive officer], who simply encouraged me to do something about it. Despite my youth and naiveté, I was able to facilitate the construction and operation of 2 dialysis units within a 250-mile radius of our main hospital campus and a third unit at the main campus. I felt empowered that I was able to make decisions and take action, even though at times, I had my doubts if I was prepared for this challenge. But I was encouraged and motivated to take on its risks because of strong CEO confidence in my ability. Plus, I was confident in the fact that a dedi- cated and extremely competent team of professionals from the main campus would shepherd the opening of these 3 units within 15 months. TPOG: It sounds like you had people around you on your leadership trajectory who you could count on and who did much to encourage you along the way? LJK: Having people I could count on has always been a key factor in my leadership journey. First and foremost, my husband, Ken, is my greatest cheerleader and supporter, but I ve been fortunate to have help from others. For instance, along my educational path, there were individuals who encouraged me and made it possible for me to pursue my degrees, even though in my rural community, they weren t always necessarily easy to obtain. At that time, there were no online education programs available as there are today. Plus my husband and I were raising 3 daughters all under the age of 5. So, it was not easy to incorporate education locally, nor was it available in a form that I could take advantage of with all the other responsibilities I had on my plate. February 2014

Fortunately, my hospital leadership supported me in taking summers off so I could attend an out-of-state university over 4 summers. Eventually, I graduated with my baccalaureate in health administration. It wasn t easy, and the challenges were many, but with all of the support I had, I was able to complete those studies. Shortly after I earned my baccalaureate, I received a call from Marie Manthey, a very influential leader in nursing, who said, Linda, I do not see your application on the master s roster for our MHA program. So, again, with her timely encouragement and mentor support, I enrolled in that program and completed my MHA [master of healthcare administration] degree. Through it all, I guess you could say I ve felt like I owed it to myself and to others who ve helped me to live true to the values my parents taught me. They both worked 2 jobs during my childhood and taught our family the values of dedication and hard work. My education didn t stop there. Later on in my career, I was serving as CNO [chief nursing officer] at our local hospital. We were seeking Magnet recognition, and I became aware of the fact that as CNO, I did not have the appropriate nursing educational preparation (baccalaureate or master s degree in nursing) as a prerequisite for the Magnet application. Once again, my colleagues and mentors helped me work through this issue. Linda Burns-Bolton was kind enough to return a call during the evening hours, and she provided me with valuable guidance. I approached the Magnet Commission during their open session and requested that a change so significant be given some runway rather than putting the standard into effect immediately. I then contacted the chair of the division of nursing at our www.nurseleader.com local university, the University of Mary, about developing a program that would allow our nursing leaders to obtain their master s degrees. As a result, I returned to school along with 23 of our nursing leaders, and we earned our master s degrees in nursing. I did not want to hold up my organization s opportunity to be recognized as a Magnet hospital. With good mentors and supportive colleagues, as well as a caring and encouraging family, I was able to make the right choices at the right time, not only for my organization, but also for my career advancement and my development as a nursing leader. TPOG: As you look back on your career, what is one of the more significant critical events that affected your personal leadership? LJK: I think one very seminal event in my career occurred when I was asked to take on services that lay outside my traditional nursing leadership role. I was asked to become a service administrator for medical staff services, medical records, quality, risk, utilization, infection control, and admitting departments. I didn t fully understand the functions and activities of these departments and roles, so I was on a steep learning curve in my attempt to provide them with good leadership. I had to admit that I didn t fully understand how these significant departments contributed to the patient care experience. My managers of these departments helped me develop those insights. I realized pretty quickly how complex healthcare is and how significant all roles are as they connect together to create a mosaic of services around the patient experience. It gave me a deep appreciation for the contribution of everyone s Nurse Leader 21

Home town and family information: Born and raised in Williston, North Dakota, I have a brother and a sister and my mother of 86 years young (my father is deceased), Ken A. Knodel, my husband of nearly 37 years, 3 daughters, and sons in law, along with 7 grandchildren. First job and work location in nursing: St. Alexius Medical Center, Bismarck, North Dakota, working straight nights on the medical floor. Spent 36 years at St. Alexius, and in 2010, accepted the position of VP/CNO Mercy Health Springfield Communities. In 2013, assumed the position of Senior VP/CNO Mercy Health. Being in a leadership position gives me the opportunity to: learn from those that I engage with every day as well as from those we serve. People don't know that I: love to sew and ballroom dance. Together, Ken and I have completed several homes of family and friends with state-ofthe-art window treatments. We also love to learn new steps to add to our repertoire of dance moves. I still have things to learn: I would love to take cooking classes and to learn to tap dance! One word that best summarizes me: servant-leader. work in the health system, and I informed my leadership of their value from that point forward. My partnership with the medical staff also grew, allowing me to find new ways to connect the medical staff in support of nursing, learning from each other and teaching together. In working with them, I was able to help co-create organizational structures that brought physicians and nurses together at key decision-making tables. The medical staff section meetings are 1 example. The chief of the medical staff requested that the chairs of the nursing shared governance councils regularly attend these meetings and provide a report to the medical executive committee. Consequently, the respect and partnership between nurses and physicians increased. That partnership deepened their understanding and value of each one s contribution, decisions, and roles that each make to the other. TPOG: As you review your wide-ranging contributions to nursing and healthcare, what is 1 that stands out for you personally? LJK: I think for me personally my single greatest sense of satisfaction comes from my emphasis in support of leadership development in healthcare. I was privileged to serve on the board of governors of the American College of Healthcare Executives (ACHE) and learn from many of our country s greatest healthcare leaders. Many leaders along my own career pathway took me under their wing, mentoring me, advising me, guiding me, helping to develop my role and my skills such that I now feel a personal sense of obligation to incorporate those same attributes into my own leadership role. As an AONE board member, I worked to develop emerging leaders. It was an awakening for me and a validation of the need to continually emphasize the development of nursing leaders. I even wrote a book, Nurse to Nurse: Nursing Management, in an effort to provide a useful, practical, and translatable format for developing contemporary nursing leaders. In order to assure that nursing continues to grow and meet the challenges of health reform and care transformation, current nursing leadership must attend to this, both through the development of emerging leaders and through good succession planning. TPOG: As you gaze over the horizon, what are a couple of specific critical factors that you see affecting the future of nursing practice? LJK: First of all, I believe there s no greater time for nursing. On the forefront of health reform, we re beginning to see the transformation in how all healthcare is organized, delivered, and paid for. The tremendous move to value-based models of care delivery calls the nurse to the forefront of decision making and action as we build a new framework for care delivery and for partnership along the continuum of care. This partnership will become increasingly central in the design of models of care delivery for which the nurse must be ready and adequately prepared. Perhaps one of the major transitions in the nurse s role will be "navigator" of health service, where the integration, coordination, and facilitation of care around episodes and populations will be essential to sustaining quality, effectiveness, and value. This important work will require nurses to not only be at the table, but they ll also be expected to provide leadership in 22 Nurse Leader February 2014

the planning, designing, and implementation of care services that are more relational, interdependent, and coordinated. We definitely need to advance the preparation and education of clinical nurses with a higher level of competence, resulting in the capacity of creative nurses to help develop better and more relevant care delivery models. All nurses will need to act at the full scope of their practice. Over time, we may in fact need more nurses with advanced education, including advanced nurse practitioners, in order to meet the growing demands ahead. Creativity, innovation, adaptability, and expanded competency development will be essential characteristics in the nurse of the future designing, practicing in, and evaluating the effectiveness of user-based, value-reflected, health-driven models of care across the continuum. In Mercy, this development is already under way. We re working to meet the changing demands of today s environment in hospital, clinic, post-acute, or telehealth access points to provide person-centered, population-oriented health. What could be more exciting for nursing? TPOG: As you look ahead in your leadership role and as AONE president, what do you see as some of the major role challenges affecting the future of nursing and healthcare? LJK: I m very excited as I become AONE s president. I m especially looking forward to the opportunity to become more familiar with health policy while also informing and advancing it from the perspective of a nurse leader. I m looking forward to the opportunity to bring my insights and perspective to the policy, politics, and public health considerations of leadership at the national level. I m equally excited about taking what I have gained in that forum back to my organization s leadership as my system continues to transform itself within the context of the next few critical years of health reform. I am fortunate to have had the opportunity to provide strong leadership at the executive level and to continue to do so in my current organization with great colleagues and peers, especially at this important time of health reform. I m learning a great deal and will continue to learn more in both my AONE leadership capacity and as an executive in my own organization. Over the long term, I m hoping that what I learn in both my AONE leadership role and my executive role will provide a good foundation for other growth opportunities at the national level to influence policy and help set the direction for the future of healthcare. I want to be ready for these opportunities and able to make meaningful contributions in a way that will have an impact, making a difference for the future of healthcare in my role as a nurse and as a leader. TPOG: What are 1 or 2 things that you think are unique to your own personal leadership capacity and skills? LJK: Others with whom I have a leadership relationship often come to me looking for answers to their questions. Instead of giving them an answer right away, I usually follow their questions with questions of my own. As a leader, I believe it s important to be able to engage others in helping them take responsibility for their own issues and concerns, and develop their own leadership capacity to address those concerns. In short, I want to be available to them and mentor them without taking control. I m eager to see others develop their leadership skills in problem solving and solution seeking through use of their own talents and opportunities. I see my role as primarily creating an environment, the context for leadership development, and doing all in my power to enable others to question, experiment, develop, learn, test, fail, and ultimately grow and mature into excellent leaders. In that way, I feel as though I m doing my part to help encourage, mature, and engage leaders in their leadership journey, sharing with them what I ve learned from others in my own leadership journey. I have been well mentored along my leadership pathway; I see it as my obligation to continue that gift by making it available to others. NL Linda Jane Knodel, MSN, MHA, NE-BC, CPQH, FACHE, is Senior Vice President/Chief Nursing Officer at Mercy Health in Springfield, Missouri. She can be reached at linda.knodel@mercy.net. 1541-4612/2014/ $ See front matter Copyright 2014 by Mosby Inc. All rights reserved. http://dx.doi.org/10.1016/j.mnl.2014.01.002 Photography by Chris Ryan 2014 www.nurseleader.com Nurse Leader 23