Leader to Watch Claire M. Zangerle, MBA, MSN, RN, DNP(c) Stuart D. Downs, DNP, MSA, RN, NEA-BC, CENP, CPHQ Being the first of anything can be exciting, but imagine being the first chief nurse executive (CNE) of a large health system. Such is the case for Claire M. Zangerle, MBA, MSN, RN, DNP(c). Zangerle is a talented and innovative nurse leader who serves as the inaugural CNE of Allegheny Health Network (AHN), a relatively new health care system formed in 2013. Her leadership career spans nearly 25 years of service to the profession and includes positions across several nursing specialties encompassing acute care, ambulatory care, and post-acute care. Zangerle is an accomplished nurse leader, and the nursing profession is stronger today because of her service, leadership, and contributions on quality improvement, mentoring, and nursing practice. www.nurseleader.com Nurse Leader 377
SDD: Claire, you are working on your doctorate of nursing practice at Texas Christian University in Fort Worth, Texas. What is your phenomenon of interest and when will you graduate? CMZ: I have defended my capstone project and expect to graduate in December 2017. My project is focused on creating an on-boarding toolkit for the chief nurse executive where the position is new to the health system or any other health care organization. I am on the AONE Chief Nurse Executive Committee, and this compliments the work we are doing. The CNE position has evolved over time. As health systems form, the importance of having an integrated nursing system with a robust strategy across all entities and care settings is essential to the success of the system. That is one of the principles supported with this capstone project. SDD: You are just over a year into your position at Allegheny Health Network as the chief nurse executive; tell me about the organization. CMZ: Allegheny Health Network (AHN) is a young network. We were formed in 2013 with the merger of West Penn Allegheny Health System Allegheny General Hospital, Allegheny Valley Hospital, Canonsburg Hospital, Forbes Hospital, and West Penn Hospital and Jefferson Hospital, all in the greater Pittsburgh, Pennsylvania/ Western Pennsylvania region. In addition, the network includes Saint Vincent Hospital in Erie, Pennsylvania, and Westfield Hospital in Westfield, New York. We are an integrated health care delivery system with a footprint serving 29 Pennsylvania counties and portions of New York, Ohio, and West Virginia. In addition to the 8 acute care hospitals, there are 6 surgery centers, 4 health and wellness pavilions, and more than 200 physician practices. There are 2,800 employees and 18,000 providers. AHN is unique in that it is part of a larger company. AHN is part of Highmark Health, an organization of health care companies serving 50 million Americans in all 50 states and the District of Columbia through health insurance, post-acute care, vision and dental care, and innovative technologybased solutions. AHN is the health care delivery provider of Highmark Health. AHN serves the acute care population with 2,224 beds, and we are proud to say that West Penn Hospital is the first hospital in Pennsylvania to achieve Magnet status, just receiving a third designation. Forbes Hospital and Saint Vincent Hospital are on the Magnet journey, and the rest of the AHN hospitals are in the gap analysis phase. SDD: You are the first CNE of AHN, which is exciting and daunting for such a young system. Were you given any charge upon hire? CMZ: I worked with my CEO, Cindy Hundorfean, at the Cleveland Clinic in a variety of roles for the 13 years I was there. When she hired me to be the first CNE at Allegheny Health Network, that familiarity served us both well. I knew what she wanted in terms of outcomes, and she knew I could do the work to get us there. During my first year, the executive nursing team has taken shape. We have built a sustainable strategy for the nursing organization across the enterprise, and fortified the infrastructure to support the core behaviors that enable us to deliver the highest quality of patient 378 Nurse Leader December 2017
care to the communities we serve. As with all CNEs, I am charged to lead nursing practice and ensure we are providing high quality care, better outcomes, and an excellent patient experience. Cindy motivates the entire team to excel, and the only charge she gives any of us is to get it done. SDD: You have some interesting geographic challenges between where you live and work. Many chief nurse execs are opting for this lifestyle. Tell me how it is working for you. CMZ: I would have never dreamed that I would work in one city and my husband would stay at our house in another city. However, I have many wonderful nurse leader friends who demonstrate to me that if you are following your passion, it will work. Most fortunate for me is that family supports me in this. I feel like I have the best of both worlds. I love Cleveland and have raised my children there. My husband, Adam, has a great job there, and we have a wonderful home and community of friends. However, we have recently built a home in Pittsburgh, and with the distance between our 2 homes being less than 2 hours, we have great flexibility between the 2 cities. SDD: Nursing is not your first degree, so let s start at the beginning with what attracted you to the profession of nursing in the first place. CMZ: My first degree was in Exercise Physiology, and as part of my graduation requirement, I had to complete an internship. My choices were clinical or corporate exercise physiology. I chose the clinical path, and ended up at The Methodist Hospital in Houston, Texas, in cardiac rehab. In my internship, the nursing staff and the exercise physiologists were a great team. We collaborated on the patient care plan and cared for the patients in different ways. Rehabbing a patient after a cardiac event takes a team, and I very much enjoyed being part of that. However, I noticed the difference in how I cared for the patients and how the nurses provided care. My care was important, but the nurses had a broader view of the patient, more holistic. My focus was solely on hemodynamics, exercise tolerance, and motivation. I was drawn to the holistic practice of nursing, including the disease process of how they got to this point and the plan for avoiding reoccurrence. During my internship, I was recruited by a former NBA player, John Lucas, to help him run his fitness and wellness program for recovering alcoholics and drug addicts in hospitals across Houston. During my time with John Lucas Fitness Systems, I also had the opportunity to collaborate with nursing staff, and again, was drawn to the holistic nature of patient care. I enrolled in an associate degree program at Houston Baptist University because I was convinced I did not need another bachelor s degree, and the ADN allowed me to practice nursing in 2 years. Although I can never say enough about how great the program was, I regret not pursing a BSN instead. However, I was able to make up for it when I matriculated to a MSN. Going to nursing school was one of the best decisions I have ever made. SDD: What motivated you to transition from the bedside to nursing leadership and how long have you been a nurse leader? CMZ: I have been a nurse leader for almost 25 years, in a variety of capacities acute care, ambulatory care, and post-acute care. However, I did not recognize I was a nurse leader until I www.nurseleader.com Nurse Leader 379
took my first CNO position at the Cleveland Clinic. All the positions I had before CNO were nontraditional nurse leader roles, so I never put that nurse leader stamp on myself. However, when Dr. Fred Loop, CEO of the Cleveland Clinic, offered me the CNO position, the last thing I wanted to do was say no to him or disappoint him. He was someone I admired as a leader and was a mentor to me. I could not tell Dr. Loop I was not certain my skill set from quality and accreditation would transfer to a CNO position, but he was my motivation. I knew I couldn t say that, because I knew him well enough to know the response would be a yes, you can. I attribute my success as a nurse leader to the opportunity and confidence Dr. Loop instilled in me by appointing me CNO. I became an accidental nurse leader because of his confidence in me and how I embraced the role. Many of my colleagues have followed a more traditional route, from bedside to manager to director to chief nursing officer. My path was a little more crooked, affording me experiences that led me to fall in love with nursing leadership. SDD: You went from CNO of the Cleveland Clinic to CEO of the Visiting Nurse Association of Ohio. That is quite a leap into another care setting that is atypical. Tell me how that came about and the value it brought to you as a nurse leader. CMZ: You are right that was an atypical move, for sure. But one I absolutely do not regret. Transitioning from the Cleveland Clinic to the VNA of Ohio provided me an opportunity to spread my nurse leader wings as well as expand my business acumen skill set. The move came at a time in my life when it felt right, personally, to change my surroundings. A Cleveland Clinic board member knew someone on the VNA board and asked me if I knew of anyone interested in the position as the long-time CEO was leaving. I looked at the job description and thought it was a perfect position for me. I had been a CNO for almost 6 years and had thought I had a good succession plan, so I took the leap of faith. As nurse leaders, we must have courage to look outside our comfort zone and try something different, all with the core value of advancing patient care. This particular care setting was getting more and more attention from the acute side as a potential partner to help reduce readmissions and empower the patient to care for themselves, once they are discharged from acute care. I saw what could be done to connect the acute and post-acute settings to accomplish better outcomes. While not an easy road, it evolved and continues to evolve. In my work at AHN today, I still approach care as a continuum, not just what is happening within the 4 walls of the hospital. SDD: You said you acquired new skill sets when you transitioned from CNO to CEO. As a nurse leader, what skill sets came naturally to you and which qualities evolved, or are still evolving, during your leadership roles? CMZ: Some natural skill sets for me, throughout my career and as a nurse leader, have been the ability to collaborate, be nimble, anticipate, and execute. Having grown up with a lot of siblings, it was necessary to join forces to not only get things done, but to ensure everyone had a voice. Sometimes there were stronger voices than others, but we were generally able to reach consensus. I find the skill set of collaboration, as a nurse leader, to be especially valuable. I always say that I am not going to come to the leadership table with only a nurs- 380 Nurse Leader December 2017
ing perspective, but with a health care perspective and a nursing lens. That opens the door for more collaborative work with non-nursing, and nursing colleagues. The changing health care landscape requires health care leaders to be nimble and anticipate the next demand. Creativity is so important in this changing health care landscape and that is a skill set I embrace. Coming from a nontraditional nurse leader path, being innovative has served me well. SDD: What do you consider to be the most challenging aspect of nursing leadership today? CMZ: Nursing leadership is the most difficult and the most rewarding career path there is. The most challenging thing for me as a nurse leader is reaching a harmonious state where the voices of the patient, the employee, and administration are heard. Our goal is to provide the highest level of care and the best experience to the patient. To do that, we must hire and engage the best employees and ensure their job satisfaction. Administration has the burden of making sure we can pay for all of our initiatives in light of the declining reimbursement models and doing more with less. As nurse leaders, it is incumbent upon us to be the voice of all 3 factions. SDD: Mentors are so important. Who were your early mentors, and how do you feel their influences have impacted your leadership career and helped to shape who you are today as a nurse leader? CMZ: Because of my nontraditional nurse leader path, I was blessed with a variety of mentors as I shaped my own leadership philosophy. In my roles, I took that exact approach global leadership with a nursing focus. I sought out mentors with a variety of leadership responsibilities and styles. During my cardiac rehab internship, Willa Decker encouraged me to pursue nursing; at the Cleveland Clinic, Dr. Loop believed in me enough to take a chance and appoint me CNO, the nontraditional nurse leader. And now, fellow nurse leaders that I have met through AONE are the mentors and influencers who I tap into every day as the collective gurus who have added to the leader that I am. SDD: Nurse leaders have a lot on their plates, and what you have described so far is certainly evidence of that. What keeps you going back to work every day, and what brings you joy in your work? CMZ: Being part of the larger team, both within and outside of nursing, and collaborating on difficult initiatives and seeing them come to fruition and having an impact is what brings me great joy. We know we do meaningful work, but this is what brings it to life for me. I also derive much joy from staff nurses taking on leadership roles within their units, both formally and informally. This is a demonstration that they understand nursing has a voice in health care reform, starting at the bedside. They get it and want to be a part of it. And, somehow, our team of nurse leaders has communicated that message either by their actions or their words, or both. They say the birth of a child is the sign the world will go on. The initiative taken by a staff nurse to lead from the bedside is the same thing. SDD: You have been a long-time member of AONE, and from 2014 to 2016, you served on the board of Hometown: Dallas, Texas; currently a dual resident of Cleveland, Ohio, and Pittsburgh, Pennsylvania Current Position: Chief nurse executive, Allegheny Health Network Education: Baccalaureate degree from Texas A&M University; associate degree in nursing, Houston Baptist University; master s degree in business administration, Lake Erie College; master s degree in nursing, Kent State University; candidate for doctor of nursing practice (December 2017), Texas Christian University First Job in Nursing: Nursing assistant in the Cardiovascular Intensive Care Unit Being in a leadership position gives me the opportunity to: Create, execute, and refine the nursing strategy across a newer health system where nurses are valued and their voices are essential to shaping the future of health care Best advice for aspiring nurse leaders: Think outside the 4 walls of your unit so you can recognize and embrace nontraditional leadership opportunities where nurses can have great influence on care transformation One thing I want to learn: To play the violin; to me, it produces the most beautiful music Most people don t know that I: Have a passion for yoga and would like to teach one day when time permits One word that describes me: Inclusive www.nurseleader.com Nurse Leader 381
directors as an appointed board member. Appointed members are new to AONE. Tell me about that role. CMZ: The experience of being an AONE board member was incredible! I have to share how it came about that I was appointed, which is different than being elected. When I left my CNO position at Cleveland Clinic to take the CEO position at VNA of Ohio, I was unable to connect with a professional organization that supported nursing leadership in the post-acute arena. I called Pam Thompson, CEO of AONE at the time, and asked her for guidance as I was not ready to hand in my nurse leader card! She listened to my concerns and my passion for supporting nurse leaders across the care continuum. She asked for some time to think about how to address my request of including nurse leaders across the continuum in AONE activities. About 2 weeks later, she called me back. As timing would go, the AONE board had just voted to expand board membership to include diversity on the board, including representation from emerging leaders, academia, and the full continuum. She offered me a 1-year appointment to the board representing the post-acute care arena, and I was thrilled to accept. That 1 year lead to another, and another. AONE board service is not passive. Each and every board member is highly engaged and contributes time, talent, and treasure to AONE, with the members needs and nursing leadership at the core. Because I was appointed to represent the continuum of care, it was my focus during my board tenure and was reflected in the committees and task force(s) I participated in. SDD: You were recently appointed to the American Hospital Association board as a trustee for 2018 to 2020. What are you most looking forward to as you start your board service? CMZ: I was thrilled when Maureen Swick presented my name to the AHA board to represent nursing. Being nominated was an honor alone, but being chosen was humbling. The strategic direction of the American Hospital Association is aligned with our work in hospitals, health systems, and health care organizations. The support, advocacy, and real-time education provided by AHA are essential to all caregivers. The AHN is forward thinking enough to support all health care providers, across the continuum, and that evolution is what I am excited about being a part of. Being the nursing voice, as well as a leadership voice, as a trustee, is something I am very much looking forward to. SDD: The current health care landscape is changing by the minute. In your role as a nurse leader, how do you deal with all this uncertainty, and what pearls of wisdom can you share about change? CMZ: Being an anticipatory leader in these uncertain times is essential. Deal with the here and now, but always be thinking ahead. Just as we would do in direct patient care, assess the current situation, but be prepared if the situation goes one way or the other. Change can be scary, so acknowledge the fear of change. But to tackle that fear, don t sit on the sidelines and let change happen to you. Be a piece of that change. It s important to be as flexible as your personality lets you (and in some cases, you may have to stretch yourself). Also, make sure the lines of communication stay open about the changes around you. SDD: What advice would you give to an aspiring nurse leader? CMZ: First, I would say thank you for considering nursing leadership! Not every nurse wants to be in a leadership position, though all nurses serve as leaders in some capacity. Choosing nursing leadership takes a leap of faith. Most important for any aspiring nurse leader is to remember where they started as that will inform decisions going forward. An aspiring nurse leader should seek to evolve into a leadership style that best suits them and the environment where they work. Being a flexible leader is difficult, but the value is meeting those you lead, where they are, which creates a followership. Stick with your global core values so that locally you can afford to be flexible. SDD: What advice do you have for nurse leaders on how to collaborate with hospital stakeholders to optimize the overall patient experience? CMZ: It is my opinion that nurse leaders can drive the improvement of the patient experience and demonstrate how it is a multidisciplinary approach. As nurses are best at convening groups and leading initiatives that result in better outcomes, bringing all stakeholders together is essential to improving patient experience and demonstrating everyone has skin in this game. SDD: What advice would you give to a CNO who may have aspirations for a CNE role? CMZ: I would suggest anyone aspiring to a CNE role embrace the AONE competencies specific to the system chief nurse executive and do a gap analysis on your own leadership. These competencies serve as a road map to current and aspiring CNEs. Connect with a CNE or 2 who you admire, telling them of your interest in the role so they can serve as a mentor. Finally, I would connect with someone like Karen Kirby at Kirby Bates Associates. She has her finger on the pulse of nursing leadership from all angles. She was a terrific mentor to me as I was considering a CNE role. She is well versed on the opportunities across the country and can help assess where a nurse leader may fit. SDD: Finally, how can nurse leaders inspire during these uncertain and tumultuous times in health care today? CMZ: Regardless of what is happening in the current health care landscape, nurse leaders can inspire by keeping their leadership teams focused on the things they can control, not what they can t control. They can control the effort they put in supporting staff and ensuring patient safety and satisfaction needs are met. This provides the leadership team stability while preparing them for the things out of their control. NL Stuart D. Downs, DNP, MSA, RN, NEA-BC, CENP, CPHQ, is the Vice President and Chief Nursing Officer at WellStar Atlanta Medical Center and Atlanta Medical Center South in Atlanta, Georgia. He can be reached at stuart.downs@wellstar.org. 1541-4612/2017/ $ See front matter Copyright 2017 by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.mnl.2017.09.003 382 Nurse Leader December 2017