Chapter 7: A ‘Hunger’ for Leadership; A View on the Independent Practice of Nursing
Files
Description
Dr. Summers begins this Chapter by giving credit to JoAnn Duffy, who taught her many leadership lessons. Dr. Summers talks about different kinds of power. She recalls her involvement in an innovative and eye-opening initiative undertaken at Greater Southeast Community Hospital: a collaborative practice established between nurses and physicians, a first step in recognizing that nurses are not mere “doctor helpers.”
Identifier
SummersB_01_20140123_C07
Publication Date
1-23-2014
Publisher
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Interview Session
Barbara Summers, PhD, Oral History Interview, January 23, 2014
Topics Covered
The Interview Subject's Story - Professional PathThe Leader Professional Path Leadership Mentoring On Leadership On Care The History of Health Care, Patient Care Overview Definitions, Explanations, Translations
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Barbara Summers, PhD:
At the same time, I started to see the potential for having an impact if you were in a management position. And I do want to mention that my boss at the time was JoAnn Duffy, and she was not yet Dr. Duffy. She was the director of Critical Care and whatever in Oncology, so she was my boss, and she taught me a tremendous amount about being a leader and about accountability. She was fun to work with, but she was also dead serious about the work we were doing.
Tacey Ann Rosolowski, PhD:
What did you learn from her?
Barbara Summers, PhD:
You know, I think I learned from her about how to use the various types of power and authority that you have to be able to achieve good, I guess, for lack of a better word, and learned about the fact that there’s legitimate authority that comes from your title and your position, but that really is a very limited type of power and authority, that, yes, you can boss people around and make them do things because you’re the boss. “You do this because I tell you you have to do it.” But that’s really a weak type of leadership, and if you have to resort to that, then you probably need to be brushing up your CV and getting ready to go someplace else. So we talked about the other kinds of power, the expert power that comes from having expert knowledge in your area, and the referent power that comes from the way that you interact with people and the reputation that you built. So I learned that from her. I learned from her about the process of developing plans for achieving improvement, if you will, and not only setting the objectives and the timelines, but also being very clear in your mind what is the evidence going to be that will demonstrate that I’ve achieved the goal, you know, causing you to have to be concrete enough to be able to say, “Okay, here’s the evidence that I’ve gotten to this place,” or that this staff has moved to this place. So that, I mean, it was just great. She also had fantastic relationships with physicians, so she was a very good role model for me there. And in this little—not little—it was a three-hundred-bed community hospital, I was also lucky enough to be working in an organization where the chief nurse and the physician-in-chief were the first in the country to launch an initiative called collaborative practice or joint practice between nurses and physicians. This was back in the early eighties. I mean, this really was pioneering stuff and—
Tacey Ann Rosolowski, PhD:
What did that look like? What does that mean?
Barbara Summers, PhD:
Well, that looked like specific nurses and physicians becoming part of a Collaborative Practice or Joint Practice Committee and together identifying areas of focus for quality improvement—I’ll just use that as a general term—within the patient population. So, setting quality-improvement objectives; identifying the strategies that were going to be employed to improve quality outcomes; identifying the metrics and then following them; performing joint record review where the team, the physicians and the nurses, would sit together and would review medical records of patients, they would review the physician documentation and the nursing documentation, to ensure that the documentation was comprehensive and reflected the whole of the patient-care experience.
Tacey Ann Rosolowski, PhD:
Was this part of a process of transforming the role of a nurse or giving formal recognition to things that nurses were already doing?
Barbara Summers, PhD:
I think it was a first step, back in the early eighties, of acknowledging that nurses and physicians practice as partners, that nurses are not simply doctor helpers. And that was a transformation that occurred in the practice of nursing after World War II. Although the very earliest nurses practiced independently and had no need for physicians at all, there was a period of time where they moved into a more dependent role, where they were fully dependent upon the physicians telling them what to do to take care of patients. But as nursing practice evolved and as this collaborative practice model developed, it became very clear that physicians have a scope of practice and nurses have a scope of practice, and there is a small overlap between the two, and that’s the interdependent practice of nurses and physicians. But physicians have independent practice and nurses have independent practice, and the care that nurses provide patients is primarily in the independent practice. Yes, they carry out physicians’ orders, but that’s only a small part of what nurses do. And, you know, when I talk to physicians about that, I tell them that, “If nurses only confined their activity to carrying out your orders, we would have patients dying left and right, because your orders are necessary for the medical plan of care, but they are not sufficient to return the patient to a state of health.” So it was just that initial collaborative practice movement was planting the seed that I think has sprouted again in the twenty-first century under the title “interprofessional practice,” which is now really coming forward as a paradigm for excellence in healthcare, that you have strong interprofessional practice teams.
Tacey Ann Rosolowski, PhD:
Now, did I hear correctly that in this organization—and the hospital name was?
Barbara Summers, PhD:
Greater Southeast Community Hospital. And it no longer exists.
Tacey Ann Rosolowski, PhD:
That this was one of the first places that had experimented with this collaborative model?
Barbara Summers, PhD:
The chief nurse and the chief physician were the two leaders who created the whole concept of collaborative practice.
Tacey Ann Rosolowski, PhD:
And what do you think enabled them to do that at this time?
Barbara Summers, PhD:
I think they were both very, very accomplished in their own work, very clear in their professional identity, and not afraid that they would or their profession would lose anything by coming together in collaboration. And they probably looked at and saw the silos that can occur when you have practitioners who are caring for patients in parallel but not in partnerships.
Tacey Ann Rosolowski, PhD:
What a great experience, I mean, to see that.
Barbara Summers, PhD:
Oh, my gosh, it was like—I was so lucky to have that.
Tacey Ann Rosolowski, PhD:
Yeah, talk about transformational.
Barbara Summers, PhD:
Yes, it was huge. It was huge. And it, again, opened my eyes to another way of practicing in partnership.
Tacey Ann Rosolowski, PhD:
And also, you know, being able to observe two professionals sharing, without ego, the power in that space, because, I mean, I remember that time. There was this thing, oh, you know, the doctors are the gods and the nurses are just the helpers, and not an understanding that there were these different spheres of operation and influence, and, you know, to see that all of that model, old model could be put aside, you could actually achieve something different, that, I’m sure, was really just visionary for you.
Barbara Summers, PhD:
It was very, very impactful for me.
Tacey Ann Rosolowski, PhD:
Yeah, yeah. So tell me what happened next.
Recommended Citation
Summers, Barbara PhD and Rosolowski, Tacey A. PhD, "Chapter 7: A ‘Hunger’ for Leadership; A View on the Independent Practice of Nursing" (2014). Interview Chapters. 1244.
https://openworks.mdanderson.org/mchv_interviewchapters/1244
Conditions Governing Access
Open
