Chapter 06 : Areas to Address as Chief Nursing Officer
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Description
In this chapter, Dr. Porter discusses areas where she felt she could make an impact at MD Anderson. She begins by summarizing her management style and notes some challenges that arose as nurses became accustomed to her style during rounds.
She tells a story about nursing in orthopedic surgery to illustrate her goal of integrating patient experience and quality scores. She also talks about bringing more use of social media to the institution. She notes that social media was used extensively in NYC, yet MD Anderson was nervous about its use when she arrived. She uses examples to demonstrate the positive impact of social media on perceptions of MD Anderson leadership. She also notes that social media can capture the ‘granularity” of the institution and its culture. She talks about receiving posts from nurses internationally, noting “you become their hope.” She talks about her philosophy and guidelines for using social media in an institutional context.
Identifier
PorterC_02_20180125_C06
Publication Date
1-25-2018
City
Houston, Texas
Interview Session
Carol Porter, DNP, RN, FAAN, Oral History Interview, January 25, 2018
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the Institution; Leadership; On Leadership; Professional Practice; The Professional at Work; Collaborations; Leadership; On Leadership; Mentoring; On Mentoring
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
T.A. Rosolowski, PhD:
What were some of the—I mean when you were here and looking around, getting a feel for the lay of the land, what were some of the things that you were already thinking oh, here I can address this, I can address that. What was your intuition?
Carol Porter, DNP, RN, FAAN:
You mean like when I was interviewing?
T.A. Rosolowski, PhD:
Yeah, and just getting a sense of the culture.
Carol Porter, DNP, RN, FAAN:
Well, with the physicians, and many of them interviewed me, the theme with them is they wanted a hands on CNO. They wanted someone that really knew clinical and quality, and I do. They wanted someone that didn’t have any airs, that was approachable, out there working with the physicians and the nurses and really keeping in touch. That’s what I do. So I felt good with that, because what they were looking for, that’s what I do. I thought that was great and the fact that they were so interested in that, I felt good that I could work with them. The nurses, I think the strength was the quality connection. A lot of times CNOs are removed, like they’re a little bit aloof and they don’t really have a direct line to the frontline staff, and part of my management style is rounding, and I found on the frontline staff. So, I connect with those frontline nurses purposely, because then I want them to feel comfortable to tell me what’s working well and what’s not working well, so I can help them fix it. The clinical nurses that interviewed me were great and again, they just wanted somebody they could talk to and somebody that could help them.
T.A. Rosolowski, PhD:
What were you hearing from them about what needed to be addressed?
Carol Porter, DNP, RN, FAAN:
They really wanted mentorship, I mean they wanted to be mentored, they wanted to learn. I think the fact that I had been a magnet surveyor and the fact that I was a CNO in New York City, they felt they could learn from me and they knew I was approachable already, so it’s not like, you know. And once I came here, and I still tell people and I mean it, that I don’t just have an open door policy. If you need to see me, I want you to stalk me, you come here and you just sit in that waiting room until I come out to get you and that’s unusual. I’ve had a lot of CNOs in my career that they would just about say hello to you. So here, many, many times Kim will say she doesn’t have any time, she’s busy and it’s true, my whole calendar is busy all day, but if you really need to see me, I can find ten minutes, I can move things around. Her job is to protect my time and so that’s why I tell them, either come—like the directors, I said come to my office and just stick your head in. I said to the clinical nurses, I tell them come upstairs, come into the waiting room and tell them you’re waiting for me, and then eventually, I’m going to see you, I’m going to come out and grab you and bring you in. I’ve done that several times. [laughs] A group of nurses were up here a couple months ago and they sat down in the waiting room and they asked them if they had an appointment and they said, “No, we’re here stalking Carol Porter,” and they were like “Stalking?” And then they said, “Carol, somebody’s here stalking.” I said, “Well that’s okay, that’s what I told them to do, I’ll be out in a few minutes.” So I think that gets around real fast, that gets around real fast. So when I came here, groups of nurses started wanting to meet with me, like the wound care, again because they’re strong on quality. The clinical nurse leaders wanted to meet with me, some of the ADs. I think they got used to my management style about rounding, because in the beginning they thought I was criticizing some of their work, because they weren’t used to it, when what I really was doing was I was trying to mentor them. So, I found graphs that were not presented correctly or the data should have been done differently, and so I then had to tell them, I was associate dean of nursing research, so I do this normally, I just can’t help myself. I have to look at your data and I want to see if I can help you, and then we’d go over all their data, I’d ask them questions, and then that got out throughout the hospital that oh, she’s not criticizing us, she’s teaching us. Then eventually what I did was when I do that, every once in a while, I give them a little hug, just because I’m in Texas, and they like that, they like that connection. Now it’s no big deal, now when I round, they’re saying, “Dr. Porter, come here, I want to show you this,” and they show me the graphs. Even with Dr. Pisters, I rounded with him on some of the units twice or three times so far, and as soon as we walked on the unit, they’re running up to him, “Oh, come on Dr. Pisters, we want to show you our quality data.” They bring him to the board, they explain all their data, and he said to me, “This is great, that they want to take me to their data to show me what they’re doing.” So, I feel like I’ve had something to do with that. I made them feel it’s really important.
T.A. Rosolowski, PhD:
That’s exciting, I mean that’s a culture change and that didn’t take all that long really.
Carol Porter, DNP, RN, FAAN:
No. I had myself an Excel spreadsheet the first year, to make sure I got everywhere. Now, I think now, I also, now I’m going to the areas that are doing fabulous and explaining to them why it all fits together; the patient experience, the clinical quality, the staff engagement, all that, and that you can’t just give an award for patient experience, because part of the patient experience is the clinical care. So I just went to P-9 today, they just got a quarterly award for their patient experience, but while—and actually, I did it with Beth Garcia. Beth Garcia was talking to them about their patient experience scores and I was checking out their quality scores at the same time, and so when I got a chance to talk to them I told them, I said, “You’re the whole package.” Not only did you do great in your quarterly patient experience scores, but all of your nurse sensitive indicators are great, and you have a mobility program so you’re preventing things, and you’re doing just culture. I said, “You are the entire package.”
T.A. Rosolowski, PhD:
What’s P-9?
Carol Porter, DNP, RN, FAAN:
P-9 is orthopedics and surgery. Then that spurred, I would say, a half-hour conversation with all of them, about why they think it’s important, do they realize how important it is. I asked them to share it with other units as a best practice. I told them maybe we should do a video clip of you guys because what you’re doing here, we should just do it on other units, just replicate it. So I try to take the time to have that conversation with them, because they want to explain why they do what they’re doing, and I think they value the fact that I know, I understand it. I’m not going to say you did a good job unless you did a good job, so if I say you did a good job, I think they know that I mean it.
T.A. Rosolowski, PhD:
Well, it devalues it if you varnish it. Also, it doesn’t do honor to all the energy they’re putting in it, if you don’t notice it at all. I mean, allowing them the time to express it and find their language is going to help strengthen the culture that is making this possible and enable them to share it with other units.
Carol Porter, DNP, RN, FAAN:
The other thing, well of course you take photos, because they know that by tonight, they’re going to be on Twitter. So when I first came here, it was really a very minimal social media culture. I don’t think it was looked at so fondly here. I came from a very big social media presence in New York City, I had LinkedIn and Twitter, and so when I first came here, I met with the Social Media Department to tell them this is what I’m going to do, so please follow me and tell me if I do something that you don’t like, but I’m going to do it, because it’s 2017, or 2016 when I came here. So every meeting I went to in the beginning, I would say hands up if you’re on social media, and it would be like one or two people, but now, like they’re all going up. Then I encouraged Steve Hahn to be on it, now he’s Tweeting out, and Peter Pisters has become very social media savvy, so now there’s no problem because if the CEO/president is on it. So now, it’s turned full circle because now, if I don’t post these pictures on tonight, I’m going to hear about it tomorrow. They’re going to say where’s our pictures, how come you didn’t post them, because they want to re-Tweet it.
T.A. Rosolowski, PhD:
What’s the impact of that, what is the benefit that’s coming from that increased presence?
Carol Porter, DNP, RN, FAAN:
On social media? Well, I think it’s reward and recognition for our own staff, because they like to be seen, because then even if they don’t—some of them don’t quite get how to do it, but you can just re-Tweet it. All you do is hit it and you’re done and they can then take whatever you put down about them and put it on their page, which is nice. The other thing which I think is as important if not more, it gives the world a glimpse into MD Anderson that’s not harsh and cold and sterile. Like today, the pictures I’m going to post was, after we went up there to give them—have given them the ward, then they had a little celebration in their conference room, balloons were hanging from the ceiling and a big poster on the wall. That’s going to show, Oh, that’s a cancer hospital, how can they be doing that? Because people think it’s all about poor outcomes and it’s not. We were laughing and we were all like huddling, and so it shows reward and recognition but it also shows leadership being humans, which I think is very, very important. I have had so many CNOs that are so not like that, that I vowed that if I ever became a CNO, I would not be like the ones I had. It shows the diversity of our staff, multi-diverse staff, which is great, and we’re all laughing. So it’s a quality thing, they just got an award, there’s a celebration and oh my God, in the middle of that, I see a CNO’s head. And then I—I don’t post a lot of words on Twitter because you can’t, I do some, but then I take some of that content and I’ll put it on LinkedIn, because the LinkedIn, you get more of the CEOs and other people looking at it . I really do more narrative on that to give them like a real insight into what it’s like here.
T.A. Rosolowski, PhD:
Do you find that using social media helps you kind of come to a new understanding? I mean, if you’re paying attention to what to post on social media, do you have a different understanding of the institution? I don’t know if that makes sense.
Carol Porter, DNP, RN, FAAN:
Well I think you may be more granular. I would be granular anyway, but I capture the granularity, because I want that captured for other people. So, I’ll get comments on LinkedIn, Twitter, about, “It must be nice to work there,” or “Boy it looks great,” from all over the world, from all over the world. Or, if we do something here, I have a couple colleagues in Saudi Arabia, “That sounds great, Carol, good work,” things like that, and then anybody that follows me can read that. So it’s also teaching the nurses here that it’s not just about MD Anderson, it’s not just about Texas or the country, it’s about the world, and so I try to teach them that. The same thing at Sinai. At Sinai I said, “It’s not just New York, it’s not just the United States. People around the world are watching us, people around the world are watching the nurses here.” You know that because every once in a while you get a nurse from a remote part of Africa that comments on your post and you then become like their hope. I’ve seen it, because I go to international conferences and I’m at a conference and all of a sudden a nurse walks up to me, “Oh my God, you’re Carol Porter, you and I are connected on LinkedIn,” and then I check, we both check and say oh my God, we are on LinkedIn and I follow you, blah-blah-blah. So it’s kind of—I can only imagine what it is if you’re in a remote part of the world without many resources, and you’re trying to understand what healthcare is like in the United States in a number one hospital. So I feel that we have an obligation to educate nurses everywhere, and other people. One person said, “Isn’t it depressing, working there?” I said, “No, there’s more living than anything.” So then I said okay, so now I have to post what we do that’s so unusual, like around the holidays, on our stem cell units, one of the associate directors always have a party for the patients and family, and has rock and roll music and line dancing. So all the patients have their masks on, their IVs dripping, and the associate director is up there with her cowboy boots leading in line dancing. I post that every year, because now you’re—what do you mean, it’s not sterile? The patients are out in the hallway and they’re having fun. So it gives people a glimpse of cancer care with a very human approach, and I have fun. The first time there was that little snowstorm and a couple of flakes were on a palm tree, I took a couple pictures and I posted it and I said something about how I brought the weather from New Jersey down to Texas, that kind of stuff.
T.A. Rosolowski, PhD:
Yeah, yeah.
Carol Porter, DNP, RN, FAAN:
So I feel very good about my contribution to getting them involved with that, and they all—everybody was worried that they would be inappropriate. They’re not inappropriate. I told them, I said social media is—whatever you put on social media should be okay on the front page of a newspaper, and it’s all for reward and recognition. Because they wanted guidelines, I said, “If you always use it for reward and recognition or education, you’ll always be fine.” So that’s my whole social media thing. I think nurses in general aren’t as savvy in social media as they should be. Doctors are.
T.A. Rosolowski, PhD:
We’re at ten minutes after five.
Carol Porter, DNP, RN, FAAN:
Okay, I know. Well that was good.
T.A. Rosolowski, PhD:
That’s good, and we will definitely have another session.
Carol Porter, DNP, RN, FAAN:
At least we got into MD Anderson now.
T.A. Rosolowski, PhD:
We’ve gotten to MD Anderson. No, this was really, this was really great. I mean, I think it’s—I’m enjoying the way you’re talking about this, because the stories layer together, a lot of practical activity, leadership philosophy, and understanding of culture. [00:36:58
Carol Porter, DNP, RN, FAAN:
Right.
T.A. Rosolowski, PhD:
It’s very complicated storytelling and I think it’s very rich, so I’m really happy that we’re having these conversations.
Carol Porter, DNP, RN, FAAN:
Good, sure. I think it’s great.
T.A. Rosolowski, PhD:
Well let me just say for the record, thank you.
Carol Porter, DNP, RN, FAAN:
Yes, thank you.
T.A. Rosolowski, PhD:
And then I’m turning off the recorder at ten minutes after five.
Carol Porter, DNP, RN, FAAN:
Okay, perfect, thank you.
Recommended Citation
Porter, Carol DNP, RN, FAAN and Rosolowski, Tacey A., "Chapter 06 : Areas to Address as Chief Nursing Officer" (2018). Interview Chapters. 1380.
https://openworks.mdanderson.org/mchv_interviewchapters/1380
Conditions Governing Access
Open
