Tell us about yourself.
What influenced you to become a nurse and eventually a nurse leader? I am a grateful nurse leader who came from humble beginnings. My story most likely parallels many of the stories of your readers. I was born in Cebu, Philippines and my family immigrated to the United States in 1986. We ended up in Illinois where a former nursing classmate of my mother invited all five of us to stay in the basement of their home for two weeks until we found an apartment. Most apartment complexes have a rule that allows only 2 people per bedroom and only same sex siblings in the bedroom. The landlord in our apartment complex was nice enough to allow us to rent a more affordable 2-bedroom apartment as long as we "hid" my brother!
Looking back, I would say that was probably one of the most exciting and scariest time of our life as a family. We were given a clean slate but yet it was unclear what lies ahead for our family's future. My brother, sister and I will never be able to thank my parents enough for the sacrifices they took and for leaving life as they know it in the Philippines and come here to ensure a better life for all us.
Without a doubt my parents have been the most powerful influence in my life. They instilled in the three kids at an early age the value of hard work, being grateful for our blessings, and giving back to the community. They never told us what to do, but we know to do our best at whatever path we chose. I think it was my childhood upbringing that really solidified my desire to become a nurse at a young age. My mother was a public health nurse at Mabolo Health Center and my father was an engineer and a land surveyor. During the summer break and on weekends, I had an opportunity to either go with my mother to the clinic or with my father to wherever remote province he worked at.
I enjoyed the time I spent at the health clinic and the outdoors. At the health center, I hung out in the waiting room and played with other kids while their parents saw the nurse, doctor or dentist. I was the official taste tester of the food whenever the nurses hosted "Nutrition Day" and they cooked and showed the mothers in the community how to make healthy meals from vegetables grown in their yard. I also went with the nurses on home visits and spent many afternoons playing with the kids in their home while the nurses provided care to the homebound patient. As a nurse in the community, it was not unusual for us to hear a knock on our door in the middle of the night and my mom had to go to a neighbor's house to deliver a baby or be the first one to assess an elderly neighbor who is sick.
On the other hand, I always looked forward to the outdoor activity that my father's work brought. In a country where land is inherited from one generation after another, he was often called to divide the land that was to be passed down to the children. I joined him and his apprentices as they traveled throughout Cebu in our 4x4 Jeep Willy's and navigating through steep mountain terrains, crossing rivers and creeks and getting areas that can only be reached on foot. While he and the men carried poles, coils of measuring tape and other instruments...my sole role on these trips was to carry the client's file. A job I took very, very seriously. Once we get to the area where we need to be...I once again often hung out with the client's family while my father and his men did their work. I played with the town's children, climbing trees, sometimes helped them with farm chores, watched the women cook in an outdoor wood stove with ingredients that was from the farm straight to the table.
It was through these visits to remote areas that I saw the difference between towns with access to health care and those that do not. In the mountain areas, where the nearest clinic might be 2 hours away...It was not unusual to see a child die from a fever of unknown origin, a teenager die because he couldn't get vaccinated with a tetanus shot, several families getting stomach flu due to contaminated water. I saw as a child the difference that a group of nurses made in the slums of Mabolo and what impact they could have had in the remote areas of the island. These experiences left an indelible memory that made want to become a nurse.
Describe your career progression from a staff nurse to your current role as the Nurse Administrator of Ambulatory Nursing Services at Mayo Clinic.
I would say that I took the scenic view in my education and career as a nurse. I had great plans to directly attend a 4-year university but had to put those aside when my mother was diagnosed with lupus during my senior year in high school. Since I was the oldest of three kids, I had to stay close to home to help drive my mom to her treatment and appointments. I was able to attend the College of Lake County and enrolled in the nursing program. I never lost sight of my goal to continue on and obtain a bachelor's degree and told myself that I will continue on after my mom got better.
Upon graduation from community college, I worked in an oncology unit and then later transferred to become an operating room nurse in a 99-bed hospital in northern Illinois. My mother's lupus responded well to the treatment and she went into remission. I found this as a great opportunity to find a nursing program that was flexible to the schedule of a working student. I enrolled in the weekend program at Alverno College in Milwaukee and attended classes every Friday, Saturday and Sunday for two years.
After 2 years in surgery and after graduating with my BSN, I became restless and decided I was still young and had many years left in my career and wanted to do something different. This was when I joined the Regional Organ Bank of Illinois (now Gift of Hope) as an Organ and Tissue Recovery nurse. It was tiring and emotionally exhausting responsibility with unpredictable work and on-call schedule but it was also very rewarding to be able to know that at the end of an 18 hour shift ...there is someone who is able to have a better quality of life because of an organ or tissue I helped recover.
Five years later, I became the bone marrow transplant coordinator at University of Illinois Medical Center. One of my greatest achievement at UIC was leading the multidisciplinary team that worked on getting the bone marrow transplant program accredited with the Foundation for the Accreditation of Cellular Therapy (FACT). It was also at this time that I went back to graduate school to pursue a Master of Science Degree in Human Services Administration.
I would say that each position built on what I had learned in the past one. In 2001, I was recruited as the Administrative Director for the Stem Cell & Bone Marrow Transplant Program at Northwestern Memorial Hospital in Chicago. I was able to use my background in coordination, leadership, marketing to further their mission. Along with the staff and medical leadership, I also led the program into a successful FACT accreditation survey.
After awhile, my husband and I relocated to Atlanta where I held the position of Director of Bone Marrow Transplant at Northside Hospital and later as Director of Nursing Education for MC Strategies/Elsevier, a leading continuing education delivery site. I felt the need to be more involved with nursing again and was recruited to join Mayo Clinic in Arizona in 2005 to manage the Ambulatory Infusion, Apheresis and Dialysis units. I also became an accreditation surveyor for FACT and have led Mayo Clinic and Phoenix Children's Hospital through four successful accreditation surveys. In 2012, I accepted the role of Nurse Administrator for Ambulatory Services at Mayo Clinic. In this position, I am able to influence the care outpatients receive from an interprofessional team at a crucial time in the evolution of our national healthcare delivery system.
What has prepared you for your current leadership role?
I held a series of progressively more responsible leadership positions prior to assuming this executive role. I took bits and pieces from each of these experiences and brought them to this position. Building from one level to the next helped me become the leader I am today. Each step gave me a new and broader perspective of nursing and healthcare. This allowed me to develop a more global appreciation for the system-level work that I do now.
What career challenges have you experienced during your transition from frontline nursing to Administration? Describe your leadership style?
I appreciate that we are now talking openly about lateral violence in nursing. This is also called bullying, nurses eating their young, hazing or earning your stripes. I saw this as a bedside nurse and it bothered me that the members of the most trusted, caring and compassionate profession would do this to each other. The nursing literature over the past 20 years has documented lateral violence and its effects. The result of lateral violence is especially serious for newly licensed nurses because it keeps them from asking questions, validating their knowledge, and feeling like they fit in -- all necessary for them to build their knowledge and become part of the organization.
I strive to be a transformational leader. In today's complex, rapidly changing healthcare environment, the ability to be a transformational leader is essential. Transformational nurse leaders are able to identify the changes their environment needs, guide the change by inspiring followers, and create a sense of commitment to change. It's a big shift from the command and control model of the past.
I work hard at creating and promoting a healthy work environment. I think that having a supportive environment is important for the overall health of nurses, for successful nurse recruitment and retention, and for the quality and safety of patient care. Healthy work environments are healing, empowering environments that have been correlated with employee engagement and organizational commitment. These environments are characterized by a high level of trust between management and employees; by employees who treat each other in a respectful manner; by an organizational culture that supports skilled communication and collaboration; and by a climate in which employees feel emotionally and physically safe.
As a respected leader in nursing, what have been defining moments for you?
Early on in my career, I had a position in a 5-suite operating room and was one of three experienced nurses on the unit. I had an "ah-ha" moment when I realized the only way we were going to survive and be the best for our patients was to teach each other everything we individually knew in nursing. It worked beautifully, and I still embrace this philosophy. We are all in this together, and the more we teach each other what we know, the more successful we all will be.
Identify the most difficult challenge in your leadership journey and how you overcame it?
I had a brief position as a director of bone marrow transplant at a community hospital. I had left a position at an academic medical center to accept this role. I had not realized the huge difference in how nurses are expected to function between a community hospital in the South and university teaching facility. I went from mentoring and educating nurses and residents to being told by physicians that they needed nurses who could pass bedpans and answer lights, not highly educated nurses. I found myself out of a job. I was devastated. I decided to go back to school and enroll in a PhD program in 2004. I started a job search again for what I call "my retirement job." I had learned a lot about myself through the experience and was determined to only work for a large academic medical center. A year later, I was offered the position at Mayo Clinic. This was the turning point of my career, and without that position, which gave me a very firm foundation in nursing and hospital administration, we probably would not be talking about me today.
Reflecting back on that experience, I would not have done anything differently. Risk taking is an important behavior if one is to have personal and professional growth and make a difference in the world around you. I have had several disappointments and losses, both personally and professionally. With each one, I have gained clarity on my personal bottom line, articulated my core values and integrity, and demonstrated the resilience of nurse leaders and the human spirit.
I am still on my leadership journey and continue to learn from those at work and those we serve. I have been blessed with trusted advisors and mentors all along the way and continue to rely on them heavily. I have had the chance in my most recent two roles to exert tremendous influence on the role definition and on the way that it is executed across large and dynamic organizations. This takes substantial support from everyone on the team and a willingness to try new things and to reinvent myself. I have found being new and being the "first ever" to be humbling, challenging, and extremely fulfilling.
What do you consider to be the most rewarding aspects of your job? How do you create work-life balance given all the roles and responsibilities?
I enjoy seeing young people coming into nursing who have pride and confidence in themselves, both as individuals and as nurses. I enjoy when people share a story on how some of my words of wisdom have influenced them personally or professionally.
I love the foundation of who we are as a profession. This relates to the interface between the art and science of caring for people. Both nursing's art and its science are essential for excellence in the performance of nursing's mission. As a nurse leader, I am always saying to other supervisors that when teaching new grad students, there is a knowledge piece that they need to learn to pass the nursing boards, but that is not the deep essence of becoming a nurse.
I love seeing nurses grow and develop the art component of nursing. Because nursing involves people in a variety of settings and situations, effectiveness is dependent on the quality of those interactions. The art of nursing will often be practiced in environments that are unpredictable and spontaneous, requiring the nurse to be creative in her/his response to individual client needs. As nurses mature professionally ....they develop the ability to sense, feel, perceive and know how to deliver care in ways that increasingly demonstrate mastery in their field. It is rewarding to be a part of their development!
I have to be honest that I no longer aim for work-life balance. I chose this career path and have to accept the positive and negative aspects that come with it. I strive to enjoy whatever I am doing. Having fun with this work is essential for success. I love what I am doing and look at my life as an expression of the choices I have made.
I don't know that seeking balance is the right thing - it's more like seeking harmony. Balance implies that all the areas of you life are equal, but there are times in your life when you're very busy professionally, and then there are times when you get to take time out for family, friends, and yourself. Harmony can be defined as "a pleasing arrangement of parts or congruity." I like that definition because it implies a fluid blending of all the components of one's life, rather than a rigid scale. As long as you're able to have good health and you're happy in what you do, that's the key. You have to be doing in life what gives you joy. I enjoy my career, so it doesn't seem like work.
When I do get the time, my husband helps me slow down. He is more laidback than I am and reminds me to stop and smell the flowers or better yet ... he encourages me to stop and enjoy art. He is a talented artist and I have developed my eye for art thanks to many hours of him taking me to art-related events. I would say that he has helped develop my right brain's focus on aesthetics, feeling, intuition and creativity!
How long have you been a member of the Philippine Nurses Association of Arizona (PNAAZ)? Can you share some details about this organization, its current activities, and the benefits of joining?
When I was a child, I used to see these green and white journals that would arrive in the mail at our house in Cebu about 4 times a year. I really did not know what it was until I was in my a teen that I knew my mom has signed up to be a lifetime member of Philippine Nurses Association and this journal subscription was one of the member benefits. I really thought how cool it was that my mom felt so strongly about her chosen profession that she had to join the national organization and support its growth. My mom still receives the journal to this day!
As for me, I joined the Philippine Nurses Association of Illinois (PNAI) the very month after passing my boards. After relocating to Arizona, I joined PNAAZ in 2007 and have taken on various leadership roles over the years. Active membership in professional organizations should be well thought out and planned for. It is important to view this work passionately and with a strong desire to give back to the profession because this work is never instead of current work, but rather in addition to it. If there is anything I would change ...it would be the common mentality of some nurses which is "What's in it for me? What do I get out of that $75.00 annual membership fee?"
I would say that your membership fee allows Fil-Am nurses to be visible, influential and be able to give back. PNAAZ is 12 years old so it has continued to flourish and live out its mission to "foster education, research, and nursing practice and to promote unity and fellowship among Filipino-American nurses in Arizona." The board works hard to organize and deliver affordable nursing education conferences with continuing education credits that many nurses in the valley need to meet career ladder requirements. Nurse volunteers host health screenings at various events throughout the year. We also take the time to honor nurses at the annual Nursing Excellence gala where we award nursing scholarships to deserving undergraduate and graduate nursing students. Through the national chapter, we have been able to provide financial assistance to help fund Gawad Kalinga – a program for the poor in the Philippines which restores dignity, empowers communities, provides access to mainstream opportunities and basic services, and eventually to character building and good citizenship. Gawad Kalinga is there to guide the poor throughout the many stages of their journey out of poverty, taking them from the level of the poorest of the poor to becoming the empowered poor, the productive poor, and eventually the new middle class.
Great support at home is essential because you give up many weekends with this high-level work. I am surrounded by a fantastic group of officers and board members who give up so much of their time, talent and treasure to ensure every single one of our activities are successful. As the President of PNAAZ, I never see myself as doing anything as just me; I see it as a team effort.
Do you have any words of wisdom for those seeking to enter the nursing field and/or advance within it?
The first thing is to take advantage of all the education, mentorship, and preceptorship opportunities available to help you transition from being a student to a nurse. Once you have mastered what you are doing, get cross-trained and learn new things. The more knowledge you have, the greater the benefit will be for patients and families that you care for. If the organization where you work offers continuing education, take advantage of that. Get additional formal education or become certified in your field of specialty. The more you know, the more you realize you don't know, and it's a great way to keep your mind stimulated. The overall key is to be in an organization that's a learning organization.
As for those wanting to advance in nursing leadership - I would encourage you to engage in leadership as your specialty. Leaders often feel the need to maintain a high level of clinical competency in order to be a leader, but I would argue that while clinical experience is important, it certainly doesn't define you as a leader. Leadership has its own competencies, and when you decide that is your career path, I encourage you to pursue it as you did your clinical career. A good leader can lead anyone, and this does not require you to only lead in clinical areas where you have worked. Most of us have worked in hospitals, and we are now in a time where hospitals are going to be less and less significant in the healthcare delivery system. The system will function primarily in the community, and we will need leaders willing to step out into that world and lead us into our future.
Finally, I suggest that you surround yourself with trusted advisors and people who are willing to give you honest advice and can serve as your "mirror." They will give you the tough truths but they also are leaders who are motivated to help you grow and achieve your career goals. Be willing to try new things and step out of your comfort zone, and know that, as a nurse leader, your resilience will serve you well and keep you energized about the unlimited possibilities in our profession and industry. Having the unwavering support of my husband has allowed me to follow my career dreams and to be as excited about my profession today as I was when I first began.
What is your personal philosophy and source of motivation? Do you have a motto that you live by?
I do not have a single motto but I do have several thoughts that serve as a blueprint for me personally and professionally. While learning from the past is important, do not let the past define your future. Do not look at yourself any less because you did not obtain a nursing degree from a top-ranked, fancy name university. Although those credentials might initially open doors for you....eventually it is your drive, ability to build relationships and motivation that will lead you to succeed. Surround yourself with forward-thinking people from all walks of life, and allow yourself to innovate, create, and think in different ways. Bring your individual wisdom, but also learn from the up-and-coming generations as they are our future. Take individual responsibility to guide, coach, and mentor; I guarantee you will learn, too. Celebrate in the successes of people you lead and influence.
I would like to stress the importance of integrity. Mean what you say and say what you mean to ensure you never have to worry about what you are saying. Embrace learning with a passion. Every morning, I ask myself, "What will I learn today?" The world is full of people who I can learn from. Never believe there is nothing more to learn or opportunities to learn from. Take the time to reflect. At the end of the day, I ask myself, "What did I do that I could have done differently today?" I try to think of people I may have wronged and try to make amends, if needed.
And finally, always be humble. Arrogance leads to poor leadership, poor decision making, and failed organizations.