Two years into her tenure, Chief Nursing Executive Karen Davis has heard the voices of her 3,500 nurses to improve processes and culture at UR Medicine
By John Addyman
Karen Davis joined the University of Rochester Medical System two years ago, charged with establishing consistent and outstanding practices. And getting and keeping great nurses.
She was walking into a big job.
In June, she and her staff completed the second year of a five-year strategic plan to accomplish those goals — achieved primarily, Davis said, by listening carefully to the 3,500 nurses working with her at Strong Memorial, Golisano Children’s Hospital, the Wilmot Cancer Center, and Highland (Rochester), Jones Memorial (Wellsville), Noyes Health (Dansville), St. James (Hornell) and Thompson (Canandaigua) community hospitals.
A 30-year veteran of the Johns Hopkins University Medical System based in Baltimore, Davis started her career as a clinical nurse, earned her master’s degree in nursing, became a nurse manager / assistant director and, after achieving her Ph.D., vice president and chief nursing officer.
She earned status as a board-certified nurse executive, and was prepared to take on a system-wide job, managing a multiple-hospital nursing program.
That’s what she found at URMC, and her route to Rochester and that system-wide job began in 2014.
After she finished her Ph.D., “I needed the experience and title of CNO [chief nursing officer] if I was ever going to lead at a system level,” she said. That took her to a Johns Hopkins-affiliate, the Howard County Community Hospital, as the CNO.
“Now I had the social work staff, the chaplaincy, the gift shop employees under me,” she said, “not just the nursing staff. I learned a lot about managing different groups.”
At Howard, she was charged with “improving the patient experience, systemization and alleviating crowding in the emergency room.”
“The emergency department [at Howard County Community Hospital] was at a bottleneck,” she explained. “The nurses told me how to work on processes. I put all the stakeholders in a room, had them look at the data compared to other hospitals. The solution is always with the people who do the work — when you put all the right people in the same room.”
She spent her first months at the hospital being everywhere her nurses were.
“I put on scrubs and spent shifts with the nurses. I wanted to be with a bedside nurse for the shift, following them, observing and seeing what was going on, see what the care was, and what opportunities for change were there. I have to get out there and see — you see the unspoken things nobody will tell you about.”
Davis also brought her experience with the academic “mother ship” of Johns Hopkins to Howard. “Sometimes a community hospital doesn’t know how to access the resources back at the mother system.”
Three years into her stay at Howard County and due for a promotion, Davis got a phone call.
“It was my old boss, asking me if I had seen the chief nurse executive posting at the University of Rochester Medical Center. Hopkins had sponsored me for a two-year fellowship at the Health Management Academy. I wanted to do oversight of multiple hospitals. A headhunter contacted me and the next thing I knew, I was interviewing.”
She said she fell in love with the executive team at URMC and was impressed that a staff nurse was on the search committee.
Davis went back to Maryland and told her college-age kids Maeve and Grace that they might want to think about Upstate New York in the near future. The family had relatives in Skaneateles.
“They told me, ‘Go for it, mom!’”
“I came two years ago and it’s been a great ride,” Davis said. “I never looked back, but I miss my colleagues at Hopkins — I was there for 30 years.”
When she came to Rochester, people at Strong knew something was different right away.
Davis had started again by walking complete shifts with her nurses. “At first, people thought I was crazy — ‘You want to work a Saturday night in the ER?’ It’s a very different place here on the weekend and at night. It was much more enlightening for me to spend a Friday night than a Wednesday at 7 a.m. when all the businesspeople are here.
“When you observe and see what’s going on, you see how care is and what opportunities are. I feel like I have to go out there and see — you see the unspoken things nobody will talk to you about. That was time well spent and I’d still be doing it if I haven’t had to deal with COVID.
“I asked nurses, ‘How long have you been here? What’s kept you here?’ ‘What gets in your way?’ ‘What are your biggest challenges in taking care of a patient?’ ‘What gets in your way when you’re trying to give optimal care?’
“My job is to remove those barriers and I have to know what they are first.
“This is how I got to know people. I could sense the different cultures of each shift. And you have to sense it — nobody hands you a book. I did that for my first six months at URMC, shared what I learned with my leadership team, then launched the strategic plan.”
In March, fate threw a knuckleball into Davis’s strategic plan.
“It feels like we’ve been dealing with COVID-19 for seven years, but we’re not going to let it get in our way. It has challenged all of us, whether you’re in a leadership role or a frontline caregiver. I feel we’ve all grown. I’ve learned so much about change momentum and communication through a crisis.
“COVID – I look at what’s been positive about this. We have a skillset now. None of us had any experience with a pandemic; now we have a skillset. This has built teams — teams that never were before. People have stronger respect for each other’s skills and abilities — we were all hands on deck, so we had pediatric nurses working with adults. This taught me how flexible people can be.”
Because of her experience at Howard, “I can really relate to the CNOs at our five community hospitals,” she said.
One of her goals at URMC was to bring a more systemic approach and she involved the CNOs quickly and directly.
“We need to have not just pockets of excellence here there, we really have to have a coordinated, sustainable optimized process for our health system.” Davis said. “Some of our CNOs had never met one another. Wellsville is two hours away and there was nobody pulling this together.
“I gathered up the CNOs, we meet monthly, and we formed a council. We travel to each other’s hospitals. It’s important that we get out to everybody’s campus, tour everyone’s hospital, and know the physical limitations. Each CNO hosts a meeting.”
Davis appointed people to have system-wide responsibilities. “For instance, I now have a chief nursing informatics officer who is a nurse focused on technology and nursing informatics. When I hired her, I hired her for the whole system.
“We also have regional educators across the system and we have new ways to implement things. If there’s a new policy, say on heart failure, that starts to get rolled out from the CNO council and then to all the affiliates. That’s a new way for us to work as an organization.
“COVID has been a perfect example of how we work as a system — making sure everybody had adequate supplies, PPE, up-to-date information. We already had those lines of communication set up, so it was easier to deal with the pandemic. Well, not easy — but now we are organized, we know how to communicate, we know what people need and we could run through those structures.
“I was grateful I had a year and a half under my belt before I had to handle a pandemic because it would have been really hard to do that having not known the system and who the players were and not having put any structures in place.”
Davis is looking for good nurses.
URMC has a “magnet” designation, a seal of approval that it’s a great place to work for nurses. And she has some criteria.
“One of the things I’ve stood for and people know about me — I ask nurses to be compassionate and vulnerable with patients. For us, it’s not about checking the box and giving meds and the physical care: the important thing is to emotionally connect with — and be emotionally available – when our patients need us, and boy, has that been a test during COVID because our nurses had to provide emotional support when families couldn’t see their loved ones.”
After her two years, Davis believes URMC nurses have seen a change in the leadership — and leadership opportunities for them. “We as a nursing group have become more flexible and more focused on retention. If you have great leadership, that drives retention and when you foster an environment of flexibility, anything is possible.”