Shaping the Future of Patient Care

Jamaican-born Diane Johnson, BSN, RN, MBA, dreamed of becoming a nurse at a very young age. Today, Johnson’s professional journey has led her far beyond what most people think a typical nurse’s job should be. As vice president of patient care services and chief nursing officer at Sinai Hospital of Baltimore, she has spearheaded major initiatives that have not only brought her immense career satisfaction but have literally changed the way the hospital delivers patient care.

She has, for instance, implemented various specialty units, including a vent unit, joint center, stem cell unit, stroke unit and an intermediate care unit. She has also helped in the facility and workflow design of Sinai’s emergency room. In her current position, Johnson has responsibility for strategic planning, financial management, and leadership over a wide range of hospital departments, including nursing, cardiology, respiratory care, pulmonary, radiology, outpatient infusion services, hemodialysis, central sterile, perioperative services, emergency services and transportation services.

Johnson immigrated to the United States with her family when she was 12, settling in Springfield, Massachusetts. Her parents supported the family through factory work. Throughout grade school and high school Johnson enjoyed studying science and Latin. She went on to earn her BSN degree from the University of Bridgeport in Connecticut in 1975. That same year, she took her first nursing job as a staff RN at Sinai Hospital.

Johnson honed her nursing skills during a six-month internship that allowed her to work on a variety of different units. She then went on to work in the newborn and intensive care nurseries until 1980, when she came to a career crossroads. Because of her outstanding commitment to patient care, she was offered her first promotion—to an administrative position as nursing supervisor in the nursing services department

“I had to decide between going the clinical or administrative route,” Johnson recalls. “I took a chance [and accepted the promotion]. It was a difficult but good decision. At that time the nursery was like a one-room shack. It was scary to take on a [larger role within the hospital], but that move helped me get where I am today.”

The new supervisory role turned out to be a great fit for Johnson. “It allowed me to be creative, be a problem solver and hone my interpersonal skills. I loved the challenge and the variety,” she says.

Constantly moving forward in her career, Johnson was quickly promoted to other administrative and managerial positions, including a dual role as director of admitting and associate director of nursing.

“I’ve learned many things in all of my positions,” she says. “As director of admitting and associate director of nursing, I learned a whole new set of skills, including accounting and billing. It turned out that I didn’t like those duties, but I wouldn’t have the knowledge I now have had I gone the [traditional bedside] nursing route. It gave me leadership strength.”

Throughout her more than 30-year career at Sinai Hospital, Johnson has relied on that leadership strength to not only advance herself professionally but also to guide the entire organization in constantly advancing the quality of its nursing care. With a management philosophy that continues to emphasize progress and innovation, Johnson and her nursing staff are currently working toward taking Sinai to yet another level in state-of-the-art patient care.

Catalyst for Change

One of the major initiatives Johnson is now working toward in her capacity as chief nursing officer is preparing Sinai Hospital to seek magnet hospital status. Magnet recognition is awarded by the American Nurses Credentialing Center (ANCC), an affiliate of the American Nurses Association, to hospitals that successfully meet a set of 14 standards of quality in nursing care and are able to provide evidence of meeting these standards on a daily basis.

“Seeking designation as a magnet hospital is a never-ending journey. It’s something that you’re constantly working on for your whole team and, ultimately, for the patients,” Johnson says. “We will go through the review this fall and we’ve set goals that we’d like to accomplish. Even if we don’t get there, the journey itself has been very rewarding. It has helped the nurses to become more fulfilled as nursing professionals, and it has helped us focus on ongoing learning and leadership as well.

“The magnet environment is all about [professionalism in] nursing and using that to ultimately improve the care delivery process,” she adds. “While we’re not there yet, I feel very good about what we’ve accomplished to date.”

Johnson was a catalyst in the decision to move toward seeking magnet recognition. It is a goal she first formulated, and began laying the groundwork for, five years ago. “The first thing that I did, without anyone knowing, was focus on certain areas like certification, how many bachelor’s-prepared nurses we have and what educational offerings we have for our nursing staff so that they can achieve their career goals,” she says.

“The next step I took was the creation of a new position: director of professional nursing practice. That person’s job is to be the champion and the voice and the conductor within the organization by interacting with the executive team, the board and other departments to sell this message across the entire hospital. While it’s heavily focused on nursing, it really is about the whole hospital and the culture of the organization.”

Johnson has also continued to use outside resources, such as conferences, to keep herself current on emerging information and methodologies. She says she sees herself as a “cheerleader” throughout this initiative by encouraging the staff as they achieve certain milestones along the way to gaining magnet status.

Putting Patients First

Johnson also played a major leadership role in developing and implementing a new hospital-wide program designed to improve the quality of patient care. Once again, she is helping to guide not just the nursing staff but the entire hospital in providing a whole new level of service.

“Our new patient care philosophy is about teaching our staff that it’s more about the patients and their families, and less about the employee,” Johnson explains. “We do care about our employees and we demonstrate that in numerous ways, but we want to ensure that patients and their families always feel welcome.”

 

One new approach to improved patient care that Johnson and her team initiated is a new hospital visitation policy that focuses on understanding what is best for the patients and their families.

 

“Traditionally, what hospitals have done is build visiting hours around the practices or convenience of the staff, whether it’s nurses, doctors or the support staff,” she says. “But that is not always what’s in the best interest of the patient or family. Sinai’s new patient care philosophy encourages [the staff] to understand what the family’s needs are and what might work best for them. For instance, one family needed unlimited visiting to help them [cope with the hospitalization process].”

Improved patient care means talking to patients and their families to help determine what is best for them on a case-by-case basis, Johnson continues. It also means improving hospital services for visitors, including better access to refreshments and better signage so that patients’ families can navigate their way around the hospital easily.

Although Johnson has been the driving force behind this initiative, as well as many other innovative programs at Sinai, she is quick to emphasize that it has been a hospital-wide team effort.

“Being able to envision the future of patient care in our organization, and being able to craft those goals, is very rewarding,” she says. “My job is to see where we are now and where we need to go next—not only in our hospital, but within the larger community—and then make it happen. It’s really rewarding when we can look back and say that it’s good to be where we are now compared to where we were then. What’s heart-warming to me is that the staff appreciates the forward movement.”

Advice for Advancement

Ask Johnson to name the biggest challenge she faces in her work and she’ll give you an answer that’s all too familiar throughout the health care industry—the nursing shortage. For Johnson and for Sinai Hospital, the issue of staffing shortfalls is always present, because with hospital growth comes a greater demand for trained nursing professionals.
“The supply and demand issue is forcing us to rely on temporary staffing,” she says. “I envision having all our own nursing staff and no agency staff here. That is an elusive goal, but we’re doing much better in that regard than we were before and I’m very pleased about that.”

The nation’s hospitals need more young nursing talent in all specialties, she notes, but the two most urgent areas of need are critical care and emergency departments.
As for the challenges of being a minority nurse in a majority-dominated industry, Johnson says she is fortunate that this has not been a problem for her. “During my tenure [at Sinai] I do not recall any sweeping dissatisfaction that is specific to minority nurses,” she adds. “The culture in our organization is that we try to reward very capable individuals who have the desire and the skill and the knowledge to perform at those high levels. We have a very diverse staff throughout the hospital and particularly in our nursing staff.”

Johnson advises minority nurses to go for their BSN degree, because it will not only help them advance their careers but also increase the quality of patient care. “Research shows that nurses who are prepared at the bachelor’s level have better outcomes with their patients than nurses who do not have that level of preparation,” she says emphatically. “I believe that if you are a true patient advocate, you can’t ignore that.”

While Johnson believes strongly in hiring nurses with baccalaureate degrees, she also understands that the severe nursing shortage makes this a challenging goal for many hospitals, including Sinai. “You can’t say that you’re not going to hire any non-bachelor’s nurses. It would be foolhardy and we would not be able to take care of our patients,” she acknowledges. “But what you can do, and what Sinai does, is set some interim milestones by asking, ‘how do we get from here to that point of having more bachelor’s-level nurses on staff?’ Right now 51% of our nurses have their bachelor’s degree.”

Focusing on this goal is important, she adds, because having a high percentage of BSN-prepared nurses is one of the qualities that distinguishes a magnet hospital.
Johnson also offers this advice to help other nurses of color navigate their career journeys: Know your job, stay current and be collaborative. And as her own example shows, having an entrepreneurial spirit and looking for ways to improve the delivery of care can make nurses extremely valuable to their employers.

Last but not least, she stresses the importance of finding strong mentors throughout your career—and she especially suggests seeking out both minority and non-minority mentors.

“If you only look at things from a single perspective, you’ll only have half of the picture and then you’ll have areas where you’re underdeveloped,” Johnson says. “There may be certain [times when it’s helpful to have a mentor from your own cultural background] who can share your perspective. But the reality is that nurses have to work with lots of different people, and so your interests are better served by having a good mix of mentors.”