What do a truck driver, a file clerk and a manager involved in helping one of the nation’s leading health care organizations implement a multi-billion-dollar electronic medical records system have in common? They’re all positions that Valerie Fong, MSN, RN, has held during her remarkable 15-plus-year career at Kaiser Permanente.

For Fong, who is currently the national patient care services practice leader for KP HealthConnect, the company’s system-wide electronic health information initiative, the road to career success with Kaiser Permanente has been filled with sharp turns, a steep learning curve or two and even a few stops for deliveries. Her nontraditional transition into a management career at America’s largest HMO is an inspiring example for nurses who may be considering the career path less traveled.

“As far back as I can remember, I was always interested in science, but nursing was never part of my vocabulary,” Fong recalls. “Growing up, I had a complete lack of understanding about the multifaceted world of nursing. It’s almost embarrassing to admit, but when my mom tried to get me thinking about becoming a nurse, I was completely turned off by the thought. I remember telling her, ‘I don’t want to just give shots and empty bedpans.’ Boy, was I clueless.”

Fong, who was raised in the heart of Los Angeles, earned a BA in biology and initially wanted to become a veterinarian. But after volunteering at a hospice towards the end of her senior year, she discovered that nursing was indeed the right career for her. The experience, she says, “completely changed [my idea of] what nursing was all about and the opportunities the profession offered.”

Fong enrolled in nursing school. But like so many other students, she had to find a job so she could support herself while pursuing her education. And that’s when Kaiser Permanente came into the picture.

“When I moved to Fresno to start nursing school, I was driving around
the neighborhood close to campus,” she says. “Out of the corner of my eye, I saw a Kaiser Permanente sign on a building. It was comforting to see something familiar. My parents had health insurance through Kaiser, so I went to a Kaiser pediatrician for my care. In addition, I remember my pediatrician telling me something about there being a lot of opportunities at Kaiser Permanente. I would never have guessed that there was a Kaiser in Fresno, and I later learned that the facility offered outpatient services only.

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“I went to the personnel department and looked over the list of job descriptions. Of course, most were clinical positions that required experience, but then I saw the job description for a part-time position as a messenger/driver in the material services department. This sounded like a great job to me–delivering supplies, lab specimens, medical records and mail to the various Kaiser clinic office buildings throughout the area. And the hours would fit with my school schedule. I got the job as the only female driver in the department, and I loved every moment. I drove a delivery truck with a lift gate on the back, and I remember getting a lot of stares from other drivers when they saw me behind the wheel.”

To Fong, the job was about more that just delivering supplies–it was a way to get her foot in the door at KP even though she had no nursing experience yet. As a new Kaiser Permanente medical center was being built in the Fresno area, Fong was actually participating in the startup of the facility’s ambulatory clinics by performing tasks like setting up the supply closets and exam rooms. At the same time, she was laying the foundation for the startup of her own nursing career.

Clinical Work vs. Clerical Work

Although she didn’t know it at the time, Valerie Fong’s next position at Kaiser was an important first step toward her eventual involvement in the KP HealthConnect initiative.

“When my school schedule changed, I transferred to a job as a file clerk in the medical records department,” she says. “As the last two semesters of nursing school were nearing, I had to make a decision between transitioning to a work experience in a hospital setting or continuing to work as a file clerk at KP. But I had a slight dilemma: I knew that the new [KP] hospital in Fresno was going to open a couple of months after my graduation date and I definitely wanted to be a part of that startup. After my pediatrics rotation, I got a job working the night shift as a pediatric nurse intern at the local children’s hospital. Since I also knew that I would probably have a better chance of getting hired as a nurse for KP when the new hospital opened because I was already in the system, I continued to work at KP as well, to keep my foot in the door.”

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While most of Fong’s classmates were working as nursing assistants or student interns at the local hospitals, she continued on in her file clerk capacity at Kaiser Permanente. “Some of them, as well as my boyfriend at the time, questioned my choice and even tried to convince me to get a ‘real’ job working with patients,” she remembers. “But I figured that once I graduated from school and started my nursing career, I would have plenty of opportunities to work with patients. Besides, I really wanted to get my foot in the door at this organization that I had heard so much about.

“During my last year of school, I signed up for a volunteer internship in the oncology unit at a local hospital where I would be able to spend time with the patients and run small errands for the staff. The thought of working with patients was a little uncomfortable, since I was pretty quiet and shy. My biggest fear was of not knowing what to talk about. Some of those patients taught me to just be myself, and at the end of the internship I discovered that I was able to talk with people after all.”

Looking back, Fong says it’s hard to believe all the progress she has made. Much of the clarity she gained about nursing was learned on the job.

“Throughout nursing school, the instructors always stressed the importance of getting a solid background in med/surg,” she says. “While many of my classmates already seemed to know what specific area of nursing they wanted to go into, like OB or Peds, I didn’t. I had some pretty unique experiences during all of my clinical rotations–always learning something, even if it was learning that I probably didn’t want to work in that specialty. I had some great role models at Kaiser Permanente, and I did know that I eventually wanted to work in an administrative capacity.”

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Making the Right Choice

When it came to balancing her work at Kaiser with her nursing studies, Fong took on the characteristics of an acrobat performing on the high wire, attempting the difficult task of keeping everything in equilibrium and living to talk about it.

“Life was a little hectic at that time, and it seemed as if I was living out of my car, going back and forth to school, work and the library,” she remembers. “My managers in medical records were pretty accommodating about my school schedule. Because my job posting was for part-time and on-call hours [rather than] set hours, I was able to pick up extra hours during the summers and holiday breaks and adjust some of my days when I needed time off for exams.

“My schedules never really seemed to clash that much,” she adds. “I was fortunate that I was able to work my school schedule for lectures and clinicals around my work at KP. I also took advantage of the tuition reimbursement program that KP offered to all employees, [which] definitely helped with tuition and books.”

After graduation, Fong got a full-time staff nurse position at the children’s hospital in med/surg/oncology, but she still kept on-call hours as a file clerk at KP.
“People thought I was nuts,” she laughs. “They could not understand why I remained in medical records when I had my nursing license.”

When the new Kaiser Permanente hospital opened in 1995 with a med/surg unit that could accommodate both adult and pediatric patients, Fong was hired to be a staff nurse primarily for Peds, but was cross-trained to take care of adults. “I was still working for the children’s hospital, but soon had to make the choice between the two. As I became increasingly involved in new hospital activities at KP, such as JCAHO preparation, I eventually made the decision to quit the job at the children’s hospital and devote all my time to KP.”

After about a year and a half, Fong transferred to the outpatient clinic as the charge nurse for adult medicine and urgent care. She then moved back to the inpatient setting, becoming the assistant nurse manager for med/surg, and eventually the director of the med/surg units.

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“I then found a new opportunity at the Northern California regional level as a nursing outreach manager for the Central Valley service area,” she says. “This unique job revolved around nurse retention at KP.”

Growing With the Organization

Fong’s next position, a precursor to her current job, was project manager for Northern California KP HealthConnect, guiding the implementation of the electronic medical record system on a regional level. All the different threads in the fabric of her career–medical records, nursing and management–had finally been knitted together.

“I know that all the jobs I have held at KP have incrementally built upon each other to successfully launch me to my current position,” she says. “In the 15-and-a-half years I have spent at Kaiser Permanente, I have been in eight different job roles. As [KP] is moving toward uncharted territory into a high-tech world of electronic documentation, knowing operations from the ground up put me in a position to really influence the nursing and ancillary practice strategies and standards of tomorrow.”

Fong notes that while her greatest support came from the Kaiser Permanente organization, she also benefited from the intangible support of the people she worked with.

“Having all health care services under one roof allowed me to meet and interact with people from all areas and professions, [from] marketing to administration to physicians to nurses to medical assistants to pharmacy to lab,” she says. “There was such a variety of role models I was able to interact with throughout the medical center. I received a huge amount of support and motivation from the people who knew I was in nursing school. The mail clerk was my personal cheerleader and introduced me to other staff going to school; the librarian was my literature search and nursing text guru; the nurse managers kept asking when I would complete my program and whether I needed any help; and the medical group administrator let me practice taking blood pressures on him and introduced me to leadership/management activities.

“Kaiser has provided the foundation for many of the skills I have today,” she continues. “[I was able to take advantage of everything] from basic computer software classes to Epic certification, new manager training to leadership academy events, legal and compliance in-services to mock survey techniques. The list goes on and on.”

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Fong says that the encouragement and support of her loved ones was also an essential factor in her success. These days, instead of balancing work and nursing school, her task is to achieve a balance between her working life and married life.

“With KP’s national offices being in Oakland and my home being in Fresno, my work takes me all over the place,” she explains. “It’s been hard to go back and forth, and my husband has had to be very supportive. It’s not easy. We both golf, so we get together on weekends and socialize with other friends who golf. This renews us.”

Over the course of her career with Kaiser Permanente, Fong says she has changed from being “pretty shy to a couple of marks above shy.” She recognizes that while some of her experiences were outside of her comfort zone, it was necessary to take some risks in order to achieve her long-term goals.

“Because of the various roles I have had at KP, not only did I get to find out what happens behind the closed doors but I have gained knowledge and skills unique to operating in a large and complex organization,” she says. “I know when to listen and when to speak and I’ve learned that if you hold on to your dreams, anything can happen. I have fine-tuned my people skills and have been able to acquire a vast repertoire of role-modeling behaviors. Most importantly, I have gained a ‘big picture’ perspective of the power of being a registered nurse and a great appreciation for the uniqueness of all the peers, colleagues and patients who have influenced me along the journey. There is just a wealth of opportunities for nurses out there.”
 

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