A Reluctant Leader: Reflections on My Leadership Roles

The question about what career accomplishments I am most proud of makes me reflect on the answer I readily give. My answer has always been that I am most proud of my mentees, who reside in different parts of the world, and their amazing leadership. However, a recent question posed by my Philadelphia Transitions group was more targeted toward leadership journeys. My immediate answer to this question is that my journey as a reluctant leader, who held many leadership roles, such as deanships, chairmanships and directorships, stems from accepting serendipitous opportunities and integrating those opportunities with the needs of my family at different life stages. While I did plan my educational trajectory and academic path, in contrast, I did not chart nor design my leadership path.

While deeply rethinking what I am most proud of, I realized I am most proud of finding my own authentic voice and using it to make a difference in the lives of women and nurses. Two articles I published earlier in my career reflect what I really wanted to achieve without deliberately articulating specific goals. The titles of these articles were “A passion for making a difference: ReVisions for empowerment” and “Does nursing intervention make a difference? A test of the ROSP,” which I wrote to convince legislators of the significant role nurses play based on a clinical trial for nursing interventions.

Reflecting on what helped develop my voice, I uncovered three main strategies:

1. First, I developed my voice through listening. As a child, I listened to women who came to my mother’s midwifery office. Then I listened to my childhood friend, Saidia, the daughter of the doorman who suddenly disappeared when she was 12-years-old. I found out her family sent her back to their village to marry her cousin. Girl/child marriages are still practiced in many countries. I also listened to women in Colombia, Brazil, Sweden, Egypt, and many more countries, where I continued to hear similar messages. Women felt oppressed, violated, burdened, undervalued, under-supported and definitely under compensated. Then I listened to nurses, and I heard about their sense of devaluation, the lack of equitable compensation and disciplinary oppression by physicians and administrators. I listened to caregivers and heard about their uncertainty, under-supported transitions when becoming caregivers, as well as the paradox of being burdened and transformed by caregiving. These messages profoundly affected me and shaped my goals, my research and my academic and leadership roles. I pondered what could be done?
   
   
2. The second strategy involved building connections, investing in partnerships, nurturing relationships globally, and then leveraging them to facilitate and support others. My colleagues and I developed global conferences that empowered women and forged connections. I continue leveraging my global connections in my current roles as a board member and a trustee. While mentoring deans and faculty in nursing, medicine and other health fields, I make use of the wonderful global relations I forged and nurtured by connecting mentors and mentees, facilitating connections between experts and those who can benefit from their expertise. I connect those in need of developing certain capacities to those who can meet their needs through my global networks. The vast repertoire of incredibly accomplished colleagues in my life and the relationships I cultivated are assets to those who benefit from shared wisdom and experience. 
   
   
3. The third strategy that led to leadership roles developed from a lesson I learned from my parents, to step outside of my comfort zone and indulge in new roles that require abilities and actions I know little about. I had to develop these uncertain capacities while always finding ways to enjoy and embrace the processes and the outcomes, uncertainties and all.

I have been privileged to get amazing leadership roles that provided me with platforms for my voice. Several instrumental milestones in my career allowed me to gain the necessary skills to lead and to have a voice that made a difference. When Mahmoud finished his Ph.D., I was already an established assistant professor at UCLA, just beginning to develop my academic portfolio, and I had no plans to leave. From his several employment offers, he wanted to accept a position in San Francisco, so we needed to move. I thought I would get a lateral move, from UCLA to UCSF (the UC system has 9 campuses). The dean and faculty at UCSF insisted the only open position I could move to was as an assistant dean. I reluctantly interviewed and got the offer for this difficult new role, particularly for someone like me who just completed my Ph.D. three years earlier, with two babies under 3-years-old, and with a minimal readily available support system for childcare, which was the norm at that time. The challenges of the new administrative role and the challenges of integrating these demands with a growing family taught me a great deal about organization, finding resources, garnering support, management, leadership and the importance of having a strong voice.

Several other events were instrumental in shaping the next 10 years of my life. My academic file went up for a university wide committee review, by what was called pre-tenure by CAP, the Committee for Academic Personnel Promotions and Tenure. This vital milestone predetermined if I would eventually qualify for tenure and stay at the university. After the review, they warned that if I continued working on a book I proposed, for which I had a contract from a top publishing company, and if I stayed in my administrative role, I would definitely fail to attain tenure - an important warning and a Iesson I listened to very carefully. It prompted me to give up the book, resign from my administrative role and re-invest my time in my women’s health research program. It was imperative and timely to put in a request for sabbatical leave, for which I was approved. I chose to go to Kuwait during my sabbatical, to continue with my research program by listening to more women’s stories.

Within a year of returning from sabbatical, with renewed energy for my research program, I was actively pursued and recruited for another administrative role, this time for a deanship in Kuwait. Because of our family goals to provide opportunities for global experiences for our 5 and 7-year-old sons, my husband and I accepted to take leaves of absence from our employers, UCSF and Bechtel Corp., so I could accept this new leadership position – yet another opportunity I did not seek nor prepare for. It turned out to be an instrumental position for cultivating my global voice and gaining more insights into global health and women’s issues. In that new role, I led multinational faculty, developed curricula, dealt with multisector organizations, promoted research agendas, listened to women’s stories of trials and tribulations and resilience and transformation and traveled to some 10 countries in the Middle East and Europe – all packed into a two year deanship appointment. 

When I returned to UCSF, I was adamant about declining every deanship and/or administrative role that came my way, and opted to focus on teaching and research and on having a voice that represented the faculty and the academic mission of our university. I did that through leadership roles with the University of California’s strong Academic Senate. I chaired system-wide academic personnel committees, listened to women faculty and students and became one of the thunderous voices for promoting equity and justice for women faculty and minorities. I testified in front of California legislators about inequity in promotions and financial compensations for women in the University of California system and about the limited resources available to support the multiple demands on their energy and time. I absorbed new skills concerning where and how to exercise my voice, and where and when to ask for policy changes. I also learned a great deal about legislative processes that drive change.   

Another milestone that was serendipitous and contributed to making my scholarly voice more impactful – I created and taught a series of three new theory, philosophy and epistemology courses for Ph.D. students. I was thoroughly invested in and enjoyed these full year courses of learning and teaching. I was settling back in, doing what I love, research and teaching. And one day, a vice president of a top publishing house for health professional education walked into my office and asked me to put those courses in a book, as he heard about my innovative theory/philosophy courses everywhere he went, nationally and internationally. Reluctantly, I agreed and I wrote the textbook, which provided approaches to viewing and studying theories and strategies for developing them by using my unique analyses. The book reflected a very different voice with regard to our discipline, about the theoretical foundation of nursing, and it provided frameworks that considered how nurses make major differences in people’s lives. I honored our discipline’s history in theory development through new approaches to viewing nursing scholarship.

This book, written from a feminist, post colonialist perspective, was used by almost every graduate program, nationally and globally. It provided more visibility for my voice and for the hundreds of journal articles I previously published. It made my ideas more accessible, and interestingly, more accepted and relevant. It expanded my scholarly voice in nursing circles globally and contributed to dialogues and deliberations about nurses as women between international organizations (such as WHO, ICN and the UN).

Another important milestone was the proactive role I played in the only organization, at the time, focused on research and practice in global women’s health issues. I became president of this organization and we held conferences all over the world, which brought clinicians, researchers, policy makers and the public together to dialogue about global women’s health issues. This organization allowed me to develop even more global relationships, investing in multidisciplinary connections with scholars and clinicians and empowering them to influence their governments to devote more attention to women’s health issues, beyond reproductive health. This organization was another platform for my voice.

With dedicated listening to women and nurses’ experiences and global relationships forged through various positions, I developed more leadership skills and increased my ability to take risks by getting out of my comfort zone, allowing me to accept the challenges in formal leadership positions, such as the deanship of The University of Pennsylvania’s School of Nursing. However, one skill I still needed to develop once accepting that position was fundraising for a private university. This was another role/skill falling totally outside of my comfort zone. This deanship position gave me the platform to not only master fundraising, but also to thoroughly embrace and enjoy it.

After reviewing this narrative, I would say the following more accurately describes my leadership trajectory. I have been a lifelong learner and listener and a reluctant adopter of formal leadership roles, who has been privileged to take advantage of and accept many serendipitous positions and opportunities. I definitely lived a life outside of my comfort zones - leaving my home and my family in Alexandria at the age of 20, becoming a citizen of a country I grew to love and immersing myself in a discipline I am proud to be a member of. I hope I made some difference and that I will continue to make an impact, however miniscule it is compared to the needs that exist for insuring justice, equity and valuation for women and nurses.

Lessons Learned From a Global Pandemic

As the world emerges from the grip of a pandemic that created so much suffering through lost lives, long-term illnesses and economic devastation, we must pause and reflect on lessons learned to inform the future. Here are a several takeaways I believe should shepherd future plans. 

• For any globalization and interconnectedness skeptics, we are a global community. What happens in one corner of the world effects everyone else, locally and globally. Nurses always have been a global force, working across nations. They can lead the planning for disasters.

• We were not ready to deal with the spread of the virus, nor to deal with its devastating effects on patients, families and communities. We did not have enough masks for the public, personal protective equipment (PPE) for health professionals, ventilators in our ICUs for patients or disaster plans in place for implementation. Can we do better in the future? Yes! Only if implementation plans are made, rehearsed, periodically modified and tested. 

• In every society, the vulnerable and the marginalized became more vulnerable and more marginalized. Note the higher percentage of illness and death among the elderly, the vaccination rate disparities between the majorities and the minorities, the rate of infection variabilities among different ethnic groups and the inability of the poor and frontline workers to shelter at home and to use distancing in their own communities. We saw how women suffered as caregivers, trying to hold jobs while monitoring their children’s education from home. Women were among those affected the most, and many either gave up their employment or significantly curtailed their careers. Systemic inequities must be addressed continuously. 

• We learned that partnerships and collaborations are vital for implementing viable prevention protocols, as well as for research to develop and produce vaccines. Competitive drug companies teamed together, countries collaborated to deal with border and sheltering policies and health care professionals saw the positive outcomes of working in egalitarian teams. Collaborations between countries were vital in the battle to decrease Covid’s spread. Partnerships and collaborations must be developed and fostered in education programs, as well as in health care organizations. Investments in interprofessional education and interdisciplinary research should become the norm. 

• We learned about different modes of communication, and that working, teaching and doing research remotely were possible. Zooming became a viable option and part of our lexicon. But again, disparities manifested, as students with limited Wi-Fi access could not connect, profoundly affecting their learning. The elderly, who were not computer literate, could not schedule or get to their health care appointments or vaccination sites. Creative solutions are needed to ensure access equity. 

Furthermore, I believe the pandemic amplified many take home messages for nurses:

• It became even more apparent that without the 24-hour care nurses provide, hospitals were not able to admit, care for and heal patients. Beds were closed and ICUs did not admit patients. The pandemic highlighted the severe global shortage of nurses. While the WHO’s 2020 State of the World’s Nursing Report presented compelling data on global shortages and highlighted the need for more nurses with higher education and more nurses in leadership roles, it took a global pandemic to make this data real. Because there was a shortage of nursing care, nurses traveled across the country to help in hospitals that lacked needed staff, ICUs closed beds and patients were sent home prematurely.

• Nurses’ creativity and innovation shined globally in the face of uncertainty about the virus and treatment. Nurses found ways to incorporate families in spite of mandated quarantine and isolation. To support their patients, they used virtual applications to ensure families were connected and able to support their loved ones and able to say goodbyes when patients were near death. Nurses celebrated weddings and birthdays, combining knowledge about social support and meaning of life with evidence about infection control and palliative care, all while providing compassionate care that was much needed in life and death situations. 

• Another important lesson was the incredible professional commitment of nurses to their patients. Nurses, physicians and other health care and frontline providers continued to fulfill their professional roles and never faltered in providing care at the expense of their own health and their families’ health. Many opted to stay in hotels, away from home, to protect their families while providing care to their Covid patients. Nurses are stoic, professional and loyal to the principles and values of our profession. They are creative and resilient.

• We learned that when policies are not protective of nurses - when there are compromised staffing levels and a scarcity of PPE to protect them - that nurses’ mental health is profoundly affected. Nurses care about their patients’ physical and psychological safety and health. Therefore, when patients suffered because of the lack of ventilators and the inability of families to visit, patients’ suffering was also nurses’ suffering, leading to mental meltdowns on top of the physical exhaustion they experienced.  

• The pandemic triggered educational changes that closed universities and opened up distance learning. This left faculty with quandaries as to how to provide virtual clinical rotations. The different experiences and responses to these major changes and their effect on graduating nurses who can safely transition into employment need to be carefully studied and warrant thoughtful planning for the future. Similarly, future research protocols also may require anticipation of unanticipated disruptions. 

The above are just some of the lessons that should inform planning and decision-making in preparing for a future in which other major disruptions may occur. 

CELEBRATING NURSES IN 2021

In 1961, I graduated from the University of Alexandria in Egypt and became a nurse. I never stopped being proud that I chose this profession. The month of May is a reminder to celebrate nurses and the discipline of nursing. Before I share my thoughts about what we are celebrating, and while we are beginning to see some rays of hope in some parts of the world about the containment of the Covid-19 global pandemic, we must pause to remember the millions affected, as well as the millions we lost.

I hope each one of us reflects on what you have and what you gleaned from living through and coping with Covid-19 during this prolonged period of the pandemic and in its aftermath. And, also reflect on what and why you are celebrating.

Here is what I believe we are celebrating today.

We celebrate today the many scientists from many parts of the world who collaborated in developing the vaccines that give us hope that we may reopen borders, schools and businesses.

We celebrate today the evidence nurse scientists developed, allowing ICU nurses to better manage lung functions for patients by proning them and the evidence based palliative models of care that helped patients die with dignity.

We celebrate today the WHO’s publication of the first world report about nursing, which provides robust global data and recommendations that should be used as a blueprint for the nursing workforce for years to come.

We celebrate today that 2020 and 2021 were designated the years of the nurse and midwife by the WHO, ICN and many other organizations. That is also a first in global nursing.

We celebrate today that the world now knows what we always knew, that nurses are the heart and soul of health care systems. The severe shortage of nurses globally and the closure of ICU beds that were much needed for Covid-19 victims was due to the fact that were not enough nurses or that there were not enough educated or qualified nurses to care for patients. This is reminding ministries and universities to increase the numbers of well-prepared advanced practice nurses. We already see the outcomes through increasing applications and admissions to schools of nursing.

We celebrate today you, wherever you are, frontline nurses for your dedication, commitment and professionalism in using evidence-based science to manage pain, ventilation, difficulties in daily life activities, discomfort, loneliness and the emotional support needs of patients infected with Covid-19.

We celebrate today frontline nurses everywhere for their compassion in caring for families who could not be with loved ones, and for their vital role in supporting their patients’ admission, discharge and end of life transitions. We celebrate them knowing that, in spite of their passion and nursing education, they too suffered from anxiety and faced many risks to their wellbeing and their families’ wellbeing. But, they demonstrated grit, resilience and creativity in a time of uncertainty.

We celebrate today nursing educators for how quickly they pivoted to using new innovative strategies, some they had to invent. They ensured their nursing students continued to receive quality education and to graduate, learning essential theoretical and clinical knowledge that prepared them to provide safe, quality care.

We celebrate today nurse scientists for continuing their programs of research with human subjects in spite of many restrictions and many precautions. They created new strategies and goals to insure science productivity continued because of their strong belief in the importance of advancing the needed evidence that translated into impactful, quality care.

We celebrate today hospital administrators who reorganized with warp speed to accommodate, heal and care for an unknown virus for which there were no known treatments. We celebrate their staff for creatively developing new protocols and routines.

We celebrate today health care teams that put the care of patients above mediocre paternalistic and hierarchal teams. We celebrate the new global emphasis on interprofessional education and interdisciplinary, equitable teams that place more emphasis on addressing the needs of patients and their care and less emphasis on the needs of team members. 

We celebrate today organizational leaders who realized health care policies must be informed by nurses’ wisdom, knowledge, expertise and voices. We celebrate them for their inclusiveness of nurse leaders in all decision-making bodies.

We celebrate today nurses’ strong advocacy voices for better policies to create and safeguard equitable working environments for nurses.

We celebrate today nurses who use theory to guide their practice, who are able to articulate the paradigms that drive their assessment of patients and the framing of the interventions they give. 

We celebrate today nurses who are mothers and fathers whose professional commitment and moral compass drove them to continue to care for Covid-19 patients in spite of the limited resources and treatments, and fear of infections for themselves and their families. This commitment has been at the expense of their psychological and physical wellbeing.

Lots that cause us to celebrate - but, celebrations are only a short stop for reflection. We nurses and midwives must continue in the long journey toward insuring access to quality care for the most vulnerable populations and insuring a healthy and equitable environment in health care for providers and recipients of care.

I am so proud to be a nurse.

Based on speeches given in Pakistan, Switzerland and Portugal.

 

Commentary on 2020 and 2021, Years of the Nurse and Midwife

From: Meleis, A.I. (2021). Commentary on 2020 and 2021 Years of the Nurse and Midwife. Nursing School of Coimbra (Ed.) Education and Interprofessional Work in Health, (p. 11-15).

In an unprecedented action, WHO declared 2020 the year of the Nurse and Midwife, and indeed it was an incredible year!

The COVID-19 Pandemic ravaged the world, causing many sorrows and much grief. It challenged health care services and health care delivery. But, it also shed an incredible light on the centrality of nurses’ roles in all aspects of the pandemic, from prevention, to diagnosis, to treatment, to healing, to managing the end of life transition. While nurses have always been at the center of health care, and in many ways have always played significant roles in health care, the global visibility and the challenges associated with the uncertainty of a new pandemic highlighted nurses’ caring and healing roles. Nurses’ knowledge, practice, voice, advocacy and caring shined.

Two other aspects of nursing practice became very apparent. One is qualitative and the other is quantitative. The severe shortage of nurses, which has been well known and much discussed, in the face of the heightened needs for expert caring in hospitals and in intensive care units, put a face on these shortages. The second highlighted aspect about nurses was the central roles they played in palliative care and in the end of life process. Due to isolation because of COVID-19 contagiousness, families could not be with patients during end of life care. But nurses were there to virtually connect their patients with families and to provide evidence-based quality care to patients during their last hours. They provided family care as well, which was virtually delivered. Telehealth acquired a different meaning and importance during this pandemic. Bravo nurses!

Policy makers saw firsthand how the shortages of nurses devastated health care delivery systems and how nurses’ expertise in family health and end of life was instrumental to provided care. What nurse leaders have always discussed and highlighted for policy makers became a tangible reality.

WHO made another unprecedented decision - to declare the continuation of the year of the nurse and midwife through 2021. Now it is imperative to take full advantage of the visibility of nurses’ roles and science in global health, as well as the declaration of WHO, to press on toward universal health policies, to insure equitable and quality health care.

Two particular areas that could benefit from the timing, the context and the touch needed for quality care are, first, nurses’ educational opportunities, and second, nurses’ leadership roles in health care policies.

Building on the platform and the goals of Nursing Now recommendations and strategic goals, which are endorsed globally, countries must provide university education for nurses that prepare them to deliver evidence-based models of care. Portugal must promptly move all educational programs for nursing to universities. Countries are expected to insure that nurses are well prepared for leadership roles and that health care policy bodies include nurses’ voices. Nurses should be expected and allowed to work up to their full capacity, and their scope of practice should be congruent with their educational levels. Nurses should be well positioned to influence health care policies globally.

I wish for my Portuguese nursing colleagues a year of leadership marked by actions, beginning with the inclusion of all nursing schools within the halls of universities as full partners and with the appointment of nurses to every policy making body in the country.

The year 2021 should be an action year for nurses who are very well positioned to use nursing knowledge in the development of the best care models and policies that will enhance the quality of care.

References

Meleis, A.I. (2021). Commentary on 2020 and 2021 Years of the Nurse and Midwife. Nursing School of Coimbra (Ed.) Education and Interprofessional Work in Health, (p. 11-15).

Nursing Now: https://www.nursingnow.org/

WHO. (2020). State of the World’s Nursing 2020: Investing in Education, Jobs and Leadership: https://www.who.int/publications/i/item/9789240003279