Nurses play a pivotal role in quality and safety, but chief quality leaders are often physicians. Petrina McGrath, RN, is an exception. Petrina, who is teaching in IHI’s upcoming professional development program, Chief Quality Officer, is the Executive Transition Lead for People, Practice, and Quality for the Saskatchewan Health Authority. In the following post, she answered some questions about how she got started in quality leadership, and offers advice to aspiring nurse leaders.
When you started out in nursing, did you aspire to a senior leadership position?
I didn’t aspire to a specific position. But I always wanted to be involved in improving things for patients and families, and also for myself and colleagues who were providing care. Throughout my career, I’ve asked myself, “If I take on this role or get involved in this project, how will it enable me to have an impact on improving the patient/family experience? Will this opportunity challenge me to learn and grow?” This mindset has helped me build a different skillset, and being open to new opportunities has led to several senior leadership roles.
Were there nurse leaders you looked up to as role models?
When I was working as a RN, our chief nursing officer led a new strategy called patient-centered care, and she created opportunities for staff nurses to be involved in shaping this work. I learned so much from her about challenging the status quo and seeking out the patient’s perspective. She helped me see how paternalism was so embedded in the health care system. She also challenged me to do things every day to seek the patient’s perspective, build their daily plan with them, and have them evaluate my care. She hired me in my first role away from the bedside. Working directly with her, I was always fascinated by how she never told you what to do when you had a challenge. She always knew that you had the answer within you and coached you to find it. She helped me hone so many of the skills that have helped me in my leadership practice.
Later on, the chief nurse executive hired me into my first director role. She was an amazing rebel of a leader. She really modeled the courage to lead for what you believe in, and to create supportive tension in the system if you want it to make progress for patients and families.
Looking back, what was the key moment (or moments) in your career that led you to your current position?
Early on in my career, I was in my first leadership role in oncology, and I ran into a nursing leader who invited me to get involved in a working group looking at radioactive iodine treatment for cancer patients. I was humbled and a little overwhelmed by the opportunity, but agreed to do it. I arrived to realize I was the only nurse on the group. I offered to take the lead in understanding the patient experience, only to realize we had very little knowledge of it. A nursing leader encouraged me to advocate for a study to be done to ensure that the patient’s experience was part of this work. I ended up being granted $24,000 to do a national qualitative study. I learned you never know where an opportunity will lead you, and to trust in yourself. You may not know the answer, but if you know how to build partnerships and ask for help, you can do more than you ever imagined, and that keeping the patient’s voice front and center is critical in everything you do in health care.
When I started in the director of nursing role, I had to lead many managers and educators who had much more years of clinical experience and administrative experience than I had. At this point, I really realized that success was not about my clinical expertise. It was about my use of self, my ability to engage others and develop leaders, and to support the staff and physicians at the point of care who held the expertise. This realization led me to focus on my leadership practice and took me in the direction of doing a PhD in human and organizational systems.
What do you do in your current role, and how do you think your nursing background informs your work?
For the past six years, I have been the Vice President of People, Practice, & Quality in a large integrated health system in Canada. So I provide strategic leadership for professional practices, quality, and people development (HR). A large part of the role is to lead quality and safety strategy across the organization.
My nursing background has given me a strong connection to the point of care. This is where value for patients and families is created. I think my nursing experience has really helped me appreciate what different team members bring to the delivery of care at each level of an organization. Nursing has given me a lot of opportunities to work with patients and families in every role I am in, and I expect to be challenged to do better by patients and their families. I know that nothing changes for patients and families in our health system unless something tactically changes at the point of care delivery.
What have you learned about how nurses can work effectively with physicians on quality and safety?
It’s important to always start with your common purpose, which is patient care. So often, we make assumptions about what other professions do or believe, and I’ve learned to try to understand what it’s like to walk in each other’s shoes. There are so many unseen things that impact the work of caregivers, and if we can make that visible it helps to align us in our pursuit of excellence. I love the ability to make work visual and to do small tests of change that help individuals and teams gain a greater understanding of their work, challenge assumptions, and develop as a team.
What would your advice be to aspiring or current nurse leaders on how they can be effective leaders in quality and safety?
Learn how to use a quality improvement methodology such as PDSA cycles. Learning happens through doing, so use PDSA in your daily practice. It can be with a team, but it can also be in your own leadership practice.
Lead from wherever you stand in an organization. Get involved. Leadership is a practice, just like when you were in your clinical practice, so you always need to learn and grow.
Learning is uncomfortable, so if you want to grow as a leader in quality and safety you need to put yourself in an uncomfortable zone. Challenge your own assumptions and be able learn rapidly through tests of change. This is practice that can be used at any level of leadership.
Finally, pay it forward. Support and coach other aspiring nurses. Teaching and coaching others requires you to learn more deeply and helps build a strong profession.
Editor’s note: This interview has been edited for length and clarity.