The Interview: Boston Children's Hospital Associate CNO Patricia A. Hickey

Internationally renowned nurse researcher Patricia Hickey says healthy work environments improve care delivery and patient outcomes.

This article appears in the January/February 2019 edition of HealthLeaders magazine.

It can be downright exhausting to be a healthcare leader. The healthcare industry continues to be turbulent, and healthcare executives are constantly trying to manage the ramifications of mergers and acquisitions, work with the changing reimbursement models, and implement value-based care requirements for their hospitals and health systems.

But Patricia A. Hickey, PhD, MBA, RN, NEA-BC, FAAN, vice president and associate chief nursing officer, cardiovascular and critical care patient services at Boston Children’s Hospital and assistant professor of pediatrics at Harvard Medical School, thinks about the current healthcare environment as a place of opportunity.

"I think this is an incredibly exciting time for all of us in nursing leadership," she says.

Why does Hickey see it that way?

While she is a pediatric nurse, her career achievements transcend any single specialty. She is internationally known for her research and work in leadership development, care delivery innovation, patient safety, and bridging nursing practice and health policy. Some of her research examines the nursing and organizational factors associated with pediatric patient outcomes and the health of the work environment.

For Hickey, healthy work environments and supporting nurses are foundational to achieving organizational goals and strategy.

In recognition of her body of work, the American Association of Critical-Care Nurses has named Hickey its 2019 Distinguished Research Lecturer.

Hickey shares her perspective about areas in nursing that are vital for nurse leaders to grow into and to move nursing forward. Following are the highlights of Hickey’s recent conversation with HealthLeaders.

"Innovation in healthcare delivery, understanding employee well-being, and taking care of our teams across the continuum of care are key priorities for leaders. [But] as important as healthcare delivery innovation is, a big part of leadership is understanding employee well-being, and taking care of the frontline staff who provide care to patients. Care complexity is increasing, and as leaders, we need to make sure that the health of the work environment is considered in all of our decisions, so we can support nurses and care teams by understanding what’s important [to them]."

"Creating and sustaining healthy work environments is an ongoing goal. We need to ensure the health of the work environment is considered in all our decisions, so that nurses and extended teams are enabled to do their best work, voice their opinions, and know that they are valued."

"The health of the work environment includes authentic leadership, true collaboration, meaningful recognition, and effective decision-making. We all benefit when frontline nurses are involved in decision-making at every level. Nurses really do have the best questions. When leaders are working through problems, the frontline staff need to be involved." 

"Our practice environments must be a place where leaders support [one another] and staff are supported in their delivery of the highest quality of care. Today’s practice areas are challenged by a multitude of competing demands and patient care complexities. At Boston Children’s Hospital, we use the AACN Healthy Work Environment Assessment Tool and results as an important measurement to improve and sustain environments that empower staff and optimize experience for patients and families."

"Through serial studies over the last 12 years, we have examined nursing and organizational characteristics and their impact on patient outcomes, including mortality and complications for pediatric patients. The most recent findings show, for the first time in adult or pediatric research, that AACN Specialty Certification is correlated with reduced complications for postoperative surgical patients. Our research findings over the last decade have also revealed that levels of nursing education and experience are significantly associated with improved patient outcomes across critical care units in the United States."

"At Boston Children’s Hospital, we developed a nurse education and support team to empower critical care nurses when they feel challenged with an ethical or complex dilemma. They can receive support, mentorship, and practical tools from an experienced cardiovascular or critical care nurse. The key component of the approach is when a nurse is feeling challenged at the bedside, he or she can call a number, and an experienced critical care nurse will come to the bedside and offer real-time coaching. It is peer-to-peer support. They know the coach has walked in their shoes."

"Leaders should be able to articulate the value of nursing and help nurses articulate professional practice, whether that be with each other or to influence public policy. Nurses are key to helping patients, families, and the general public understand and navigate what is becoming an increasingly complex healthcare system. Sharing and effectively communicating a collective vision for the future and supporting staff in achieving personal and professional goals is always important."