Angelleen Peters-Lewis is Care New England’s senior vice president and chief nursing officer, a new position at CNE. Earlier, she served as senior vice president for patient care services and chief nursing officer at Women & Infants Hospital.
After earning her master's degree from Northeastern University and her doctorate in nursing from Boston College, where she graduated with distinction, Peters-Lewis completed post-doctoral education at the Harvard Business School and is part of the Robert Wood Johnson Foundation Executive Nurses Fellows Program.
Peters-Lewis talked with Providence Business News about her new position at CNE, the future of nursing care and nursing challenges that await CNE.
PBN: What was the rationale for CNE to establish the new position as senior vice president and chief nursing officer, and what are your key roles and responsibilities in that position?
PETERS-LEWIS: The focus of the system chief nursing officer is to build on the tradition of excellence at CNE by creating a partnership to design innovative health care delivery models that are safe, efficient, cost-effective, coordinated and advance a culture of health. Our goal is to promote health equity for all patients and families and ensure that the recommendations of the national strategic plan for nursing are fully implemented. This will create one standard for nursing practice excellence across all CNE entities and ensure that nurses are well-positioned to assume leadership roles in designing, implementing and measuring CNE’s innovative health care delivery models. This also establishes a climate in which new knowledge is generated and used for patient care locally, nationally and globally.
The nation has recognized the pivotal role nurses hold in the new health care environment and in accomplishing the goal of advancing a culture of health. As the system chief nurse, I am responsible for ensuring that we are well-positioned, engaged and fully prepared to advance this important work. This is essential for the continued success of our system and the health of the patients and families who trust us with their care.
PBN: Nursing school enrollments are not growing at a rate that keeps pace with the projected demands for both registered nurses and advanced practice nurses. What are the reasons for that and what can be done to address the problem?
PETERS-LEWIS: Nursing school enrollments are stagnant while the average age of nurses continues to increase – that’s a huge concern in Rhode Island and potentially leaves us without an adequate supply of nurses to care for patients and families. In the short term, we need to identify funding and develop educational programs that are accessible and affordable to support nurses in pursuing advanced degrees. Also, health care and educational institutions need to continue to develop partnerships that facilitate the development of clinical experts who also may serve as faculty members. In many areas of the country, newer educational curricula, such as accelerated second baccalaureate degree programs, encourages individuals to pursue a bachelor of science in nursing degree. These programs prepare individuals within a 14-17-month period to work in professional nursing practice. These programs should dramatically increase the number of nurses and limit the projected shortage in many areas of the country, including Rhode Island.
Having nurses achieve higher levels of education can help us meet the projected demands for registered nurses. It is one of the primary goals of the national strategic plan that 80 percent of our nursing workforce has, at a minimum, a BSN degree. Currently, significant faculty shortages limit student capacity at schools and nursing colleges across the country. The factors that contribute to the faculty shortage include aging faculty, budgetary constraints and inadequate supply of nurses with advanced degrees as well as job competition at clinical sites with significantly higher wages.
PBN: How has your post-doctoral education at Harvard Business School and your participation in the Robert Wood Johnson Foundation Executive Nurse Fellows Program informed your leadership and responsibilities at CNE?
PETERS-LEWIS: Both leadership development programs have been instrumental in helping me transform from a nurse leader to a health care executive with responsibility for influencing and shaping the design of a system to ensure that everyone has access to care that is equitable, safe and efficient. My academic preparation and experience working in a variety of health care settings certainly influence my perspective as a leader. My responsibility, however, is broader than my own discipline or patient care; it requires I use this knowledge to collaborate with others to redesign health care and build a culture of health. This concept of transformation is promoted at both the Harvard Business School and the Robert Wood Johnson Foundation through intense development in the areas of personal leadership, leading teams, leadership across the boundaries of my own clinical discipline and organizations, leading locally and nationally and developing and influencing health care policies.
The knowledge and skills obtained from these exceptional leadership programs prepared me well for my role as system chief nursing officer. As health care evolves and the needs of patients and families become more dynamic and complex, it is essential that the delivery of health care occurs within the context of an inter-professional team. Given my current role, the chief medical quality officer and I spend a significant amount of time role-modeling true collaboration and building effective teams to care for patients and families. Redesigning health care requires the ability to leverage the expertise and talents of all members of the health care team, working across boundaries of nursing to build partnerships and programs that ultimately benefit patients, families and communities.
PBN: You’ve testified at the Statehouse on public policy issues around nurse staffing ratios, the use of traveling nurses and the changing role of nurses. What are your views on each of these issues, and why do you think it’s important to lend your voice to these debates?
PETERS-LEWIS: Nurse staffing and the use of traveling nurses are not legislative issues; they are quality issues. Nursing is a profession with the primary role of providing quality care and, in this new health care environment, at a reduced cost. Numerous studies agree that appropriate staffing improves patient outcomes, although no study has determined an exact staffing ratio that works for every patient, in every care setting, at all times.
The CNE leadership team believes appropriate and consistent staffing is essential for patients and families to receive quality care. Further, decisions about nursing care should be decided at the point of care by teams who are the experts on the needs of the patients and families. The literature also suggests there are other factors, including education, work environments, team supports as well as relationships, that improve patient care and outcomes. We are working with our staff to develop a professional practice environment for nurses that addresses these important issues with the goal of improving the work environment.
PBN: Given the shortages of nurses, what are the primary challenges and opportunities facing you at CNE in the next six months, and how will you address them?
PETERS-LEWIS: CNE does not currently have a shortage of nurses, and the average tenure of our nurses is at least 10 years. We do, however, face key challenges going forward. The ideal scenario is to maintain a multigenerational workforce to ensure that experienced nurses are available to care for patients and families when their colleagues retire. Both a stagnant economy and the mandates of health care reform have prevented health care systems across the country from being able to implement the ideal recruitment strategy. The economy has limited the number of nurses retiring while we must address simultaneously the mandates of health care reform. The mandates also require that CNE work toward decreasing the number of patients who receive care in hospitals – a shift toward community-based care and population health. This has resulted in a decrease in the overall size of the workforce in hospitals and the emergence of nursing roles in nontraditional settings, such as with the Visiting Nurse Association of CNE.
As the health care industry continues to become more dynamic and complex, it becomes increasingly difficult to prepare new nurses to practice independently. As the economy recovers, we anticipate that large numbers of nurses will take the opportunity to retire, and this will lead to vacancies in specialty areas – such as surgical services, emergency departments and critical care – that have traditionally employed experienced, long-tenured nurses. CNE has begun to develop fellowship programs to support new nurses in these key specialty areas.