Fellowship Providing Vital Support for Nursing Leaders

As she spoke to nurse managers from Rwanda, Liberia and Haiti, Dr. Lynda Tyer-Viola—a longtime nurse manager in Texas—cited a daily situation that’s true for medical professionals anywhere. 

“The everyday minutiae sucks all the air out of the room,” she said, referring to the flood of unexpected, urgent tasks that arise in busy hospital environments. Such tasks often detract from larger projects or duties, Tyer-Viola said, and can change whatever plans managers thought they had for their day.

Heads nodded around the table. Multitasking work situations were very familiar to Angeline Charles, operating room nurse manager at the Hôpital Universitaire de Mirebalais (HUM) in Haïti; Emmanuel Dushimimana, director of nursing and midwifery at Butaro District Hospital in Rwanda; and Viola Karanja, director of nursing for Partners In Health (PIH) in Liberia.

Also part of the group, but not present on that November day in Boston, is Graciela Cadet, nurse manager in HUM’s intensive care unit. Together, the four rising stars are PIH’s first Nightingale Fellows. The new, yearlong fellowship program began in May and includes online instruction and webinars, monthly conference calls, mentorship from veteran nursing leaders such as Tyer-Viola, and an individual leadership project that each fellow will complete at their site.

“Nurses often are placed into leadership positions without being given the skills or support that’s needed to be successful,” said Cory McMahon, PIH director of nursing. 

One such skill is how to manage all of those unexpected tasks. 

Tyer-Viola told the small group of fellows that, simply put, they need to delegate. As assistant vice president of nursing for women’s services at Texas Children’s Hospital in Houston, with a nursing doctorate from Boston College, she knows a thing or two about how to avoid getting overwhelmed. 

“As leaders, you have to learn when to push yourself away from that, and step away, with trust that others will handle the minutiae appropriately,” Tyer-Viola said. “Don’t cut your long-term goals short—because that’s actually what you’re measured by, in the long run.” 

PIH designed its Nightingale Fellowship for nurses in senior or executive leadership positions, to provide support and training, and ultimately improve patient care. The program focuses on critical analysis, health information systems, strengthening health systems, performance monitoring, evaluation and supervision, quality assurance, resources management, and customer relations.

Karanja said sharing common challenges with nursing leaders at other PIH sites has been incredibly beneficial. 

“We’ve learned quite a lot about different experiences through one another,” said Karanja, who has more than 20 years in nursing and worked in South Africa, Kenya and South Sudan before joining PIH in 2015. She’s focusing on improving maternal and child health in Liberia. 

Dushimimana also said the program is fostering new connections among the fellows, who were strangers to each other before meeting last May. 

“Now, we are exchanging ideas everywhere,” he said, listing WhatsApp and email as long-term communication channels.

Dushimimana said his individual project for the fellowship, “will target the education of new pediatric cancer patients, who usually don’t know a lot about cancer or chemotherapy.”

A lack of knowledge about treatment can stop some parents from bringing their children to chemotherapy at Butaro District Hospital in Rwanda, he said, “because they see the child not improving (right away) and they think that means the prognosis is bad.”

In her native Haiti, Charles has worked her way into management with Zanmi Lasante, as PIH is known there. She began as an operating room scrub nurse in 2010, and became operating room nurse manager in 2013. She hopes to continue growing as a leader in the medical field, where she already has gained wide recognition. 

“Ms. Charles is truly a surgical nurse expert in all things related to the operating theater, from patient care to surgical practice, scheduling, operating room (OR) management, supplies and essential medicines, and more,” McMahon said. “The OR is a place where there is little room for error, and so maintaining appropriate ‘stuff, staff, space, and systems’— to use a popular PIH description of essential needs—is critical, and Ms. Charles is really the lead in this.” 

McMahon said Charles soon will travel to Liberia to help expand and improve OR operations and surgical care at J.J. Dossen Hospital in Maryland County. The trip arose through Charles’ relationship with Karanja during the fellowship program. 

“I would like to become a strong leader with a large vision and become an agent of change of an organization or a country, able to influence a group and lead them in the right direction,” Charles said. 

Her individual project aims to reduce infections after surgeries at HUM. 

Also at HUM, Cadet hopes to use her project to improve doctors’ performance and patients’ outcomes. 

“I really like the fact that I will be able to participate in the decision-making of my institution, to promote best practice in nursing and provide direction,” Cadet said. “My country really needs young dynamic professionals with those advanced skills in order to improve the Haitian health system.”

Developing young professionals is a key goal of the fellowship, and starting in 2018, the program will merge with an institution that’s doing just that: the University of Global Health Equity, a PIH initiative in Rwanda. The university will support the fellowship beginning with next year’s cohort. 

Karanja said she hopes the Nightingale Fellowship will have broad impacts on hospitals and patients for years to come. 

“I think it’s going to empower us to be better leaders,” Karanja said. “It’s a program that we would like to continue—not just for us, but for others.”