Kenneth R. White – the School’s associate dean for strategic partnerships and innovation – is the UVA Medical Center Professor of Nursing and holds joint honorary appointments at the Darden School of Business and the McIntire School of Commerce. A veteran hospital administrator and the former Sentara Healthcare Professor in the Department of Health Administration at VCU School of Allied Health Professions, White studies palliative care, healthcare executive leadership, clinical and organizational outcomes of healthcare organizations, and the future of U.S. Catholic hospitals.
He sat down at his home in Afton to answer questions about himself, his scholarship and the forces that drew him to nursing.
Q: Talk about what brought you to nursing in the first place.
I grew up in a small town in northeastern Oklahoma, and in 8th or 9th grade, I attended a medical explorer’s post where the local hospital administrator was the post leader. I was always good in science, and at this post – sort of like an internship -- I heard a lot about the different health professions. That was my first taste.
By 15, I was a junior volunteer at a hospital where it was my job to transport patients to get X-rays. I washed wheelchairs and gurneys, and by 16, I was an orderly, full-time. I took care of many of the male patients, did the heavy lifting -- that was my junior and senior year in high school – and by then I’d fallen in love with the hospital environment.
My early taste of nursing really speaks to how critical it is to reach out not just to prospective college-age students but also well before that – when students are in high school. That was certainly the case with me.
After graduating from high school, I attended a diploma nursing program which closed after the first year so I then transferred to a four-year college where I majored in biology. I worked as an ER tech throughout college – dealing with orthopedic emergencies – and became very good at applying plaster casts for broken bones. I thought about med school, or going to school for pharmacy, or something in the health professions, but kept coming back to nursing.
Someone told me about hospital administration, and so I went to the University of Oklahoma and earned a master’s degree in that. From there, I took a job at Mercy Health Center in Oklahoma City, where I’d done my administrative residency, then moved to Ft. Worth, Texas, to become vice president of operations and then was recruited back to Oklahoma where I became vice president for business development and marketing. I then transitioned to Mercy International, at Mercy’s corporate office in Detroit, and was assigned to Guam for four years as the CEO of their hospital – but in the back of my mind, planned for a long time to go back to school for nursing.
I started out wanting to be a nurse -- I said that to Janet Younger, a UVa alumna and one of my mentors at VCU who made it possible for me to enter nursing school as an accelerated, second-degree student while I earned my PhD in health services organization and research.
Q: Were there people in your family who worked in health care?
My grandmother, with whom I was very close, dropped out of school in 8th grade. She was born in Arkansas in 1898, and nursing was not an option for her. She needed to earn a living for her family and she took a job as a cook and nursemaid to the children of a wealthy family in my hometown of Okmulgee, Oklahoma. She always said that if she’d had the opportunity, she would have been a nurse. Incidentally, in the 1920 U.S. Census, nurses were listed as “domestic servants.” Although she was a domestic servant, nursing was in her blood. She was one of my earliest role models, and was a remarkable person.
But no, no one else was a nurse or doctor in my family. I think I was just always interested in helping people, alleviating their suffering, making them comfortable and making things better for them. People would sometimes say to me that, when someone was in pain, or sad, or suffering that they “didn’t know what to do, didn’t know what to say,” and somehow I’ve always known how to act, what to do, what to say, and never felt uncomfortable with that.
I feel drawn to people who are sick; I think of them as underdogs in many ways, which is often the way I think of people who are most vulnerable -- especially people who are dying.
Q: Talk about that a little, your keen interest in palliative care. Where does that come from?
Throughout my adolescence, I had a folder I marked DEATH – I had a kind of fascination or intrigue with it, as some teenage boys do – and in that folder I’d collected poems, articles, paintings, little tidbits information and LOTS of Emily Dickinson. I knew a lot of patients, family and friends who’d died, and it was impactful. It wasn’t morbid to me: it was pure curiosity.
It made me realize early on that there is indeed a good death, that there are ways to die well. Once people are in the health care system, if they don’t have choices, they may not know that there’s another way. There’s no reason in this day and age that people should suffer in ways that they do – in pain, having shortness of breath, being so fatigued they can’t move. People put so much faith in what their doctors say and do that they believe there’s always a medical answer for everything. But that isn’t always the case.
In the early days when I was a nurse, you weren’t allowed to talk to patients about death, about their illness, even if you knew with every certainty that whatever it was would ultimately claim their life. It was simply unheard of.
But patients need to have information on which to make an informed decision about their life-limiting disease or condition – and they need encouragement to realize that. We often do to the patient what we think is best – but really, ours should be a patient-centered health care system. That means that they’re in the driver’s, rather than the passenger’s seat, in the best of situations.
Q: At UVA, we talk a lot about interprofessional work between physicians and nurses, and why it’s critical to our nurses’ success. You take IPE a step further, though, by insisting that nursing students should practice interprofessional skills with administrators, too, in order to understand that perspective.
It’s true. When we talk about IPE, and medical and nursing students, we need to include health care administrators in the mix too, because they’re the decision-makers about the resources. They think they know about patients, and the patient’s experience, but most health care administrators and the health administration educational programs do not focus on the patient’s perspective . That’s where nurses have to tell their stories.
Often administrators overrule nurses, and they don’t listen. But nurses need to be better at communicating too. Just saying, “We’re short-staffed, we’re tired,” may not get an administrator to move on an issue. But building a case and knowing how to speak the language of nursing’s contribution to the bottom line is a real route to change.
Good nursing improves outcomes; it saves money. If you do what’s best for your patients, you’ll get good outcomes. But nurses haven’t been very good at being able to put a price tag on what they bring to the table.
Nurses have to consider and be taught how to QUANTIFY issues: how a particular kind of care saves money, reduces infections, reduces pain and suffering, reduces the number of tests required, or the number of falls a patient experiences. The way you present that information to an administrator matters a great deal. You QUANTIFY it. You say, “if we do this, it shortens the length of stay of a patient. It frees up a bed. We avoid costly penalties.”
And too, nurses have to understand what the constraints are. Educating nurses and doctors together with administrator types makes a real difference in that regard. Remember too, that I was an administrator before I was a nurse. I really try to bridge that gap in my teaching.
You can’t just tell an administrator, “we need more staff, we are so tired, and worn out.” That’s not going to cut it. It’s useful information, but it’s not a way to quantify the importance of good nursing care. There’s a real business case for quality, safety and outcomes.
Q: Talk a bit about the role of resilience practices in nursing.
In my opinion, resilience and burnout is related to emotional intelligence – people need to know themselves first to be able to weigh in on what comes at them, if it’s something they can handle, or not. Resilience, and the need for it, will be reduced if a person is more emotionally intelligent, more self-aware, to begin with.
Some of that comes with confidence. If you project confidence in an emotionally intelligent way, one may recognize and reflect on what went well, what didn’t, learn from the experience, and move on. Keeping oneself resilient – strong, confident, assured – will not always be there, especially for nurses. We work so closely with people’s emotions – people who are hurt, angry, emotional, grieving – so the way they speak to us isn’t always necessarily the way they might normally speak to us. That goes for physicians, too. We’re all human here.
My VCU mentor Janet Younger, talked a lot about “The Theory of Mastery.” How do people who’ve survived a life-threatening disease or trauma bounce back?
People master suffering by drawing on a previous experience – they call on things like meditation, yoga, prayer, whatever – to help them get to a more peaceful place. Resilience, too, is an important part of leadership – but it’s also tied very closely to a healthy view of self and one’s ability to connect with others in an emotionally-intelligent way.