According to recent data, 20% of Washington’s Nurse Practitioner workforce will retire by 2028, and 20% of Registered Nurses will retire by 2029. As Washington prepares for this loss of knowledge, experience, and skills in the nursing workforce, WCN is creating an interview series dedicated to capturing the voices of nursing leaders preparing to leave nursing through retirement.
For this series, we sat down with Chief Nurse Officer for King County Public Health, Dorene Hersh, MN, RN. Hersh graduated from a hospital diploma program in June of 1980. As her career progressed, she continued to advance her education, receiving her BSN in 1990 and her Pediatric Nurse Practitioner degree from the UW in 2000. She has been a working nurse for 43 years and in nursing leadership at King County Public Health for the last 22 years, the last 13 years as the Chief Nurse Officer. Hersh is planning on retiring at the end of 2023. Here is what she had to share with us about her nursing journey.
WCN: Can you share with us what inspired you to choose a career in nursing?
Hersh: I grew up in a very, very small town. I wanted a job that I could use as a ticket to get out of that town. I knew if I became a nurse, I could go anywhere.
Then, in my senior year, I was working for a restaurant, and I cut myself with a knife and had to go to the ER to get stitches. That was when I got a glimpse of what nurses do. That was when I thought, wow, I could be a nurse. There were no nurses in my family. I didn’t have any experience other than wanting a ticket out of that small town.
WCN: Can you briefly share with us your journey into nursing leadership?
Hersh: I remember when I was a senior in nursing school, and graduation was coming up, and everyone wanted to work in labor and delivery. We all put our applications in at the Children’s Hospital for labor and delivery, but they didn’t take new grads; they only hired experienced nurses. So, they funneled all our applications to the neonatal intensive care unit. My friends and I all ended up there. There were around six of us, and we all worked that first job together.
Several years later, I moved to San Diego and continued working in the NICU. That was when I went back to get my bachelor’s degree. The University of San Diego was the only program that had an RN to BSN program at that time. I attended school full-time while working full-time and got my bachelor’s degree. That was in 1990. While still in the Southern California area, I relocated to Loma Linda and worked in the NICU there. It was there I began working in home care when I “followed a preemie home”, who was one of my primary patients. I fell in love with it. I left the NICU to work in home care. I worked my way up to supervisor and then to Director of Nursing of a daycare center for medically fragile children. That was my first introduction to higher levels of nursing administration.
After several years, I moved to Seattle to earn my Pediatric Nurse Practitioner Degree from the University of Washington.
I was halfway through my program at UW when I thought if I had to look in another set of ears, I will scream. It was not what I wanted at all. But I was invested in the program with both time and money. So, I finished the program, took the boards, passed, and never worked a single day as a nurse practitioner.
I went to one of my professors who said, why don’t you go to work in public health? All they do is mother/baby. And I thought, oh, alright. So, I started applying for jobs in public health. Well, they do a lot more than mother/baby. But I didn’t know that at the time. It was telling that this was a professor of nursing who felt that all public health did was mother and baby care.
From there, I fell in love with public health. And I’ve been here for the past 23 years. It’s been the best thing. It’s been such a gift to me.
WCN: What do you enjoy most about the profession of nursing?
Hersh: It has evolved over the years. At first, it was being at the bedside and following a preemie from birth to going home and seeing them move to home care and into their home environment. But now, I enjoy that nursing has allowed me to change my career and make it whatever I want it to be. I’ve been a bedside nurse and a home care nurse. I did pediatric hospice for a while and went into nursing leadership. As a public health nurse leader, my job is different each day. I never get bored because every day is different. There are times during my career I thought, “I want to do something else.” And as I moved into different positions in nursing, I got the change I needed. My needs were met by the variety and breadth of nursing because there are so many things that people can do in nursing.
Sometimes you’re in a position that seems thankless. And you know what? I’ve left those positions. Not every job is created equal when you’re a nurse. And if I’m in a job that I’m unhappy in, I change my circumstance. I’m not one to sit and complain if I can’t influence change from within to make things better. I just move on because other organizations will appreciate the skills and gifts that I bring to them. Nursing affords us all that opportunity.
WCN: What positions and experience prepared you best for nursing leadership?
Hersh: I’ve been very fortunate to have had some very talented nurse leaders throughout my career. But you can learn as much from a not-so-good supervisor as you can from a great one. You learn what not to do when you become a leader. And then you correct all those things you thought were wrong, and then you end up making your own mistakes. You know, that’s sort of how it goes.
Robert Wood Johnson has made a huge impact on my career, and I received a large amount of training from them. I think their leadership has provided the most pivotal change in my career. I think an important thing that people don’t always know is it is equally important to join organizations like WCN. That was how I got the Robert Wood Johnson fellowship, through my connections at WCN and Linda Tieman, the first director there. When you get involved with your local or state organizations, you learn leadership by osmosis through the peers and colleagues that you work around.
What I think people sometimes don’t understand is that we need people in nursing leadership positions who are new to nursing, too, new grad students all the way up through seasoned professionals. There’s so much valuable input that nurses need from every generation. There’s a lot of focus on diversity in nursing, which is extremely important, but we also need to pay attention to the multiple generations in nursing. From graduation through retirement, everyone has something valuable to offer. Every nurse is a leader from whatever position they’re in. If they’re a bedside nurse, they’re a leader. It’s not something you have to have behind your name, you know, like a “manager” or “supervisor.” It’s everybody. It’s all our responsibility.
WCN: From your perspective, what attributes are important to be an effective nursing leader?
Hersh: I think the attributes of being an effective nursing leader are the same attributes that you need to be an effective nurse. If I believe that every nurse is a leader from their chair, then being trauma-informed, listening, meeting people where they are at, all the tools that we use as nurses to make ourselves more effective, that’s the same skill set that you need as a leader. The difference is you are switching your audience.
I think the hardest jump to being a nurse leader is from a staff nurse. Some staff nurses don’t want to go into leadership because they want to “touch patients”. It is equally rewarding to mentor and help new nurses become the most effective nurses they can be and to see their impact on patients and our communities.
WCN: You have seen a lot of changes in the nursing workforce throughout your career. What do you find encouraging?
Hersh: One of the most recent experiences I find inspiring as a nurse leader is mentoring graduate students. For the last three years, I’ve had graduate students from the University of Washington DNP program, and they challenge me to think differently. I honestly think I learn more from them than they do from me. They come into public health because of our mission and vision. So, they share that with me. I think that’s part of it. We are moving towards the same thing. We are leading with race and health equity, and that’s important. It’s wonderful to see the increase in the number of nurses wanting to go into public health.
I didn’t even know what public health was until I worked here. I mean, literally, I did not know what public health did. I don’t think that’s the case anymore post-COVID. There was a time when schools would say you need two years of med-surg before you can go into public health. We’ve been trying to change that message. And though it’s still out there, it’s false.
When we had the Robert Wood Johnson grant, and we were looking at the knowledge and awareness of social determinants of health in bedside nurses and conducted focus groups across the state; in speaking with groups of school nurses, I just thought if we could invest in school nursing, we could change the trajectory of healthcare in our state, or even in our nation. They have such a pivotal role. They’re in the community and they are embedded just as much as public health is. But at a level where you can influence children, you could really change the world.
Another thing I find encouraging is, because of the pandemic, public health’s role is more visible. People know what public health is right now. And I think our legislators are listening, too, and increasing investments in public health and foundational public health services. This is allowing us to do some of the foundational work we haven’t been able to do because we haven’t had money to do it. It is just the inception of this funding, but it is very encouraging for the future of our state that our legislators are taking this seriously and acting.
WCN: Where do you think there is still work to do?
Hersh: One of my current passions is anti-racism in nursing. In my journey, I’m inspired by leaders in our state, like Frankie Manning and Christina Nyirati, and their work around anti-racism. They have been really looking at racism within nursing as a profession. It’s easy to see racism in somebody else, but when you see it in yourself and your profession, it’s our duty to change that. We need to look at ourselves first, along with the history of nursing and where we failed. We are at just as much fault as everyone else in these institutionally racist systems. I’m so inspired by the work they are doing. We want nursing programs to be teaching this, too, so when students come out to the nursing workforce, we are all on the same page. This is our new way of being.
WCN: That leads right into my next question. America’s healthcare systems are married in structural racism and bureaucracies that contribute to health inequities. How do you see nursing contributing to action-based solutions to improve access to quality healthcare for everyone?
Hersh: When I think of structural racism, I don’t necessarily think it all centers around access. There are so many different barriers in our systems. And it’s really complicated. If it wasn’t, we would have it fixed by now. Structural racism clearly plays into healthcare. But it’s not about having a provider. When you look at people like Serena Williams, our healthcare system failed her. It’s not because she didn’t have access to healthcare. We need to look seriously at the social determinants of health and structural determinants of health, like racism. That’s what we need to unpack and what needs to change.
I feel hopeful in Seattle and King County, we do lead with race, and at meetings we have, the community is first. People talk about racism in every conversation that we have about programs. It needs to be talked about every time. It is not just public health having these conversations. We recognize that we have a long way to go. Though, I feel blessed to work in an organization that is so forward-thinking. When I meet with colleagues from across the country, we seem ahead of the game. But when you’re on the inside, it’s like, why aren’t we doing more? Racism will take a long time to dismantle. But we never discussed it as we have in the last five years. It was brought up and went away. We talk about it daily now. So, I’m hoping that we see change.
WCN: Since the experiences of the COVID-19 pandemic, self-care and work-life balance have taken on new importance in nursing as ways to prevent burnout and ultimately retain a highly qualified nursing workforce. As a nurse leader, how do you fill your own cup and model self-care?
Hersh: Well, that’s interesting, because being in public health, we were on the frontlines. I guess every nurse was on the frontlines of it, but it felt like we were really on the frontlines early on.
It’s been almost three years now. I never thought it was going to be that long. And I think all of us fell into that trap because we all want to work as hard as we can to help our community, and we put ourselves second. I think nursing is a caring profession, and we sacrifice a lot of ourselves for our patients. But, when you’re doing it every day for three years at such a high level, it’s different than when you work overtime a shift or two to help somebody out. And when it’s every day that they’re asking more and more of you, it can be hard to say no.
Personally, I started not checking my email after five o’clock or on the weekends. People have my cell number, and if they need me, they can call me. And especially now, with so many people working from home. I work from home now, and if I don’t shut it off, I can be in front of my computer 24/7. There’s always going to be more work than you can possibly do.
But, also, taking the time to connect with what’s important to you. I’m grateful that we at public health have some great healthcare resources. We have toolkits on our websites for belonging and wellness and other trainings.
There is also a free course on Coursera.org by Yale University that I especially liked called The Science of Well-Being. I think it’s probably like 8 or 12 weeks, but every week they teach you something else about the science of being happy, well-being, and appreciating what you have. It has been very helpful.
WCN: What advice do you have for our future nurse leaders
Hersh: The most important thing people can do is get involved in nursing organizations like the WCN or their nursing unions. They are all working to make change. Everyone’s voice is important. Everyone needs to be heard. And we’re only going to be as strong as our organizations and their members. We need engaged nurses at every level and in every specialty. Nurses are everywhere now. We need to work together to make sure we are heard.
And I think by empowering and engaging nurses in Washington state, at every level, that’s how we’re going to change the health of our state. We’re the largest workforce, we have so much power, and we don’t even realize it. I think if we truly activate our nursing workforce, we will see huge shifts in our state. We can lead from our chairs no matter where we are. That’s the beauty of nursing.
WCN: Is there anything else you would like to share?
Hersh: I would just like to thank the nursing leaders in my life and throughout my career that have believed in me and given me opportunities for growth. Those nursing leaders had grace with my learning curve, and there’s been so many, too many to name. And it continues to this day.
It really has been a privilege to work alongside so many talented professionals, nurses and non-nurses. It’s been wonderful. It’s been a great ride. Moving towards retirement, these are the years that I worried about. I often thought that I would go back to school to learn another profession. What I now realize is that nursing was what I needed all along.