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 the 25-year Executive Director of Washington’s Nursing Care Quality Assurance Commission (NCQAC), Paula Meyer, MSN, RN, FRE. Meyer, who retired in June (2023) started her nursing career as a nursing assistant at a small rural hospital in Deer Lodge, MT. She graduated with her BSN from Montana State University in 1980 and later moved to the Washington, D.C. area to work at Arlington Hospital and continue her education. Meyer graduated with her master’s from George Mason University in 1989. After returning to Montana for two years, Meyer and her family moved to Olympia, WA, where she worked in home health for five years before becoming the NCQAC’s Executive Director in 1998. Here is what she had to share with us about her nursing journey.

WCN: What inspired you to pursue a career in nursing?

Meyer: When I was 16 years old, I had stomach surgery, and I had an incredible nurse. To this very day, I remember her name, Terry. She helped me so much. One day she walked by my room, and I said, “Hi, Terry.” She came in, sat on my bed, and talked to me. She just took a little time with me. And that was the moment I said I wanted to be a nurse.

So, I became a nursing assistant when I was 16 years old. I worked at a tiny little hospital in western Montana with about 16 beds, a two-bed ICU, a two-bed maternity unit, many geriatric patients, some pediatric patients, and an ER. The nurses were incredible and helped me so much. The director of nursing was young and took me under her wing. A friend of mine and I were in classes at Montana State University, and the nurses at the hospital let us go in and see surgeries, see deliveries, work in the emergency room, and work all shifts. They gave us all sorts of experiences. The doctors also took a keen interest in us. By the time I graduated six years later, I was well-prepared to be a nurse.

WCN: Can you briefly share with us your journey into nursing leadership?

Meyer: I describe it as a gentle hand on my back. As a young nurse about nine months into nursing, I was still working the night shift on the orthopedics floor and teaching classes to my peers there, and the Director of Nursing Education said, “Who is this Paula Meyer?” She interviewed me, and I became a clinician in orthopedics. After the hospital went through budget cuts, I became the med-surg clinician and taught classes throughout the hospital. When I moved to the Washington D.C. area, I became an Assistant Head Nurse for the night shift at Arlington Hospital in Virginia, one of the original Magnet hospitals. From there, I got promoted up through the ranks to Department Manager.

A person that had a significant impact on me was Dr. Hazel Johnson-Brown. Dr. Johnson-Brown was the first woman Rear Admiral in the public health service and worked hard to achieve what she did. She was one of our instructors at George Mason University and gave us some incredible lessons. Part of being in a Magnet hospital is our director said, “If you are going to be on my management team, you will get your master’s degree,” which was part of why I went to D.C. to begin with, to get my graduate degree. In a class taught by Dr. Johnson-Brown, Politics in Nursing, she said, “Paula, what is your emphasis in nursing?” I said I wanted to be a geriatrics nurse practitioner. And she said, “No. You are a leader.” And I was like, okay. She was one of the gentle hands on my back that moved me from wanting to be a geriatrics nurse practitioner to going into the administration track.’

I want to share a story Dr. Johnson-Brown shared with us. As a Rear Admiral, she noticed that as Generals entered the room, they would first stand there and hike up their pants before throwing their shoulders back and taking control of the room. She said, as a woman, you couldn’t hike up your skirt. So, if she had to speak, she would stand there, take the lapels of her coat with both hands, crisp them up, look around the room, and then begin speaking. It was a story on how to command yourself. How to sit in a room and not be intimidated by one-, two-, three-, or four-star Generals. And she was an African American woman surrounded by a bunch of men, and she did it. And she did it with poise. She did it with confidence. But she also did it with seriousness. She was an incredible role model.

WCN: What positions and experiences prepared you best for nursing leadership?

Meyer: That reminds me of a question I had when interviewing for the Executive Director position at the Commission. The question was, what has prepared you for this position? When I look back at my career, my senior year experience was in neonatal care. I loved those babies! I was on my way to being a helicopter nurse for neonatal when I had a sports accident that changed my career trajectory, and I became an orthopedic nurse. Then I went from rural Montana and a 16-bed hospital to Arlington and a big hospital. I had done nights, rural, metropolitan, and neonatal. And the job I had before this one was in home health and hospice. So, I had experience from the beginning to the end of life. I also served as a Staff Education Director. I have had broad experience in nursing. And that has helped me in this position because I knew lots of people and understood a lot of settings.

The other thing that prepared me to be a leader was learning how to really listen in critical conversations and not have my own agenda in the way. Because that is the way I was as a young person. I had my agenda, and I had to get it out there first; otherwise, I was going to get run over. But I had to step back and learn how to listen. And it has served me exceptionally well in this position. You have got to listen to people. You can’t just dominate.

WCN: How would you describe your leadership approach?

Meyer: With the transition of my retiring and bringing on a new Director, one of the things that they wanted me to do was something they call the Book of Knowledge. I thought about how I do this brain dump. I started to think back to what helped me throughout this career because I learned so much from many people. And again, it goes back to that listening. And on different levels, too. It is listening to a staff person, a director, all the way up to the Governor. It is listening to people at public meetings as they tell you their lived experiences as we are writing rules and developing testimony. It is listening to Commission members. It is saying, okay, this is my viewpoint–now what did I learn from all these other people? And sometimes, it means changing my mind because I have learned. And to not be afraid to change your decisions. Sometimes people say that changing decisions might make you look wishy-washy, but I don’t think so. I think it makes you look humble and willing to learn. I agree with making a decision. But also, with being willing to change it based on new information.

WCN: What do you enjoy most about the profession of nursing?

Meyer: Nursing is the number one most trusted profession in the Gallop Polls and has been for a long time. I think back to when I was a young assistant head nurse working the night shift and how people would share some of their most vulnerable truths with me. It is that trust that people give us. And with that trust comes a great responsibility to know what confidential information is and how to protect it. Those are the two things I feel passionate about, public trust and how to maintain confidentiality so that people continue to trust you. It carries through to the Commission going from patients’ trust to public trust. I have heard that trust is saying what you will do and then doing it. It is learning how to keep your mouth shut for a while until you are firm on the direction to take and then following through. It is the trust and responsibility that people place in you as a nurse and being sure that what you are doing is safe for people.

WCN: You have seen a lot of changes in the nursing workforce throughout your career. What do you find encouraging? Where is there still work to do?

Meyer: I can’t remember who I was talking to, but it was about the nursing shortage, and they asked, is this new? And I said, you know, we have never had enough nurses. We do not have enough nurses to care for the population and the demand we have. What gives me hope is the response we have had to the pandemic. There are a lot of people out there who are not nurses ready to support nurses right now. And they recognize what the need is. The legislature has been responsive. They have been investing in nursing and nursing education. The governor has been responsive, listened to what nurses need, and has been helpful. The other day, I had a phone call meeting with a man in the NE corner of the state, not a nurse, but someone who recognized that they don’t have enough of a nursing workforce up there, and he wants to start working on training nursing assistants, and then work on a career path into nursing for NAs. Seeing how many people are interested in nursing right now gives me hope. Because our nurses are tired, they have been through an incredible time. And it is still a hard time for them. We all need to keep pitching in, lock arms together, and keep working on this.

WCN: America’s healthcare systems are mired 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?

Meyer: I will give you two concrete examples, one in this state and one internationally. Currently, in Washington State, we have a small group of people, including representatives from WCN and two Commission members, along with others, looking at the administrative rules for nurses to identify unintentional barriers for people getting into nursing. This group is also looking to see if these barriers impact health equity, so, as a result of unintentional bias, we don’t have the best outcomes for people.

On the national and international level, at the National Council of State Boards of Nursing annual meeting in August of 2022, Dawn Morrell, a delegate with me, wanted to make a motion to have land acknowledgments at the meetings. We got the motion, but it was unpopular and met with resistance. The motion co-sponsor was from British Columbia, and the process it worked through was very interesting. However, the Executive Officer from British Columbia and I continued to lead this effort with Executive Officers. As a result, at our Executive Officers meeting in June (2023), half of it will be dedicated to diversity, equity, and inclusion and the role of the nurse regulator. Because some boards of nursing aren’t there yet, and Washington and British Columbia are farther along in the journey, we want nurse regulators and boards of nursing to recognize their role in setting standards, identifying barriers, and alleviating some of those barriers. I get goosebumps from it because it is just long overdue.

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 burn-out and ultimately retain a highly qualified nursing workforce. As a nurse leader, how do you support and model that? How do you refill your cup?

Meyer: Early in the pandemic, Gerianne Babbo, our Director for Nursing Education, and I were in some challenging meetings with other state agencies and educational organizations. There was one meeting that was particularly challenging for us. After the meeting, I called Geri back to debrief, and she said, “Oh Paula, I’m sorry I’m late. I just had to take a walk.” Well, it was pouring down rain outside. And I mean pouring down rain. And this woman is out there walking. And I thought, if she can do it, I can too. And now, I walk five miles a day. Sometimes I get up at five in the morning, sometimes six. But I am out there. And let me tell you, there are times I have had five layers on, and it’s been gloves inside my mittens, but it is life-changing. It is the best thing in the world for me to get out, to get fresh air, to get exercise, and have a chance to think about nothing or maybe think about a challenge. And there have been times when I’ve been stomping in mud puddles. Or, kicking my heels up, too. But it has been one of the best things I have ever done to care for myself.

WCN: What advice do you have for future nursing leaders?

Meyer: Love the people you work with. There are so many people who have helped and guided me. Several people have told me, Paula, I’ve watched you navigate some very choppy waters. But I never thought of it that way because I was constantly weighing, measuring, assessing, and asking what the risk is, where should we be, and what do we want to do. So, my advice is to have a good, strong peer group. Other women have said, know who your tribe is. And not just friends who will tell you that you look great, but friends who will give you honest feedback. And cherish those relationships.

The staff always saw me as more of a leader than I think I saw myself. And I said I’m not afraid to be out there and lead. But sometimes you feel like you are out there on a branch and you’re alone. And I always had to look behind me to see if anybody was back there. Because if nobody is back there and if nobody is following you, you are just lost. So, you must be sure that when you’re off doing your leadership thing, you check, do I have anybody back there?

Another lesson that served me well was what I call the O-ring situation because there were warnings that the shuttle would have problems. But it wasn’t clear enough to the leaders and the decision-makers. So, I would say to my staff, if I am going down a stupid path, not only do I want you to tell me, I expect you to. And I have been blessed with people with the strength to do that.