Nursing’s new leader had a choice: the perfect job or the perfect moment.
Sharon Smyth, DNP, RN, was at Johns Hopkins Bayview Medical Center, leading an all-engines-full push toward the finish line on Magnet designation. “We were just kind of on this great momentum,”
she explains. Then Johns Hopkins Hospital, the flagship facility of Johns Hopkins Health System, posted a job opening. “To be the CNO of a world-leading organization, you have to take that opportunity when it comes.”
Smyth threw her hat in the ring, betting on the team and staff she’d built over three and a half years at Bayview as well as herself. They could handle it (Bayview will submit the official application later this year), and how could she lose?
“If I didn’t get the position, it was a win. I get to stay at Bayview doing a job [CNO and vice president of nursing] that I absolutely loved. If I did get the position, it was a great career opportunity and I get to come home to JHH.”
You don’t have to know everything in order to lead.
She got it, of course, the last nurse leader standing after a national search. And today, Smyth is a couple of months into the post, one half of the dual role held for eight years by Deborah Baker, DNP, AG-ACNP, NEA-BC, FAAN. The transition will enable Baker to focus on her system-level role as senior vice president for nursing for the Johns Hopkins Health System. (“I’ve still got her on speed dial,” Smyth jokes.)
It’s a job that Smyth, born and raised in England, had been stretching toward since she arrived at JHH from Yale New Haven Health in Connecticut, recruited to Baltimore to serve as senior director of nursing for emergency medicine over JHH as well as Bayview. Or really since her bedside days in the emergency department, where she got her first taste, and tests, of leadership. “I was that very clinically savvy nurse,” she says. “I was in charge of a busy emergency department. I precepted. Ninety-nine percent of the things that came through the door I could deal with, and I enjoyed that. … But having an influence at a higher level became intriguing to me.”
Smyth “dangled my toes into it” with an assistant nurse manager position and a return to school for a more advanced degree. A mentor at Yale “plucked me out of the ED with orders to launch a new 26-bed observation unit as the manager. I thought, ‘Well, OK, I’ll do that.’ I kept being given these opportunities and running with them, enough of them fairly well because I kept getting more. I always said yes.”
That openness to new challenges—stretching—is something she preaches among younger nurses, and it’s a message she will bring to all nurses at JHH. Be ready. Be flexible. Be open.
Also, she could add, be aware of how things work.
The CNO position at JHH appeared on her radar because of what Smyth had learned at other health systems. “Most do it differently, separating CNO and chief nurse executive roles. But it made sense for the Johns Hopkins Health System at the time.” Largely because few other systems have a Deb Baker. “I don’t know how she was able to accomplish the things she has,” Smyth says of her mentor and close colleague, adding that on top of everything else, Baker understood her own limits. Eight years were enough.
“As we were talking around the Director of Nursing Table, Deb had mentioned on more than one occasion that at some point she would be separating from the CNO role. So we sort of knew it was coming.”
COVID came first.
“It threw everything off,” with Baker instead asking Smyth in spring of 2020 to serve as CNO at the Baltimore Convention Center Field Hospital, Ground Zero of the city’s inpatient, testing, and treatment operation. “That sort of exposed me to being in the CNO world.”
Then Maria Koszalka, CNO and VP of patient care services at Bayview, announced that she would retire. “Deb let me know, like she did all the other directors, that this opportunity was going to present itself.”
“We both know what a gem Bayview is, and at that moment in time it made total sense for me to apply to the position. Bayview had been on the Magnet journey for a long time and I really believed I could help them accomplish that goal. Staff engagement and culture are very important to me, so I made it a priority to listen to the staff, hear their concerns, and help advocate for needed resources. Most importantly, with COVID having taken a toll on our staff, I was determined to bring the fun back to nursing.”
Bayview is and has been an amazing hospital. But it needed work in “the Big 3 when it comes to Magnet”: staff engagement (“huge vacancies when I got there, compounded by COVID”), quality outcomes linked to nursing, and patient experience, a deficiency resulting from, among other factors, the age of buildings and use of double rooms.
“All had to be course corrected to be in a position to submit that Magnet document. I say all of that because they are improved and Bayview will submit this October,” she adds proudly.
“Bayview is so special. The way I look at it, they needed my energy and my engagement then. [Today] they are rock stars. All the tools they need to be successful, they’ve all been set up or put into practice. So even though it’s a little bit earlier than I would have liked
to leave, it’s OK.”
Be Genuine, Be Visible
As for JHH, Smyth is still waiting for the day she sits at her desk and doesn’t feel as though she’s “in Deb Baker’s Office.” But Baker’s shoes are becoming more comfortable as Smyth walks the familiar floors of JHH. Meantime, there’s work to do. Before Baker assumed the top role, nursing had no control over its own budget. Silos created inefficiencies. Baker worked to dissolve both issues. Then COVID mandated a save-lives-today-worry-tomorrow approach to staffing that is unsustainable post-pandemic. “JHHS hospitals should be proud. We not only kept all our beds open during COVID, we even added additional beds to meet the needs of the community,” Smyth says. “Still, the financial impact of this was significant, and now we need to make sure we are staffing our units to our actual census, not the ‘what if’ scenario.”
You don’t have to know everything in order to lead, she insists. What you do need is to be genuine, be visible, and connect on a personal level with those whose work lives are in your hands, and whose continued success you depend upon. It all starts with hello, Smyth figures. “Then, once people are used to you being in the background, once you get that comfort level, then you start getting all the real information. You get to the meat of the problems.”
And the meatier the problem, the bigger the opportunity. Smyth can’t wait.
This time, she won’t have to. ◼