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Nurses in the Robert Wood Johnson Executive Nurse Fellows program receive advanced leadership training, mentoring, and networking opportunities. New Mexico nurse fellows (from left) Genevieve Blackgoat, Ora Begay, and Louise Kahn are involved in the New Mexico Community Foundation’s “Strengthening New Mexico Families” Community Health Nursing Project.

Within the stark gray walls of the domestic violence shelter, a group of women sits in a classroom mastering life lessons.

“I want my children to live free of violence,” one of the women says. “I’d like to learn how to give them a happy childhood.”

Louise Kahn, RN, MSN, MA, CPNP, nods at the woman’s words. It’s a lament that she and her nursing colleagues hear often when working with families with young children. As the program director for New Mexico Community Foundation’s “Strengthening New Mexico Families,” Community Health Nursing Project, Kahn oversees a substance abuse prevention and health care access project that integrates community health nurses into eight rural childhood programs across the state.

The program’s primary focus is on developing care for economically disadvantaged families with children, and working to improve their knowledge and access to the health care system. In her work throughout New Mexico, Kahn talks with many families who lack knowledge of how to access the health care system, and who often only seek care in an emergency.

“There are so many disparities within our health care system,” Kahn says. “Our goal is to educate families about their health care rights and how critical it is to take their children to the doctor for well-child checkups and immunizations, rather than getting poor-quality episodic care in emergency rooms.”

Kahn’s passion for helping others, combined with her education and expertise, made her a natural candidate for a leadership position in nursing. Yet Kahn admits that much of her leadership training has been learned on the job.

“Effective leadership skills typically aren’t taught in nursing school,” Kahn says. “Nurses traditionally haven’t received opportunities to become empowered.”

Enter the Robert Wood Johnson (RWJ) Executive Nurse Fellows Program, a national program that provides advanced leadership training to nurses in senior executive roles who aspire to shape the future of the nation’s health care system.

Each year, the RWJ program accepts a cohort of about 20 qualified nurses to participate in its three-year fellowships. Participants receive advanced leadership training, mentoring, and networking opportunities. The fellowship program, now in its seventh year, is supported by a grant from the Robert Wood Johnson Foundation, the nation’s largest philanthropic organization devoted exclusively to health and health care.

RWJ fellows such as Kahn choose an individual learning plan that will guide their leadership activities over the three-year program. For her, the program has provided a new perspective on her goal of making health care more accessible for families.

“When I first entered the program, I was thinking in terms of making my project a reality within New Mexico,” Kahn says. “After meeting with my RWJ colleagues, I began to see where my project could be emulated throughout the country.”

While the program allows participants to complete most of their work within their own communities, they do attend group sessions that take them away from their jobs for four to six weeks each year.

“Coming together and meeting other nurses who are implementing innovative programs across the United States is an incredible experience,” Kahn says. “It made me realize that by working together, we can change the health care system.”

Meeting future challenges

In an article in the August 2003 issue of Policy, Politics, & Nursing Practice, Edward O’Neil, PhD, professor of family and community medicine and dental public health at the University of California, San Francisco, and a member of the RWJ Fellows Core Resource Team, presents the nursing leadership challenges and opportunities that nurses will face in the next decade.

Among the most significant changes, he says, will be an aging nursing workforce contending with the growing demands of an aging population, and the question of the viability of the primary care practice model in hospital-based systems of care.

“The challenges nursing leaders face will not be addressed without an ability to step outside the box and create new institutions, practices and programs,” O’Neil says.

RWJ participants are encouraged to identify strengths and weaknesses within the health care system and to challenge themselves to identify and implement solutions.

For Maxine Proskurowski, RN, MS, BSN, program manager for the Eugene 4J District Health Services in Oregon, this means examining unique ways of increasing community school-based health centers.

“We’re working to offer complete mental and physical health services at schools through sustainable state and federal funding,” she says. “These centers provide health care to uninsured children, but also provide important services to all students.”