Because Nancy Ray is attuned to the nursing staff and the mission of her hospital system, she is able to create a workplace that meets the expectations of both.

Of nurses, she said, "They expect to see me. They expect to have me listen to them. And they expect me to take their words forward to the top," which she has done, particularly in making major strides against the nursing shortage.

Ray said she depends on RNs because "they're the experts" to tell her what the standards of care and nurse-to-patient ratio should be, as well as the skill mix of nurses and support staff. RNs also are the ones who know the products to use and the technology that saves them time away from patients, she said.

University Health System is a public hospital and Ray said it's her privilege to make sure the uninsured receive the same standard of care as people with insurance. "Because we are co-partners with the University of Texas Health Science Center, which probably has the best physicians in our community, we easily can do that," she said.

But only one-fourth of the cost of care for the uninsured is covered by taxes. "The rest is covered because paying patients come to see us," she said.

Among Ray's major achievements was selling a $150,000 scholarship endowment to the hospital's foundation to help more than 100 employees join the ranks of registered nurses. The two-point pitch centered on employee loyalty and an awareness that "our foundation was not naive to the fact that we need more nurses," Ray said.

The nursing school scholarships are for staff that range from vocational nurses to technicians, clerks and housekeeping staff.

"We have all kinds of talented people who, just to keep their lives together, could never get out of the rut of their low-paying jobs," Ray said.

Career mobility, enhanced by flexible schedules, creates unshakeable loyalty to the health system while addressing the nursing shortage from within, she said.

A year ago, the hospital was 150 nurses short of its needs and, on occasion, the trauma unit was closed for lack of surgical intensive care beds.

Ray's focus on nursing recruitment and retention turned the situation around.

"I have to advocate for everything that will possibly create-in the future and the near future-more nurses," she said. Options range from persuading elementary school students to consider nursing as a career to using master's-prepared nurses in clinical rotations so that nursing schools can graduate more students.

Financial incentives for retention-not recruitment-are part of her strategy, too.

"If our employees feel that they're going to get every drop of money that's extra, that's more important than giving a bonus to a nurse who comes in and is sitting next to a nurse who never got a bonus," Ray said.

Competitive pay rates are sufficient if nurses feel supported, she said. "They want to work in an environment where they know they're going to be given the resources to keep patients safe and to have the feeling when they go home that they've done the very best job that they can. And that they haven't had to cut corners."