>>MARCIA DAY CHILDRESS:
Hello,
and welcome to Medical Center
Hour, the University of
Virginia's weekly public forum
on medicine, healthcare, and
society. I'm Marcia Day
Childress from the Center for
Health Humanities and Ethics
in
the School of Medicine. We're
grateful you've joined us
today -- indeed, we hope
you'll
come every Wednesday.
The slides before and after
this
program provide resources,
information about continuing
education credit for
healthcare
professionals, a link to our
Center's website for
information
about today's presenter, and a
link to Medical Center Hour's
YouTube channel with program
recordings. This program's
closed-captioned recording
will
be posted to YouTube.
On Zoom, we handle audience
contributions using the Q&A
function. Write your questions
and comments there. We'll
monitor questions as they come
in, and we'll make them the
stuff of my conversation with
our presenter at the end of
the
hour.
Our program today is the 2021
Bice Memorial Lecture of the
UVA
School of Nursing. The Bice
Lecture at Medical Center Hour
is the heart of our
longstanding
partnership with the School of
Nursin -a most valuable
interprofessional
collaboration.
This Bice Lecture, "Anchored
in
Nursing: A Life In
Leadership,"
is presented by Rebecca Rimel,
who looks back on a most
successful career with The Pew
Charitable Trusts, one of this
country's, and the world's,
most
innovative and highly
influential public charities.
For the last 26 of her 37
years
with Pew, Rebecca Rimel served
as president and chief
executive
officer, from which position
she
led and oversaw significant
expansion of The Trusts'
engagements and activities. As
we'll discover, she
understands
her service at Pew as anchored
in nursing, in what she
learned
and practiced, actually, as a
nurse at UV -management under
pressure, clear communication,
purpose and motivation,
empathy
and caring.
I'm pleased to welcome School
of
Nursing Dean Pam Cipriano, who
will introduce Rebecca Rimel.
welcome Pam, and welcome,
Rebecca.
>>PAM CIPRIANO: It's my
pleasure to introduce the
speaker, this lecture is named
for the beloved dean who
passed away in 1975 from
breast cancer, her husband,
professor Raymond Bice, also
beloved by students who taught
across grounds and was revered
here for years, served in
various leadership roles.
He endowed this lectureship
in her honor. We're pleased
to be able to join Medical
Center Hour to speak about
issues that really matter for
the future of medicine.
Today's issue, leadership, is
timeless, yet personal. As
you'll hear from Rebecca Rimel
and her journey in a life of
leadership.
Most of us acquire skills and
experience we need to succeed
across the span of our
careers, with each new role
boosting our confidence and
increasing our competencies,
but few of us have had a first
job that proved to be as
consequential as the one our
speaker today experienced. In
1973, Rebecca Rimel was hired
as head nurse of the UVA
emergency room, she often
worked night shift from 11:00
to 7:00 AM in a job that was
intense, challenging and
grounding.
It was that first job that
she told us early last year,
perhaps more than any other
that prepared her for her life
course and readied her for
anything that she might face
in her professional career.
Rebecca will tell you the
school, University, and
Charlottesville where she grew
up, were quite different in
the -- made their mark rising
above limitations. With
courage and drive, these
individuals stretched the
boundaries of what it meant to
be a nurse. And in the
process, asserting this nurses
make excellent caregivers,
yes, but also, great managers,
and scientists, scholars, and
business people and of course
leaders. As in Rebecca's
case, CEOs and presidents.
Rebecca was part of UVA's
first emergency nurse
practitioner program and
lobbied passionately for the
UVA purchase of the first air
ambulance, the vehicle we
today call Pegasus. She was
appointed as an assistant
professor in the UVA
Department of Neurosurgery,
the first nurse ever to assume
a faculty role. The head
injuries have on attention, by
studying football players.
And her publication of that
study was chosen as the lead
paper in the 50th anniversary
meeting of the American
association of neural logical
surgeons.
It wasn't long after earning
her MBA that Rebecca was
tapped by the Pew charitable
trusts. The group that has
today produced four Nobel
Laureates. In 1988, five
years after joining Pew, she
became the executive director
and in 1994 the president and
CEO. She retired from the
organization in 2020. It is
her name, in her name, that
Pew the new dean's chair, a
professor ship.
a Kellogg national fellow,
having earned the alumni award
in 1988 and the UVA women's
center award in 1999.
She is also a Fellow of the
college of physicians of
Philadelphia and the member of
the American academy of arts
and sciences and the
philosophical a society along
with the association.
It is with great Mr. You are
that I introduce today's
speaker and our 2021 Bice
lecturer Rebecca Rimel,
Anchored in nursing.
>>REBECCA RIMEL: Thank you
for that amazingly generous
introduction, that's very,
very kind of you, I think that
only my mother would have done
one -- done me so proud.
It is an honor to be giving
the Bice lecture, someone who
gave so much to the University
of Virginia. And also, so
much to nursing.
I want to start my comments
where I plan to end them. And
that is to thank nurses and
healthcare providers sincerely
for what they have done during
this COVID pandemic.
It has been extraordinary to
watch their selfless giving to
patients, sharing and putting
themselves in harm's way every
day. I have always been very
proud to be a nurse, but never
more so than over the last
year, so for that, my
sincerest gratitude and I know
you have the gratitude of a
grateful nation, and a
grateful world.
It was many years ago that
the Wall Street journal
actually did an article about
our work at Pew and in that,
he said, and can you believe
it, she was a nurse? As I
call the recorder and I
thanked him for the article
which was balanced and at the
end I said, you know, you only
made one error.
And you don't really like
reporters -- don't like to
hear that they made mistakes,
he said, what is that? He
said, I am a nurse. I think
that was lost on him, but it
won't be to my many nursing
colleagues in the audience.
Once a nurse, always a nurse,
we carry that with us
throughout our life course.
You, there are some benefits,
believe it or not, to getting
older. In addition, to being
in the COVID line, vaccine
line first. And some of those
benefits are that you have a
bit more perspective on life's
journey, and so, some of those
perspectives can be
informative, some of them
amusing and I'm hoping today
that I can share just a few of
those with you.
Much has been written about
leadership. Thousands no
doubt, millions of books, how
to teach it, how to recognize
it, how to mentor it, is it
some gift that we're given at
birth? Is it something that
we're taught? And I don't
have any great insights on
that, I think we all have our
perspectives, but what I do
know is mentoring in the
moment matters a lot.
And probably if you asked
everyone in this audience, who
their first maybe even most
important mentors would be,
they would say their parents
and that certainly was true
for me.
But I want to share my first
professional mentoring moment
with you, and it was on the
grounds at UVA. And it was at
the height of the Vietnam war.
Kent state had just occurred
and we had witnessed fellow
students killed when they were
testing. There were state
troopers, at university hall,
waiting to discipline us. The
board of visitors had said
that if we continued to
demonstrate, we would be
expelled. We would not be
able to take our final exams.
And there would be serious
consequences.
It was Edgar Shannon that
stood on the steps of the
rotunda and actually told us
that he understood our anger,
he understood our need to lift
our voice, he understood our
need to care. And that he
would to everything personally
possible to make sure that we
were able to continue to take
our exams at a later date and
not penalized. Had did this
at great personal sacrifice.
The board of visitors was not
happy. And I came to
understand that this really
was a leadership, it wasn't
taught in a book, but it was
witnessing somebody, taking a
stand, and a great personal
sacrifice.
I was fortunate through the
years to see other people do
similar acts of leadership,
and they were always
inspirational and served as a
guide post for me. Like many
of you, I'm often asked to
counsel young people about
their life course and journey,
and how to have an effective
career. How to get up the
ladder. How to perhaps become
a leader.
And I think that sadly, we
might do a disservice to young
people by saying to them that
my course is linear, if they
climb one rung on the ladder,
the next will follow and the
next will follow, that's not
true today and it never was
true. We all know that hard
work matters and preparation,
commitment. But we also know
that success comes with a bit
of a dose of luck.
And sort of hopeful effect of
knowing when to seize that
luck and that was certainly
true for me. I once in my
life had a job where I would
watch the clock and wonder if
it was broken once an hour,
because it didn't seem to move
and I made a commitment to
myself that whatever I did, it
was going to be fulfilling and
most importantly, it was going
to add joy. And unfortunately
-- fortunately for me, that
has been my life course.
I'm often ask add how does
one go from nursing to a
career at a large public
charity? Well, again, with a
little bit of luck and some
preparation. But it was all
because of nursing.
I was engaged and had injury
research on minor head injury,
and my research had been
written up in that article in
the Wall Street journal, I
described. And because of
again, some luck, I was asked
to go to Philadelphia, I had
never been north of
Washington, I have to be
honest, and I was assigned to
follow around a very important
person, take notes,
that he could look quite smart
at the end of this conference.
Halfway through the
conference, he came over and
introduced himself and said,
aren't you the woman that was
discussed in this article, in
the Wall Street journal last
week? I said, yes, sir, well,
my wife and daughter have had
a minor head injury and
everybody thinks their
symptoms are not real,
malingering, but it's exactly
as you described. He said,
could we have lunch? I said
to my girlfriend, fellow
nurse, I said, so who is this
guy?
And she said, well, that's
the president of Yale, who
some of you know, went on to
be the baseball commissioner.
Well, off to lunch we went.
And with him, he had a Yale
alum. Turns out, that was the
Pew family accountant. Well,
last of the four donors of Pew
passed away, it's four years
later, and they decided to
hire their first person --
staff person, and decided a
physician might be rather
expensive, maybe a nurse would
do. And they said, this
person helped me very much
with his wife and daughter.
So that's how I ended up, I
often -- people say how did
you prepare for this role?
The answer is I was doing
something I loved, my
research, at UVA, and this
opportunity just happened
along.
About four weeks into the
job, I realized that it was
not what I had thought. So I
did what anybody would do, I
called my mom, and I says,
I've made a tragic
professional mistake. And she
said, and I knew exactly what
this meant, apply yourself,
and above all else, do not
embarrass this family. Which
meant you're not coming home.
So sometimes those mentoring
moments can be tough,
sometimes they can be
supportive, but the lessons I
learned in nursing, have been
invaluable to me. First of
all, in nursing, we know
everything takes a team.
Whether it's in the surgical
suite or the C-Suite, that is
exactly the same lesson we
need to learn.
We need to surround ourselves
with the absolute very best
talent. We need to know our
limits, we're not good at
everything. We need to have
people who are smarter and
more gifted at certain things
to help us achieve our goals.
And we need to encourage
unpopular and descending
voices, particularly if we're
in a leadership position,
because it will help us make
better decisions.
And we need to keep an open
mind and a willingness to
follow others advice, we
shouldn't ask for it, unless
we're willing to hear it.
Often many jokes made about
lawyers, but I would say some
of the very best advice I got
along the way was from
lawyers, my general counsel,
and others, we were attempting
to straighten out a very
difficult situation with the
Barnes foundation. Some of
you may have visited it, it's
a fabulous collection of art
in Philadelphia. It was
engaged in endless litigation.
And we had finally decided we
had come to the end of the
road. There was no way to
solve it. And sitting in a
board room, I was admitting
defeat, and the then lawyer,
very wise man, on our board,
said, you know, you could go
to the state Supreme Court in
Pennsylvania. It is the only
court in the country that has
something called a king's
bench petition.
I said a what? He said,
well, all you have lawyers and
friends ask them, if they know
what a kings bench petition is
and I guarantee you, most of
them won't. It allows the
Supreme Court to reach down
into the lowest court, take
any case, and decide it
overnight. We filed the
petition, and the Supreme
Court decided it, and the rest
is history.
And that's how the Barnes
collection was saved. And how
it's now available for anyone
who would like to see it.
So I learned my lesson over
and over, wise people with
good advice should be listened
to. Nurses understand this,
because we are really trained
that our observation
techniques and our lifelong
learning needs to be honed.
You know, innovation is not
well understood, because we
all know it when we see it.
But we really have a hard time
describing it. But I really
think that an open mind and
eagerness to learn are key to
innovation. It's certainly
something that we are gifted
in nursing and taught early
on. But I used to tell my
staff, you ought to have a 100
new ideas all the time.
But there's only two or three
of those ideas that are really
ripe for acting on. They may
not be feasible, they may not
be wise and you need to
surround yourselves with
people that can help you
determine what those three
ideas are. That could be
successful. I'm going to
share just a couple and all of
the success of these go to my
colleagues at Pew, but I
remember it was 1989 and our
new head of the environment
program
came in my office and said we
have to work on a big issue.
I said, what's that? And he
said, climate change. Now,
think about the 89, had you
ever even what it was? I
hadn't. I said, what is it?
There will be palm trees
growing in Philadelphia, I
said, well that doesn't sound
so bad. Once we got over the
humor, understood how serious
the problem was. And the I
think long and hard about what
would have happened if we as a
country and we as citizens of
the globe, had started to work
in Ernest on climate change in
1989.
But we had other big ideas
that were more successful.
The same individual came to me
and said, we need to do for
the oceans what was done for
the tropical forests. This
was in the mid 90s, and he
said, I think that we ought to
create the first generation of
parks in the sea.
Parks in the sea? He said,
yes, think about it. A place
where you can go and enjoy it
but you can't take anything
out but a photograph.
And he said, we can create 22
of them. They would be the
size of Texas or larger.
Well, what a big idea. That
turned out what was
implementable. And it was
George H. Bush that created
the first of these, in the
Hawaiian islands, 18 marches
its way to 22.
But data does need to drive
decisions, we understand that
critical need for this in
healthcare, where we're very
data-driven. And in any
leadership position, I think,
that this is important.
Another example, the same
individual came and said, you
know, I think that we can set
aside 100 million acres in the
Boreal forest, they will be
protected forever, the reason
I gave this, and he gave the
list and the data and the
facts. Well, turned out he
was right, and over the next
decade, with the help of first
nations groups, and the
Government of Canada and many,
many others. We were able to
achieve a billion acres set
aside to be protected in
perpetuity.
So sometimes big ideas can
start small, but they always
need to start with data.
Sometimes in leadership, the
hardest, I think, is deciding
whatnot to do.
Again, another example from
my time at Pew, we worked
very, very hard in some years
ago, to get legislation passed
on campaign finance reform.
It was a huge win. We came --
it was challenged in the
Supreme Court, we worked and
fought all the way, won that
litigation. A huge success.
That would have limited the
amount of money going in to
campaigns from the individual
sources from companies or
other organizations.
And only to have it
overturned three years later.
So success was fleeting. It
was sweet. But then I was
asked repeatedly, year after
year, why don't you get back
in? Why don't you try again?
And the answer was clear.
Because the facts were not in
our favor and we did not feel
that it was winnable. So
sometimes data can be your
friend and sometimes and often
it can tell you whatnot to do.
And everyone's career, we
understand the importance of
accountability, performance,
and evaluating results. And
again, from my experiences as
Pew in leadership, that was
true in our work on antibiotic
resistance which we started
probably 15 years ago. We got
into the area, because of the
impact on animal agriculture.
Only to begin to understand
its huge implications for
healthcare.
And now, I do get a chuckle
when I walk by a subway or
whatever, and they taught that
everything that they have is
antibiotic-free. Well, we
still don't have enough
antibiotics in the pipeline,
there's much more work to be
done.
But again, that was driven by
facts and data and
understating what we might
accomplish.
The other thing I would say
is the importance of
leadership of bringing
together the differences that
divide us. And this is
certainly true in the policy
area. One of my proudest
moments was when one of the
magazines in Washington
labelled us raging moderates.
And I thought, well, if I can
keep that label for the time
that I'm in charge of Pew,
that will be a success. Being
able to bring together people
from different political
persuasions,s and different
idealogies, to work on a
common goal.
And I think that's true of
the leader in any career or
discipline, but I'll give you
one.
And it involves, might
surprisingly find this
surprising, Rush Limbaugh and
his recent passing.
We had come to understand
that people who were serving
in military or living overseas
were not able to vote for
their commander in chief.
Because of the way we got
them ballots and what we
required to get them back,
they could not get their
ballot back in town to get
them counted. It was a
national disgrace and so
unnecessary, so we launch a
campaign with the pentagon, it
needed to have legislation
passed, so we needed people on
both sides of the aisle. And
surprisingly, it was more of a
struggle than I would have
guessed until Rush heard about
this and decided to make it a
key part of his program for
like two weeks on end. About
calling this a national
disgrace. Well, you know,
what? I never listened to
Rush Limbaugh and I became a
short-term fan, he did more to
allow us to bridge the divides
that we had in Congress to get
this passed.
I guess the other lesson I
learned is that nothing really
is easy -- nothing really
important is ever easy.
And I think that also, that,
you know, we need in life, in
particularly, in leadership
positions, we need to hope for
the best but we need to plan
for the worst and always have
an exit strategy. It was
mentioned that I ran the 11:00
to 7:00 shift in the ER and,
you know, for sure, this is a
place where you need to
understand how to hope for the
best and plan for the worst.
And I really do believe that
those years of training helped
me in every leadership
position that I had to make.
Or leadership decision.
You know, I hope that you --
the dose of self-doubt and
insecurity is really a good
thing for a leader to have.
First of all, that humility
helps us, I believe, make
better decisions. And it
often motivates people around
us to offer their suggestions
and to be their best.
Self-deprecating approach to
leadership, I believe is key.
And admitting our mistakes
much more loudly than we try
to claim our successes. It's
important to remember that
success needs to have many
parents. Failure often only
one and that often falls at
the foot of the leader.
But we all need to learn from
success, but learn even more
from our failures.
You know, I -- this seems so
obvious to people in
healthcare, but in other
groups, less so. Inaction is
basically incapacitated. One
of the big problems leaders
often have is that their lack
of willingness to make a
decision without perfect
information. And you never
have perfect information and
all of us in healthcare know
that hesitation is never our
friend.
In business, it can cost
profits, but in healthcare, it
can actually cost a life.
We have to take informed risk
in every aspect of our
business lives and in our
career. And also, in our
personal lives, and those
risks need to be informed but
we cannot let the perfect be
the enemy of the good in terms
of exercising our judgment and
our experience.
Hesitation as I said, is
highly problematic. I was
very unwilling to launch one
of our programs at Pew that
maim bun of the most
successful and that was
criminal justice reform. You
know the data about how many
people in America, one in 100,
African-American males are
incarcerated in this country.
We know that recidivism is
high for those incarcerated
for nonviolent or petty
crimes. So we set out to see
if we couldn't help to reform
the criminal justice system.
The reason I was opposed is I
was sure as heck we were going
to get label as the soft on
crime crowd that this was
going to hurt us in our work
and we would be seen as shall
we say, much too far left of
center.
Well, I turned out to be
really, really wrong. First
of all, our first partner,
turned out to be the attorney
general in Texas. And he
became a huge advocate for
criminal justice reform. Not
a state you would have pick
for that, I'm sure.
And then the Coke brothers
became our partners in pushing
for this as a national
movement. And now, has gotten
lots of partners, and lots of
energy behind it. And I
believe that the public, both
in terms of the dollars that
they spend on criminal justice
reform, but even more
importantly, the lives that
are saved and turned into
productive citizens has been
result.
You know, I want to talk
about another mentoring moment
that happened in
Charlottesville and I was
really fortunate to be asked
at a fairly young age to serve
on the board at Monticello,
Thomas Jefferson foundation.
And I had many, mentors on
that board. It was my first.
Lee Cochran was the chair
known to many in this audience
of phenomenal individual, and
a great role model for female
leadership. And Ann Jordan
who I'm sure many of you know,
was our very effective
president. Well, probably a
year or two into my tenure, on
the board, the whole issue of
Sally Hemings emerged as a
very important topic.
Well, this was highly debated
and contested around the
country. But also, in the
board room. And to be honest,
we had a couple of board
members that felt that we
should just not involved
ourselves with this. That it
could disparage
Mr. Jefferson's reputation,
our job was to support his
reputation, and his legacy.
These were very important
donors to the institution.
And I'll never forget the
moment when Dan Jordan stood
up with strong support from
his chair, Lee Cochran, and he
said, and he said, we will do
what Mr. Jefferson had always
done, we will follow truth
wherever it may take us.
And so, again, at great
personal sacrifice, and also,
what could have been somewhat
hurtful, to the financial well
being of Monticello, the
leaders did the right thing.
And again, every time I have
been confronted with a
decision, I always think, I
never want to the be put in a
situation where I would have
said to myself afterwards, I
should have, could have, would
have. If I had only done the
right thing.
So I guess my most important
message for all of you in your
leadership roles and I know
you all have many, is to
always be proud of the
decisions that you make and
know that you followed truth
wherever it may take you. You
know, Charlottesville, it was
said has been very important
part of my life.
I was born and raised there.
And I must say, some of the
recent event, watching them on
the national news, were very
troubling and sad. You know,
I spent every Sunday playing a
lead part, partly to make sure
that I wouldn't have to go to
Sunday school too long at the
church right across the
street. My father was the
head of the parks and so
seeing these situations just
was very troubling to me. And
sad.
That we really had in
Charlottesville moved on very
far from when I was getting
ready to go to the first
grade. I remember coming
home, all excited, this first
year in school, and my mother
sat me down, you know, you
can't got back to school. And
I couldn't understand this.
The question was why? And she
said, well, they closed all of
the public schools in
Charlottesville.
And people find this story
sort of amazing when they
think about the
Charlottesville of today but
they did. They closed them
all. Rather than integrate
them. And your parents had
one of three choices, wealthy
enough to send you to a
private school, that wasn't
us. They would basically send
you off to live with relatives
in another town to attend
school, and that wasn't going
to happen for us.
Or they paid the teachers to
teach in church basements with
groceries. And maybe that's
why I'm not really good with
math. ( Laughter ) I still do
the tip on my fingers under
the dinner table, but I did
get a decent education until
they reopened the public
schools.
But it took many years. And
so I guess, in hearing about
some of the recent problems, I
had hoped that maybe
Charlottesville had advanced
beyond it but I'm delighted to
hear that now the
conversations are much more
transparent and inclusive and
healthy. When I got ready to
go to University, it was just
about the time that the
University was still fighting
about whether to admit women.
And now, I understand, that
women have taken their place
in leadership and throughout
Mr. Jefferson's university, as
they should have many decades
before they were allowed to.
And then when I entered
nursing, there was a battle
royal about advanced practice
nurses, were we even going to
have them? Were physicians
going to let them practice?
If they let them practice,
under how tight of a thumb,
how many times did they need
to get their prescriptions
signed off on? Maybe not all
the way that some of us would
hope. Nurse practitioners,
are advanced practice nurses
are vital to the healthcare
system. Those of us that have
either been part of the
healthcare system as a patient
or watched from afar,
absolutely know this.
But, you know, standing up
for what you think is right,
is going to be not easy. Like
many of you knew was somebody
who would always speak truth
to power, sometimes I think
that the powers that be
weren't happy to hear from
him. But he was the one that
really led the charge to start
the emergency nurse
practitioner program of which
I was in the first class.
Which now is part of the acute
care nurse practitioner
program. And he is the one
that really deserves the
credit for peg sis, he fought
hard for that, because people
in the western part of the
state had access to no
emergency care and people were
dying or severely injured and
unnecessarily so because we
couldn't get them to the great
care provided in
Charlottesville.
So for all of those people
that blazed the trail and
taught me so much about
leadership, I am eternally
grateful, but I want to come
back and express my gratitude
to the University of Virginia.
To the school of nursing. Not
for great education I got, but
for the life experiences that
it taught me, that I hope I in
turn was able to share with
some of my staff along the
way. And certainly, informed
a lot of the programs at Pew
that were helpful to others.
It was great training, I did
have a bit of luck along the
way, I don't want to deny.
That but above all else, I had
great partners, people I
counted on, people I trusted
and much more talent.
People often say they want to
make a difference in their
careers. And I say, well, you
know, making a difference can
come in many ways but the most
important thing is to have
great joy in what you do.
Know that you're doing the
right thing. Know that you're
giving back. And have as few
of regrets as possible, and I
certainly can say that.
So I have the deepest
admiration and respect for all
of the healthcare providers as
I said when I started, and I
want to thank them, but I also
want to thank their friends
and family, because they have
sacrificed so much along the
way and particularly during
this pandemic.
And to thank them full all
for selflessly putting
themselves in harm's way each
and every day, for the well
being of all of us. Thank you
very much and hopefully we can
have some questions.
>>MARCIA DAY CHILDRESS: Thank
you, Rebecca, so much, I will
ask Pam Cipriano, if you would
like to sit in on the Q & A
conversation, we will welcome
your voice in this
conversation as well.
That was a wonderful talk and
you took us many places, and
always as promised, you
Anchored us definitely in
nursing, and so, for those of
us who have worked with
nurses, for year, and years,
it was lovely to see all of
those talents and skills
celebrated. And their
practical use in so many
domains. Celebrated. So
thank you so much.
For starters, one of the
things you said, right at the
beginning was once a nurse,
always a nurse. As you
reminded that Wall Street
journal reporter.
So to extend nursing even as
a metaphor, we have a question
at Pew, across all of those
years of service, whom did you
consider your most challenging
patients? Was it staff?
Donors? Board members? Grant
recipients? Public?
>>REBECCA RIMEL: Wow.
( Laughter ) to be honest, I
would probably say the press.
They do their job, and I
admire what they do. But it's
often very difficult to tell
two sides of a story. And I
think that particularly
working on the challenging
issue, that was some of the
hardest dynamics to manage.
Certainly, again, going back
to the comments about the
Barnes foundation, and the
effort to try and save the
collection and relocate it.
Much was written and said
because it made for great copy
but it was not true and in
some cases was quite hurtful
so some of the donor partners
and my board stood beside me,
and they had every reason to
doubt that decision from time
to time. You know, I think
that anyone that's been in
management and leadership
knows that one of the great
thrills is managing and
mentoring staff, but it's also
one of the things that some
days can be a great challenge.
But trust is key. And having
a trusting relationship with
your staff, and with your
board, if there isn't trust,
in a mutual respect and
understanding, then it makes
everything impossible. So
working on that trust, only
comes with time and
experience, candor, and I this
I that this openness to
admitting mistakes and
including people in your -- if
your decisions. So -- in your
decisions, so I know some of
the conventional wisdom is you
shouldn't stay in any job five
year, I would be an utter
failure by those criteria, but
I think that some longevity is
helpful, particularly in
leadership positions, because
it does allow time to build
trust and mutual respect. And
you need to rely on that
particularly during difficult
times.
>>MARCIA DAY CHILDRESS: It
does strike me, though, that
in thinking about establishing
trust, thinking of your
experience as a nurse, in
nursing, particularly perhaps
most -- most often in the
emergency departments
situations, establishing trust
with a patient at his or her
most vulnerable or with the
family is something that needs
to happen quickly and
efficiently and effectively.
Any thoughts on how having
learned to do that early on
translated into your work with
Pew?
>>REBECCA RIMEL: Well,
should have commented one of
the other characteristics that
is absolutely vital is
empathy. And sitting with
someone and being a good
listener and letting them
know, perhaps, that you have
in some ways, shared in the
similar experience, walked in
their shoes, or a least if not
have some understanding of the
challenges and difficulty that
they may be facing.
One of my most difficult,
difficult moments in my
nursing school training, was
we were assigned patients.
And I was assigned a young
woman. Who had anorexia and I
worked and worked and worked
with her, and I could not
understand why she was not
getting better. And
ultimately, sadly, we lost
her. And I think that that
probably taught me more about
the importance of listening
and empathy, I don't think
that I probably did as good a
job as maybe I could have.
I've often wondered if I had
been better at it, would have
made any difference. So I
think that this sense that to
walk in another's shoes, or at
least to imagine what they
might -- must be experiencing,
has to be key. And people
understand that in their
interactions. We all do. And
we know if it's real and we
know if it's not, and building
that quick trust, which is
your point, I think, it
requires those types of
skills.
>>MARCIA DAY CHILDRESS: I may
put Pam a little on the spot
and say, so are we teaching
that now? If so, how?
>>PAM CIPRIANO: I am so
impressed with the nurses who
we are graduating today.
Absolutely. Part of what we
teach is to -- and this may
sound an exaggeration, but you
have to almost be fearless,
you have to be able to pursue
what you think is right, you
have you to be able to
comfortably ask questions, as
Rebecca said, you have to kind
of question yours and your
competency in that moment.
You have to be open to
feedback. And our clinical
faculty, I believe are really
excellent as they support
students in the moment, in
this clinical settings. They
can tell if someone is a
little uncomfortable and take
them aside and have that
conversation. So, you know,
we, again, are enormously
proud of our students, our
faculty, our permanent faculty
as well as your clinical
partners who actually are
there in the moment for the
patient interactions.
Because nursing not for the
faint of heart. It is not
this just the skills, it is
that insight, it is that
intuition, it is understanding
the reliance on your team
members, it is being able to
pull together all of the
things that you know and have
learned and be able to then
formulate a plan sometimes
very quickly
to have that -- those
communication skills with the
individual or with the family.
Because, you know, going back
your question about trust,
absolutely, there is almost a
need to instantaneously convey
that you are in command of
your knowledge, and that's
sometimes challenging for
students, because they see
themselves in the learner role
and haven't had as many
opportunities yet to be able
to build that self-confidence.
But I am very pleased with
the skill and knowledge that
our students emerge from our
program with.
>>MARCIA DAY CHILDRESS:
Right. So we have a
combination comment and
question from a gentleman
named Jeff Allen. As the
luckiest husband of a UVA
nurse, I have been active with
the UVA school of nursing for
almost 50 years. What's the
magic in the water there?
That's not the question for
you. But he says that he
thinks it's the high social IQ
which is cultivated through
each nursing school class.
And their interactions with
such a driven and caring
faculty as Pam was saying.
Once that caring and
understanding approach to man
kind is established, I think
that UVA nurses can go
anywhere and easily lead
others.
What do you think?
>>REBECCA RIMEL: I have no
doubt. ( Laughter ) I wish I
had said it. I wish I could
take that and maybe make that
my talk, no, I couldn't agree
more. You know, it is -- you
said it well, it is the social
IQ, it's the self-awareness,
it's the humility that comes
with the training and also,
the mentoring and, you know, I
commented on this, but, you
know, not everybody arrives at
nursing school sort of wired
exactly ready for the
profession. And I do believe
that learning the technical
side of it, it's vitally
important, probably more
easily taught and easily
learned than the empathy, the
social IQ that one needs, you
know, I always laughingly say,
it took me about three years
to understand how ever July
1st, I became like super
smart. And then I got
gradually, I lost that over
the year. As the interns and
residents matriculated through
their training.
But, you know, how do you --
how do you insert yourselves?
How do you motivate others?
How do you -- these are skills
that the leader needs and
these are skills that a nurse
needs to learn very early in
her career. So lucky you for
having married a UVA nurse.
I'm sure that it has enriched
your life enormously.
>>MARCIA DAY CHILDRESS: So
one of the other things that
you talked about was this --
was practicing using informed
risk, as something that you
learned to practice. In
healthcare. But in that same
vein, it struck me in the
examples you gave from your
experience at Pew, that Pew as
an organization, has not in
recent years shied away from
some of the hard questions.
And big issues.
Facing us. Including as you
were saying, some political
issues. But you seem to have
come to know and rely on your
moral compass, in the kind of
leadership work you were doing
at Pew and I wonder if you'd
say something about where does
this -- what's the anchorage
for your moral compass in
nursing?
>>REBECCA RIMEL: Well, I
think that it really does go
back to watching individuals
who you deeply admire. And
then, asking yourself, why do
you admire them so much? And
then, conversely, looking at
people who are leading and you
maybe have a little less
respect and what is it that
you do not want to emulate?
And I think that that more
than anything for me,
obviously, I give credit to
early bringing, these events
like discrimination, to me, I
find it just so difficult to
on board probably in large
part probably watching it, how
it affected so many, including
myself at a very young age.
So I do think that we are a
very much a product of our
experiences. And I try once a
month to ask myself what did I
learn that really surprised me
this month? I used to try to
do it once a week. Who did
learn it from? Who did
something that I really
thought was exceptional or I
admired? And who did I think
really blew it? ( Laughter )
in some way, and I try to do
these with personal
experiences, not people that I
see on the news or -- I think
that's in some ways too easy
to judge situations that
you're not part of.
And that's been really,
really helpful and so
recalibrating one's compass,
because times change.
Circumstances change. And we
don't always get it right.
And I think that if we think
that we -- you know, deserve
or we occupy the higher
ground, that's a very
dangerous place to put
ourselves as a leader.
>>MARCIA DAY CHILDRESS: You
alluded to sort of learning
from a variety of people and
encountering a variety of
people, and personalities in
the course of your work, and
one of the people you
mentioned from your early
years at UVA is someone I also
knew, Dick Edlik, plastic
surgeon, but so much more.
And his work with establishing
Pegasus. In later years, when
you had moved on to Pew, I was
working in administrative
office where Dick would make
visits, maybe once a month,
maybe once every two months,
in his little motorized
scooter.
His new mission and he was
just as fierce an advocate,
for this, was to scout
throughout the health system
facilities for any places that
were not fully accessible to
disabled persons. And he
found plenty. And he every
time was just as fierce and
energized and advocate for
that kind of accessibility.
In that way.
>>REBECCA RIMEL: I only
laugh because -- you didn't
want to get in those cross
hairs. I think that they
would have launched Pegasus
just to make Dick stop
complaining about it.
( Laughter ) but that's what
leadership sometimes takes,
it's somebody for the very,
very clear purpose. But you
have to be able to motivate
others and he was able to
motivate obviously many others
on a handicapped accessible,
and certainly, to motivate me
to be out there championing
and many, many others on our
ambulance service back in a
time where that seemed so
obvious now. But, you know,
in the late 70's, that was not
so obviously.
>>MARCIA DAY CHILDRESS: He
also was, you know, just a
memorable personality in so
many ways and it strikes me
that as in nursing and again,
in the emergency room, you can
open the door or pull back the
curtain and, you know, what
memorable person are you going
to meet there? And you deal
with --
>>REBECCA RIMEL: Well, you,
I -- not to make this -- I had
so many people at UVA that
gave me a helping hand. I
mean, had he not hired me as a
nurse practitioner, had the
team not supported me in my
head injury research, you
know, had not and -- and the
list goes on, so many people,
you know, offering a helping
hand, giving some, you know,
very wise advice.
So I really, to watch the
institution and how it's
flourished and particularly
this school of nursing, it's
been a treat.
>>MARCIA DAY CHILDRESS: So
you retired in 2020, our COVID
year. We have a question
that's asking about this new
territory of requirement.
What fill your days post-Pew?
>>REBECCA RIMEL: Well, let
me be the first to tell
people, it's not nearly as
scary as advertised, and I do
believe it is highly
underrated. Everyone told me
that before you retire, oh, my
gosh, you know, you're a work
a alcoholic tendencies, you'll
have to go through
detoxification, my husband was
a little bit anxious, more
than a little bit. You know,
I -- I have found it
delightful to be able to
pursue many things that I
never had time for.
Reading and a 100 other
things. I still continue to
serve on boards of healthcare
companies and other kinds of
boards, and I do occasionally
get to talk to my successor as
she's managing very ably the
future agenda. For Pew.
Actually, the timing, again,
was luck, and a gift, because
you might find that I'm very
much of a hands-on people
person manager, some people
say I like to control things,
a fair amount. Probably
that's not always a
compliment. I think that
managing during COVID has been
extremely -- would have been
extremely difficult for me and
probably has been for a lot of
people, both leaders and their
colleagues and employees.
So probably the timing could
not have been better. But I
also hope it's going to give
me time to revisit my roots in
Charlottesville where I still
have family and the school of
nursing, some of those things
had to be put on hold,
obviously.
>>MARCIA DAY CHILDRESS: We're
so sorry that you couldn't be
with us in-person today. One
thing that you mentioned, and
I'll direct this question
first to Rebecca and also to
Pam. You were talking about
the importance of finding joy
in your work. And in some
ways, that's an important
anchorage as well. So I found
myself hoping that our health
professionals working today
aren't too busy to be joyful.
And maybe to have the time
and the energy to engage,
locate, and engage their joy,
do you have any good counsel
for people who feel that
they're overworked and
overstressed? They do have
sources of joy but how do they
tap into that?
>>REBECCA RIMEL: Well, I
would hope that healthcare
systems would reflect once
COVID is in the rear-view
mirror, about how to
reenergize and to reward our
healthcare providers. Whether
that is -- this is -- I'm sure
if they're healthcare
providers or administrators in
the audience, they may go, oh,
you're out on a limb, but to
give people, perhaps, a week
of sort of self-renewal and
rejuvenation.
Or a chance to perhaps spend
time with family, over above
their normal vacation or leave
time. Because they gave and
continue to give 150%. And I
think that if we could just
give something back, to allow
them to recalibrate, because
again, it's really hard to
seek joy if you're feeling
completely exhausted.
Overworked.
And I would hope none of them
do, but undervalued. So that
said, I think there is
probably few professions that
tell you every day if you made
a difference. So many people
say I want a career where I'm
making a difference, I say,
well, you ought to look at
nursing because every day when
you leave your shift, you know
that if you made a difference
and you will virtually always
know it's a yes. And then
coupling that with the joy
that comes from lifetime of
learn, giving back, caring,
it's a great, great formula.
And my guess is, a lot of
people are going to understand
that and I bet you
applications to nursing
schools are going to soar,
people are going to want to
pursue this profession,
because they're going to
understand that they are going
to be able to make a
difference and have a joyful
career at it.
>>MARCIA DAY CHILDRESS: Yeah,
Pam, anything you'd like to
add to that?
>>PAM CIPRIANO: Yes, thanks,
Marcia and I think Rebecca is
on target with many of the
things that she pointed out.
It's helpful for us to
recognize that prior to the
pandemic, the whole concept of
joy at work was really being
challenged. As healthcare has
become more complex, more and
more work has been added to
the delivery of care, such as
documentation, such as many
different kinds of reporting,
that are important, like
quality outcomes and things
like that.
But it has often been
additive as opposed to how do
we figure out how to have some
kind of balance? The amount
of time and effort that's
required to have that very
personalized care being
delivered. And so for nurses,
physicians, pharmacists who
have been in that really
challenging spot of having to
do more, where the most
meaningful work that
interaction with patients. We
had seen joy to become eroded,
and so it's really been a dual
responsibility of
organizations as well as all
of our healthcare
professionals to say, how do
we restore joy? How do we
make sure that we remove the
work that's not necessary,
that we use technology to help
with efficiency and to replace
some of the onerous
requirement of regulation and
those kinds of things? So its
just magnified with the
pandemic, unfortunately, we
have been hearing for almost a
year now, how overworked and
exhausted our caregivers are.
And many of them,
unfortunately, do not feel
valued by the organizations
for a whole variety of
reasons.
And for members of society,
that haven't really followed
the protective mechanisms that
have put healthcare
practitioners at risk, an
important time for us to
regroup, not just in the
healthcare industry, but in
the organizations but to
engage the public around how
important it is for us to
restore joy for all of the
people that work in
healthcare, across the board,
as well as recognize that
organizations have a
responsibility. We're
fortunate at the University of
Virginia, the wisdom and well
being programs are focused on
saying we are unite in
recognizing that it's
important to take care of our
caregivers.
>>MARCIA DAY CHILDRESS: We've
come to the end of the hour,
what a joy it has been to have
you Rebecca Rimel with us and
Pam Cipriano also, what a the
joy, also to hear about the
creation, thanks to the Pew
charitable trusts of the
Rebecca W. Rimel dean of
nursing endowed professor ship
at UVA in recognition of
Rebecca and her leadership.
I'll encourage you to come
back next week, we have a
program featuring architect
Sara Jensen Carr from
Northeastern University and
the environmental planner,
Timothy Beatley, from UVA
School of Architecture, a
program on the topography of
wellness. How health and
disease have shaped the
American landscape. With some
anticipation of how COVID is
going to change design around
our cities and our places of
life and work.
So please join us then,
again, thank you Rebecca
Rimel, Pam Cipriano and all of
you, thank you for your
attention.