Running Head: FINAL QUALITATIVE RESEARCH PROJECT

2018

Success of a Rural
Hospital
EDUCATION AND MANAGEMENT ARE THE DIFFERENCE MAKERS
CHRISTOPHER PAYNE
FINAL QUALITATIVE RESEARCH PROJECT 1

Abstract
In this paper I explore an element of a successful rural hospital that many similar hospitals
struggle with. One of the biggest challenges to the success of rural hospitals is that they
struggle to recruit and maintain healthcare professionals. In small communities, nurses and
other staff are often promoted to leadership positions simply because they’ve been there
longer than anyone else, and not necessarily because they have leadership training or exhibit
good leadership qualities. In this qualitative study, I interview mid-level managers and assistant
managers to assess their education, experience and overall feelings of preparedness as it
relates to the awareness and success of their organization.
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Table of Contents

1a. Introduction

2a. Literature Review

3a. Methods

3b. Context and Sample

3c. Data Collection and Analysis

3d. Researcher Reflexivity

4a. Findings

4b. Education

4c. Differences in Perspectives

5a. Standards for Validation and Evaluation

5b. Evaluation

5c. Significance

6a. Discussion

6b. Conclusion

7a. References

Appendix A: Questions sent to interviewees

Appendix B: Transcript of Interviews

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1a. Introduction

The purpose of this case study is to identify whether leaders in managerial roles in a rural

hospital are or at least feel prepared for growth. At this stage in the research, the level of

preparedness will be defined as how prepared the leader feels to manage a department or area

at twice the level of its current capacity. The central question is “Do leaders feel prepared to

lead a group that is twice the size of the current group they’re leading?”. This question will lead

to many sub-questions:

 Do the executive level leaders feel that their managers are equipped to lead when

growth occurs?

 Do the executive level leaders and managerial level leaders agree on their

preparedness?

 What else do managers feel they need to lead well when growth occurs?

 What has already been done to prepare leaders for growth?

The study is focused on leaders in managerial roles at Kearny County Hospital, a rural

hospital that is bucking the trend of most rural hospitals and is growing at an exponential rate.

The hospital has plans for expanding its facilities very soon. One of the largest challenges in

rural areas is a lack of leadership. Many people are simply thrust into leadership positions

because they’ve been in the organization the longest. Most are not offered leadership training

but expected to lead. In an area with more jobs than people, workers who are willing to work

hard and invest in their roles are a rarity.

A recent survey on growth within businesses showed that 65% worry that growth will

put excessive pressure on operations, damaging quality and customer satisfaction. However,
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only 6% of businesses experienced growth within their plans, meaning that growth figures were

either less or more than expected for 94% of businesses (CFO Innovation Asia, 2016) . Applying

that to rural hospitals, which faced a 28% loss nationwide between 1971 and 1998 (American

Hospital Association, 2000), expansion of facilities and adding more staff could be the tipping

the point that either accelerates growth or makes this rural hospital just another statistic.

Previous research on the topic of mid-level management preparedness is nearly non-

existent. Most surveys focus on executive level leadership in business, and in healthcare, the

focus tends to be on providers themselves. However, it would seem that since 32% of people

quit their jobs because they feel they were treated unfairly (Gilbertson ,1998), the lens should

be on those who are leading those who were treated poorly. Were those people treated poorly

by executive level leaders? Unlikely, as managers and mid-level leaders are the ones directly

responsible for the culture within their departments. It would seem then that the spotlight for

employee retention should actually shine on both managers and executive level leaders.

Also take in to consideration that the primary reason that rural hospitals have such a

high rate of closure was due to the fact that providers no longer wanted to work there

(Kaufman, B. et.al, 2016). Rare are the days of a doctor coming to and staying in a rural

community to serve its population. Rarer still are nurses who will come and work at

understaffed hospitals that offer very few health services. The importance of retaining valuable

health care professionals becomes even more important in these small hospitals. Not only is

recruitment of these professionals important but leading them well becomes even more crucial

in areas like Kearny County so that they will continue to stay.

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By studying the expectations of executive level leaders and comparing them to the

expectations and felt needs of the managerial leaders, I hope to either find that they are on the

same page in regards to preparing for projected growth or expose a gap which can be

addressed. With this understanding, hospitals and health care leaders can better understand

how to create a culture in which leaders develop and employees don’t want to leave.

2a. Literature Review

Kearny County Hospital is a rural hospital in Southwest Kansas that has managed to

avoid the plight of many rural and critical access hospitals. They have more than doubled the

amount of births and see over 21,000 separate people, more than double the amount of people

in Kearny county. While that is great news for this small hospital and the towns it serves, they

still face many challenges that urban hospitals don’t. For instance, rural hospitals see a greater

percentage of patients who are sick, and have fewer well visits, which can be more financially

burdensome on a health-care system. Low occupancy can also be an issue when there simply

aren’t enough people to keep a hospital open. (Muus, Ludtkey, & Gibbons, 1995) They are also

challenged by having fewer interested providers, administrators and other professionals who

are willing to stay long enough to develop a patient base (Commins, 2015).

As such, many leaders, particularly mid-level leaders and managers find themselves in

leadership roles much sooner and likely with less training than those within an urban setting.

Employees who leave often blame poor leadership as a primary reason, and without proper

leadership training and experience, employee retention can drop dramatically.

A recent study revealed that Nurses in leadership positions have a more organizational

focus with a master’s degree. Personal growth and development focus with a bachelors and
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task focus with an associate’s degree. Leaders with a higher level of education tend to think at

an organizational level. (Baxter and Warshawsky, 2014).

I inquired about the levels of education that the current leaders have, ask about

personal growth tracks and goals the leaders have set for themselves and compare that to what

the executive level leaders expect, have trained and have set as goals for their managers and

see if those expectations line up with each other. These questions and research performed are

specific to managers leading within a rural hospital.

Key Words: Rural Hospital Growth, healthcare leader, leader prepared growth, rural hospital

closure

Databases: CINAHL, Forsyth Library, Google Scholar

3a. Methods

I interviewed 7 leaders at an assistant manager or manager level in a closed conference

room. The interviews were recorded with a voice-memo app on my phone, and then

transcribed after the fact. Interview questions were given to these leaders ahead of time so

they could be prepared and feel more at ease. This approach is best suited to answer the

research questions because the purpose is all about whether or not leaders feel prepared and

invested in to best serve in the capacity for which they’ve been hired. A focus group approach

would not have been confidential enough for these leaders to feel like they could be honest

with me. Simply viewing documents may be helpful, but the kind of information I’d need would

likely be in a personnel file that most of the participants likely would not have felt comfortable

with a third-party viewing.

3b. Context and Sample

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The organization this research project is centered on is a rural hospital. But not just any

rural hospital. Kearny County Hospital is a successful and growing rural hospital that sees more

patients than they have people in the county. They have managed to recruit excellent

providers, recruit and retain valuable nursing and administrative staff and have even been able

to draw people from areas with larger hospitals and towns.

3c. Data collection and analysis

Leaders were selected based upon availability and willingness to participate in the

interview process. The CNO (Chief Nursing Officer) of Kearny County Hospital selected the

leaders interviewed and I took an entire day and utilized my phone as a recording device and

had access to a conference room.

The participants were selected because this is a growing hospital in an isolated rural

community who lead a staff of people in an area that isn’t known to grow or draw in good

leaders. As the hospital grows in beds and patients served, I inquired as to how these leaders

felt about the growth, whether they felt equipped to lead and the methods by which the

hospital is investing in these leaders.

3d. Researcher reflexivity

My biases and assumptions are that many leaders in an organization that is failing or

declining have been simply promoted people who’ve been there the longest, without

determining if those people should be in leadership or bothered to train them in leadership and

invested in their education. It should also be noted that since this project is an assignment for a

master’s level class, I, as the researcher, find immense value in education. While it could be

argued that the kind of people who think organizationally are the kind of people who pursue
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higher levels of education, it would be beyond the scope of this research to attempt to tackle a

nature vs. nurture conversation. My educational bias, nonetheless, is confirmed in studies

regarding nurse education. Nurses that have an associates degree are task focused, whereas

nurses with a masters tend to have an organizational focus, better suiting them to leadership.

Many nurses in rural communities get promoted due to their longevity within the hospital and

not necessarily because they should be leading, nor are they invested in as leaders, which

causes higher attrition rates (Baxter and Warshawsky, 2014).

Since confidentiality is vital to obtaining honest answers, I did not actually name the

individual being interviewed, neither in the interview or have it written down. As I’m

transcribing and collecting data, the only identifier of that individual would be someone’s

familiarity with their voice or story. After the data was compiled and presented, there is no

direct tie to that person or their position, only the answers that the participant has provided,

ensuring the most amount of anonymity possible.

4a. Findings

In my research performed at Kearny County Hospital, I was attempting to qualify the

factors surrounding the success of the hospital. While the CEO has certainly been a catalyst to

the nearly unheard-of success of a rural hospital, there are many other factors that must be in

place for a hospital to not only grow, but retain talented and qualified professionals. This

growth and quality employee retention is also a result of leaders who are prepared and

understand their roles as well. In this study, I attempt to find the factors that contribute to the

success.

4b. Education
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Of the seven leaders interviewed, three had their associates. Two of those three are

nurses and the other manages a branch of food services. All three leaders who had their

Associates explicitly stated that an Associate’s degree offers no leadership training whatsoever.

The degree focuses specifically on the tasks involved within nursing on a general level. My first

interviewee stated, “It’s not in-depth ‘cause there’s just so much to learn in the nursing

program”, (lines 12,13) referencing the brevity of the program and amount of content just

devoted to nursing practice itself.

The three leaders with their associates degrees all mentioned mentors as extremely

beneficial in helping them navigate leadership challenges, primarily in regards to staff

interactions and disciplinary actions. One mentioned length of experience as beneficial to

leading. She said, “I don’t think it had anything to do with it” referring to her degree. She

continued, “My work experience had everything to do with it” (182,183). That same leader

mentioned trial and error as an effective method for growth as a leader.

All but one of the interviewees mentioned a meeting in which they read leadership

books and have conversation about them and found that as valuable continued leadership

investment by their direct reports. (85-86, 231, 369-370, 477, 629-631, 869-873)

The leaders with their associates degrees all expressed interest in continuing to lead in

the areas in which they are the most familiar, with mentions of continuing to develop the

culture and see the growth of their area in which they are currently leading as their highest

goals for their careers. One interviewee stated, “That’s where I want to go and change the

culture where I’m at, not sure if I want to go up any higher.”

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Another three leaders received a bachelor’s degree and all made mention of valued

leadership education and training as a part of that degree. All three felt equipped and qualified

to lead because of the education they received within that field degree’s field of study. “I

would have to say my classes in the OML (Organizational management and leadership) helped

me with leadership more than anything I’ve had through the hospital…” (271-272) commented

one interviewee.

Two of the three bachelors-educated leaders cited their education as beneficial in

solving leadership related challenges (320-322). All three leaders with their bachelors

mentioned mentors as helping them acclimate to their current position. One leader who has

been around longer than others mentioned that their entry into leadership at KCH was more of

an immersive experience rather than a calculated, informed move (304-306).

One of the bachelors-educated leaders expressed concerns about people in leadership

positions without a bachelors, but only cited vague concerns about them having leadership

“struggles in certain areas”. This leader also made mention of her own challenges early on in

her leadership, so the suspicion towards non-bachelor’s educated leaders may have to do with

her own personal experience.

Only one of leaders with a bachelors expressed any potential interest in advancing

beyond their current position. The other two expressed concerns that they might not be in an

area in which they are passionate and continue to focus on the culture within the department

in which they currently lead.

One of the interviewees has their Masters and felt like it gave them excellent leadership

training. She felt like it prepared her well to lead meetings, give presentations and understand
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how to communicate information to a variety of listeners. Because her job is so varied, she felt

like specialized training was needed in areas specific to certain areas of the hospital. While a

Masters degree prepares an individual for leadership in a generic sense, more training is

needed to navigate the specifics of a particular job.

She noted that because of her training within the organization and the requirements of

her job, she’s able to learn from the CEO things that are specific to the hospital. She cites

mentoring as a key aspect of what the hospital offers as far as continued education and

learning. She also notes that in regards to leadership training, the hospital doesn’t offer any in-

house leadership training besides a leadership meeting that discusses books, which is helpful,

but not as in-depth as it could be. Most leadership training is outsourced to Kansas leadership

center.

In regards to experience, she notes that it is valuable and combined with a masters

degree she feels more equipped to be successful in her current role at the hospital. She states,

“I feel like, at this point now, I have some experience and kind of know how to motivate and

mobilize people.” (833-844) Because of her schooling, access to successful mentors, and

experience, she feels the strong desire to continue to move up within the organization as she

desires to create an organization-wide culture of environmental awareness and understands

that with a higher position comes greater influence.

4c. Differences in Perspectives

The interviewees who have associates degrees tended to focus on the tasks of the

people they led. All mentioned interactions with CNA’s, who are the entry level staff who

handle any sort of nursing tasks. They mentioned a disconnect with quality of work, or
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disagreements or work ethic and alluded to themselves as having a better understanding of the

tasks versus the ethos of the role.

Those leaders with their associates degrees found experience and upper level

management to be the greatest influence on their preparedness for the role. When asked

about career advancement, the three leaders all expressed a desire to stay and continue to

influence at the departmental or shift level with no expectations or desire of advancement

within the organization.

When asked about continuing leadership education, they all found what the hospital

offered in the form of leadership book groups to be beneficial and cited continued reading as a

valid form of leadership development for their current roles. Only one mentioned pursuing

leadership growth outside of what was offered by the hospital.

The interviewees with bachelors degrees all agreed that their degree helped prepare

them for leadership. They cited classes within their degree requirement as being directly

beneficial for leadership and as being more valuable than what the hospital had offered, but

still found benefit in book study groups.

Only one interviewee with her bachelors would even consider moving to a higher level

of leadership and she expressed concern that she may have less influence over the culture in

which she is currently leading.

The interviewee with her Master’s degree emphatically posited that her education was

the primary influence in her leadership success. She expressed concern that KCH doesn’t

currently have any in-house leadership initiatives outside of a book study group.
FINAL QUALITATIVE RESEARCH PROJECT 13

In regards to career advancement, she expressed that advancement is absolutely one of

her goals and hopes to influence well beyond where she currently leads.

5a. Standards for Validation and Evaluation

In order to make sure that each interviewee was able to provide the same information

as every other interviewee, the questions that were asked were identical between each

participant. While I did personally know 2 of the interviewees, I did not know that they would

be participating in this research until I actually interviewed them. Each interviewee was given

the opportunity to answer each question as they saw fit, and the transcription from each

interview is included in Appendix B.

5b. Evaluation

Per Stake’s (1995) evaluative criteria for case studies, the strengths of this project are

that it develops a consistent story, it uses quotations effectively and the case is adequately

defined. The limited sample size and lack of extensive raw data do effectively limit the use of

this particular qualitative research, but it could be supplemental for a more comprehensive

study if paired with research from more organizations.

5c. Significance

The significance of this study lies in that the organization being studied is a hospital that

is both rural and growing. This is such an anomaly that there is not currently any academic

research into the reasons and causes behind it.

6a. Discussion

When I started writing the questions for this Qualitative research project, I hoped to

uncover at least one element that might help explain the success of Kearny County Hospital, a
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rural hospital that seems to be swimming upstream in a river of hospitals that are either

imminently closing or path towards closure and financial insolvency. My questions were

designed to bring out educational levels, future aspirations and concerns to determine where

these leaders felt successful and where these leaders felt more work was needed. What I

uncovered once I attempted to distill the information was a clear line of demarcation between

those leaders with an Associate’s degree, those with a Bachelor’s, and those with a Master’s

degree. It could certainly be argued that those who have roles only requiring an associates

would be simply focused on accomplishing tasks while those with higher degrees have a more

organizational or departmental focus. However, all of the individuals interviewed were in

leadership positions, at the very least requiring a departmental focus.

6b. Conclusion

This would lead one to believe then, that either those individuals who pursue higher levels of

education are people who inherently see a bigger picture, or they were trained to do that

within their education. More research on this would be required in order to develop a hiring

process that could soundly declare that all individuals with higher levels of education would be

better suited to lead at a managerial level within the parameters of a rural hospital.
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7a. References

Commins, John. (2015). Rural healthcare and the challenge of population health: The issues facing

rural providers are significant, but leaders are creating ways to survive in the changing

healthcare environment. HealthLeaders Magazine.

Howitz, J. and Nichols, A. (2018) Rural hospital ownership: medical service provision, market mix, and

spillover effects. Health Services Research, p. 1452

CFO Innovation Asia (2016) Study Reveals Most Businesses Are Not Prepared For a Growth Surge. CFO

Innovation Asia; Newton.

Hayes, C. W., Rhee, A., Detsky, M. E., Leblanc, V. R., & Wax, R. S. (2007). Residents feel unprepared and

unsupervised as leaders of cardiac arrest teams in teaching hospitals: A survey of internal

medicine residents*. Critical Care Medicine, 35(7), 1668.

Kaufman, B. G., Thomas, S. R., Randolph, R. K., Perry, J. R., Thompson, K. W., Holmes, G. M., & Pink, G.

H. (2016). The Rising Rate of Rural Hospital Closures. The Journal of Rural Health: Official

Journal of the American Rural Health Association and the National Rural Health Care

Association; Washington, 32(1), 35–43.

Baxter, C. and Warshawsky, N. (2014) Exploring the acquisition of nurse manager competence. Nurse

Leader Magazine. Mosby (2).

Roberge, C. (2009). Who stays in rural nursing practice? An international review of the literature on

factors influencing rural nurse retention. Online Journal of Rural Nursing and Health Care ,9(1).

Muus, K. J., Ludtke, R. L., & Gibbens, B. (1995). Community perceptions of rural hospital

closure. Journal of Community Health, 20(1), 65-73.

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Alves Pereira, L., Domingues Hirsch, C., Silva Silveira, R., Tomaschewski Barlem, J. G., Schalenberger, C.

D., & Devos Barlem, E. L. (2018). Nurse-Leader Construction Process Barriers: An Ethnonursing.

Journal of Nursing UFPE / Revista de Enfermagem UFPE, 12(5), 1372–1380.

https://doi.org/10.5205/1981-8963-v12i5a234546p1372-1380-2018

Muus, K. J., Ludtke, R. L., & Gibbens, B. (1995). Community perceptions of rural hospital

closure. Journal of Community Health, 20(1), 65-73.

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Appendix A: Interview Questions sent to interviewees.

The purpose of this interview will be to assess the overall feeling of confidence and

preparedness of leaders at the managerial level. This information will be used for a qualitative

research study for a Masters level class at Fort Hayes State University. You have been selected

because you are a manager at a successful and growing rural hospital which is abnormal among

rural hospitals. I will ask a series of questions regarding your leadership experience, education

level, expectations and goals for the future. Your honesty in this interview will benefit the

hospital whether they are positive or negative or neutral. I will be recording the audio of this

interview for transcription at a later time.

Your anonymity will be protected and only the aggregate data from all of the interviews will

be presented to executive leaders and my class professor. Nothing tying your name or position

to your answers will exist, so you can be honest with me. You can also stop the interview at any

point if you’re uncomfortable with the questions or choose not to answer them. There are no

right or wrong answers. There is simply your perspective on the questions I’m asking.

I’ve also requested that I not know who you work for specifically, as my father is the CNO,

and I don’t want your answers to be biased because of that relationship. The goal is to study

the managerial leaders and see their impact on the success of this organization.

1.) In what ways has your educational background prepared you to take on leadership roles

within the organization? What areas of leadership did it not prepare you for? Why?

2.) How long have you been leading in any capacity? Were you leading before you were

employed at Kearny County Hospital?

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3.) What did Kearny County Hospital do to prepare you for your leadership role? In what

ways was this sufficient or insufficient?

4.) Think of a time when you encountered a leadership challenge you felt prepared to

tackle. What was it and how did your training or education help you approach the

situation well? Think of another situation where you encountered a leadership

challenge you felt unprepared to handle. How did you resolve it and where did you go

for help to manage it?

5.) What leadership training have you had beyond your degree? Was leadership training a

part of your degree?

6.) Do you hope to be promoted at some point beyond where you currently lead? Do you

feel safe enough to express that to your direct report? Why or Why Not?

7.) What are you currently doing to grow as a leader on your own?

8.) What are your goals for your career as a leader? How are you working toward these

goals? What could the hospital do to help you toward these goals?

Thank you for your time and your honest responses to this interview. If you would like a copy

of the study when it is completed, my email address is cbpldc@gmail.com. If, within the next 3

weeks, you’ve changed your mind about your participation in the study, please contact me and

I will remove your answers. Again, thank you for your help in my project and for investing your

time in helping Kearny County Hospital as you invest in people.

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Appendix B: Transcript of Interviews

M = Me
I = Interviewee

Interview 1

M: In what ways has your educational background prepared you to take on leadership roles
within your organization?

I: Um, so, for my educational background, um…I did, of course the ADN program at Garden City Commented [C1]: Associates degree
Community college and they do talk a little bit about leadership as nurses, um….in that program
you do go through a small section of leadership through one of your semesters. It’s not in
depth ‘cause there’s just so much to learn in the nursing program. Commented [C2]: Very little leadership in associates

M: Oh my gosh, yes.

I: Um, yeah, I was going to say, I think you’ve probably experienced that with your wife, right?
So, it’s a lot. Um….so, in a way, it didn’t really prepare me totally for this position. Now, for a Commented [C3]: Education didn’t prepare for leadership
charge nurse position on the floor, yes. But as for a director of nursing services, no. Not at all. role

M: Okay *laughing. Well, that answers my second question. Um, so I guess its what areas did
it not prepare you for and why? Specifically, the differences between what you got there and
what you have here.

I: Like I said, because there’s so much information you have to learn because in the nursing
program, you know, for education, you’re focused on um….patient safety and critical thinking
and okay, so here comes this patient and this and this and this is what’s wrong with them and
all these answers are correct, which one is the most right. And so you’re learning those critical
thinking skills, which do help when it comes to leadership because you’ve got to have that there
with some of the problems you address, but as far as um, showing how to, like an area I
struggled in when I first came here was I wanted to do too much, and I wanted to help them
too much and I didn’t understand where to draw that line, or what tools I could use, or um,.. Commented [C4]: Accidental micro-managing

M: When you say “them”, do you mean those whom you’re leading?

I: Yeah, yes, I wasn’t prepared for that, to a point. Um…I’ve been in long-term care for a lot of
years and I’ve worked under several different DON’s (Director of Nursing) and they actually
made this job look really easy, but once I got behind the door and behind this desk, I was like,
“Holy cow” how did they do this? Because I never saw this side of it, so… um, it didn’t prepare
me to have those crucial conversations, it didn’t prepare you to make choices well, um, there’s
a conflict between two staff members, how will you handle it? You know, it didn’t prepare you
for that.
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M: Okay. You use the term ADN, could you define that for me?

I: Um…yeah….the associates degree in nursing. That’s an ADN, sorry.

M: No, that’s fine. Um, how long have you been leading in any capacity?

I: Uh, two years.

M: Two years, okay. Were you leading anywhere before your were employed at Kearny County
hospital?

I: No, um, I worked in a surgery department. I had an awesome team there. We actually all Commented [C5]: No leadership experience before KCH
had kind of the same work ethic and personalities and we had a great leader and I was a
recovery room nurse and our supervisor did an amazing job, and I think it helped that we were
all kind of on the same page with how we did stuff, So, no. I did not.

M: Okay. What did Kearny County Hospital do to prepare you for your leadership role?

I: So, one thing that helped a lot um, when it came to this position, I did not understand what
was expected. I didn’t know what the exact role of director of nursing services meant. The
year I came was the year CMS, center for Medicaid/ Medicare services decided to roll out all
new regulations for long-term care. Um, its been very stressful. And um, I didn’t have the best
mentor at that time- she’s a very, very good nurse, I don’t want that to be construed, but long
term care was not a passion of hers. So it wasn’t what I needed, so what happened was we got
with a consultant who is a long term care guru-she knows everything about it. She did it for a
lot of years, and she’s retired and now what she does is consult with long term care facilities.
So she came in and that started to change around how I did things here. So I finally had, like, a
mentor, somebody to say “this is what you do in long term care, here’s the regulation”. Then Commented [C6]: Mentor for leadership role
KCH put me through Leading Age Kansas, it’s a non-profit organization in Topeka for places with
aging services. They have a center for leadership that’s a year long program, and I actually
completed it in July. And that was the greatest thing in the world. I would do it again in a
heartbeat. Like, the stuff you learn listening to other people’s stories, going to other long term
care facilities, you just learn so much. It was amazing. Commented [C7]: Leadership training from outside source

M: And so, um, I feel like you kind of described in what ways that was sufficient – the
mentoring, and understanding the stories of others and applying those. In what way do you
feel like there were some areas that it didn’t cover, like you had to find things out on your own
or figure this stuff out?

I: Um, yes and no. One thing I didn’t mention that we’re doing here that I absolutely like,
because I do love to read. I can read an entire book in one day. That’s my favorite thing to do
but with kids it doesn’t happen so much any more, but uh, we started a book club with the
book Crucial Conversations and right now, the book that we’re reading, Hardwiring Excellence, I
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love that book. Like, I’ve ordered it for some of my staff members and we meet every other
week to discuss it. Okay, what from this book can we apply here, and we’ve started to do that
stuff. So those areas that weren’t so much covered in the center for leadership, I’ve been able
to pull from those books. Commented [C8]: Leadership books read in staff

M: Okay, Excellent. Think of a time when you encountered a leadership challenge that you felt
prepared to tackle. What was it and how did your training or education help you manage the
situation well?

I: Um, Hmm…I’m trying to think of something. So, um. I know there’s been times, but Jesus I
can’t recall them. Um. Oh yeah! I had just gotten home, and I got a call from one of my
supervisors. She said, “You’ve got to get back up here, a CNA and a nurse have gotten into an
argument, they both are crying , both want to leave because they’re so mad at each other. I
was like, “okay”. So I got in my car, drove back up here, and pulled them each in separately and
listened to their side of the story, cause something I’ve definitely learned is that there are two
sides to every story, you should listen before you react. Um, and once we got done I said,
“We’re going to try an exercise that I learned in my center for leadership class called active
listening.” And what it is, is, you face each other, the two of them faced each other and for five Commented [C9]: Apply technique from leadership
minutes they had to actively listen to what the other was saying on how she felt about the training

situation. And then, once that time was up, the one who was listening had to tell her, had to
say back, “Okay, when you said this, I heard you say this.” And then the other one, for 5
minutes got to tell her story, and the other one got to say “this is what I heard from you.”. And
by the endof it, they were actually talking to each other, and they understood why…the CAN
took it as the charge nurse didn’t have faith in her and the charge nurse took it as there were
some nursing things that should have been done, but that’s not what came out of her mouth at
the time. When you’re on the floor, our minds work a mile a minute sometimes, and so it
ended up being a miscommunication. Both staff members had the interest of the resident in
mind, but they didn’t communicate and they weren’t willing to listen to each other until they
were forced to. I felt that was the first time I felt like I could apply a tool and it really worked.

M: That’s very cool. Can you think of another situation where you encountered a leadership
challenge that you felt unprepared to handle?

I: Um, so…one challenged I’ve been faced with a lot lately is I’ve had staff members lose close
relatives to them. This last year, my assistant’s daughter was killed in a car accident and one of
my nurses grand-daughters drowned in a pool on the 4 th of July. And that was something I
wasn’t prepared for. I should have gotten a degree in psychology or something.. along with
this. Because where I don’t feel I’m prepared is …. One area I struggle with is empathy, and if
that was my child, I don’t think I’d be able to function again. And so I’ve been very lenient,
which some of the other staff gets very frustrated with. But I’m like, if it was me, I’d need
someone to be very calm, kind and compassionate with what I’m going through. That’s what I
try to give to them and it comes off the wrong way sometimes, because I…even with the
nurse..she is different than she was before the accident. She doesn’t have much patience, she
gets very angry very easily. It’s just been very, very, very interesting, and I do struggle there. Commented [C10]: Possible chaplain training?
FINAL QUALITATIVE RESEARCH PROJECT 22

M: So, leading your team through tragedy

I: Yes, especially…that is one thing I really struggle with because I try to put myself in their
shoes and I think about how I’d want to be treated. That’s not working very well.

M: You mentioned earlier about a leadership opportunity in Topeka…The next question may be
answered by that. What leadership training have you had beyond your education and was
leadership training a part of your degree?

I: Um, so, I had the center for leadership , but right now I’m also taking a class that will take me
about a year to complete at your pace to become a board-certified geriatric nurse. Um and in
that there’s a huge section on leadership in aging services so that will also get me um, some
more training in leadership too, and I’ll have that board certification behind my RN title. Commented [C11]: Continued education in leadership

M: Just collecting those initials, huh? My wife has a bunch behind her name too. I get it.
Do you hope to be promoted at some point beyond where you currently lead right now? Do
you feel safe enough to share that with your direct report? Why or why not?

I: Um, I don’t know if I really want to be promoted at some point. Because one, I like aging
services, and to go to an administrator role, I wouldn’t get to do it. Two, this is probably going
to sound bad, but there’s been a huge change in the work force. Huge. Um, and I think there’s Commented [C12]: Not interested in greater leadership
going to be a struggle in the future with “well, that schedule doesn’t work for me, can I come in role

at this time” or, kind of those little things that you’re already seeing and um, we have a huge
nursing shortage in our country in general and it doesn’t seem to be ending and so um, I don’t
know this will always be something I want to do because of that, because of the mentality
change and stress, beause it does take away from my family and my time, and your kids are
only young once. And I don’t like missing out on some things, so as far as going on, I want to
do…my ultimate goal with aging services is to try to make it home for our residents and it be
like “this is the way I did things at home, and that doesn’t have to change when they come
here”. When I get to that age where I might need nursing care, I worked since I was 15, I’m
retired now and I’m not waking up at 6:15 in the morning because it suits the schedule of some
nurse. I am sleeping in, watching whatever show I want to watch. I am doing what I want to do
, because even if my mind or body has failed me, I still have the right to do what I want to do
because I paid my dues. I think everybody deserves that. That’s where I want to go as a leader
and change the culture where I’m at, not sure if I want to go up any further. Commented [C13]: Wants to change culture in her
department.

M: Okay. That’s very reasonable. What are you currently doing to grow as a leader? You
mentioned that earlier as well, right?

I: Yeah, I like to learn and read books, and even after this one, there’s a book called Extreme
Ownership and there’s a second book that goes with it that I want to read as well. Um, it will
be interesting to say what the author has to say. As a leader you can never stop learning. Um,
some people are natural born leaders, and some aren’t, but you can always learn. Commented [C14]: Leaders are learners.
FINAL QUALITATIVE RESEARCH PROJECT 23

Interview 2

M: In what way has your leadership background or education prepared you to take on
leadership roles within the organization you currently work for?

I: Uh, personally, I don’t think my education had anything to do with leadership. My work
experience had everything to do with it. Commented [C15]: No leadership training in associates.

M: Okay, excellent. What areas of leadership did you feel like your work experience didn’t
prepare you for?

I: Well, I went to school for an LPN, and I don’t think they taught us anything about leadership.
Because most of the time you’re under the leadership of an RN. So, I don’t believe it prepared
me for any of it.

M: Okay, that is certainly fair. How long have you been leading in any capacity?

I: I would say probably the last, um, probably…management leading? I’ve been a charge nurse
for 30 years. Yeah, thirty years.

M: Okay, Excellent. Um, and were you leading before you were employed at KCH?

I: Yes.

M: What were you doing?

I: Charge nurse

M: Okay. What did KCH do to prepare you for your leadership role?

I: Um, I think I had some good mentors. The DON that was here prior taught me a lot. And Sue
Staley taught me a lot. Commented [C16]: Mentors help in leadership training.

M: Okay. Um, in what ways was this sufficient or insufficient?

I: Um… I think it was sufficient. I think some of the stuff you just have to learn as you go. Commented [C17]: Experience as a teacher.

M: Okay. Think of a time when you encountered a leadership challenge that you were
prepared to face. What was it and how did your training help you approach the situation well.
FINAL QUALITATIVE RESEARCH PROJECT 24

I: Um, I guess just dealing with staff and attendance, and that just comes from many years of
dealing with CNA’s and you learn as you go, you learn how to deal with them and what works
and what doesn’t work.

M: And on the other side of that coin, think of another situation where you faced a leadership
challenge you felt unprepared to handle . How did you resolve it and where did you go for help
to manage it.

I: Um, I think it was probably when I had to deal with a family member, and I used my superiors
to help me because I didn’t know the answers, so I, I feel like here, there’s a lot of people you
can go to for help with the answers if you don’t know what they are. Commented [C18]: Upper management is helpful.

M: Excellent, okay. Um, what leadership training have you had beyond your degree?

I: Um, your dad is having us read some books (my dad is the Chief Nursing officer at this Commented [C19]: Executive leadership is interested in
hospital), some leadership books. We’ve done, we’re on our second one now. Um, as far as investing in leaders

leadership training, he’s the only one I’ve worked with in all my years of working that’s
addressed any leadership issues, or training.

M: Okay, awesome. Do you hope to be promoted at some point beyond where you currently
lead?

I: No… Commented [C20]: Comfortable in leadership role

M: Okay, if you did would you feel safe enough to express that to your direct report?

I: I would feel safe enough to tell them that. Its because he listens well, Mary listens well.
Those are my two people, so I wouldn’t have a problem telling them. I wouldn’t be
uncomfortable. Commented [C21]: Executive and upper management are
approachable

M: Okay. I think you answered the next question already, but is there anything you’d like to
add to what you’re doing to grow as a leader?

I: Yeah, reading those books and learning from them. Commented [C22]: Team book reading viewed as
beneficial.

M: Sure, what are your goals for your career?

I: Um, I’m happy where I’m at. I don’t care to go back to school. I don’t care to…

M: * laughing* Otherwise, you’d be doing this!

I: Yeah, exactly. I don’t care to become any higher on the ladder than I already am. I’m quite
content.
FINAL QUALITATIVE RESEARCH PROJECT 25

M: Well, that is all of your time that I need today. Thank you for your time!

Interview 3

M: Okay, in what ways has your educational background prepared you to take on leadership
roles within the organization?

I: My educational background is…I have an associates in nursing and a bachelors in Commented [C23]: No leadership in Associates
organizational management and leadership through Friends. I would have to say my classes in
the OML helped me with leadership more than anything I’ve had through the hospital or
leadership classes offered here. Commented [C24]: Bachelors focused on leadership

M: Alright, what areas of leadership did it not prepare you for?

I: Hmmm…. I think maybe sometimes just the day to day ways to talk with different staff in
different ways, a situation I think some more ways to communicate with people would have
helped. Commented [C25]: Communication classes possibly
beneficial

M: Oh, sure. That’s good. Um, how long have you been leading in any capacity?

I: Um, I’m an old nurse, I mean a lot of years. I’ve been here for 18 years, I mean I’ve been in a
supervisor role for that long at this hospital.

M: Okay, good. Um, were you leading before you were employed at KCH?

I: Yes.

M: Alright. And what did you do?

I: Um, before I came here I worked at St. Catherine’s Hospital for a couple of years and I was
not in a supervisor role there. Before moving to Kansas, I was in a hospital where I was, what
we call a house supervisor.

M: Uh, huh. Sure. Uh, what did KCH do to prepare you for your current leadership role? In
what way was this sufficient or insufficient?

I: I, when I first took the position I was..I don’t know, I was kind of talked into it when I first
came. Commented [C26]: Unclear initial job understanding.

M: Okay.
FINAL QUALITATIVE RESEARCH PROJECT 26

I: Because there was a need and I just uh, fell in love with the patients and how things can
happen here. So, I don’t really think I was given anything to really help me with leadership in
the beginning.

M: Okay.

I: Did I answer that question?

M: Absolutely. So, it was kind of a trial by fire?

I: laughing Yes, yes it was

M: Okay. So think of a time when you encountered a leadership challenge that you felt
prepared to tackle. What was it and how did your training or education help you approach the
situation well?

I: So the training I took from Friends is what I’d be referring to. So like, a task force to come up
with a solution for something and how to have those meetings and filter out the brainstorming
and come up with a solution. Is that what you’re looking for? Commented [C27]: Implemented Bachelor’s training.

M: Absolutely. That’s perfect. How about on the other side of that coin, did you have a
situation where you felt unprepared to handle it, how did you resolve it and where did you go
for help?

I: Oh, I’d have to say terminating an employee. And I went to the administrator for assistance. Commented [C28]: Upper management and executive
level leaders helpful.

M: Okay. Gotcha. What leadership training have you had beyond your degree? Um, and you
answered that leadership was a part of your degree.

I: Mmhmm. Through the hospital we’ve had um, little pieces of leadership training throughout
the years. Whatever the leadership fad was we got a little taste of it, but never the full Commented [C29]: Leadership seminars
experience.

M: Okay. Um, do you hope to be promoted at some point beyond where you’re currently
leading, and then do you feel safe enough to express that to your direct report? Why or why
not?

I: I, uh, I’ve been asked about that several times. I don’t know that I really want a position
higher than what I have. I often think that my title as supervisor might better be called a
director than a supervisor, you know. Maybe you shouldn’t put that on there, I don’t
know…Um, I’m happy in my position.

M: Okay, that’s fair. That’s good. And do you feel safe enough to express those thoughts to
your direct report?
FINAL QUALITATIVE RESEARCH PROJECT 27

I: Yes. Yeah, I think he knows I’m happy where I’m at. Just, I think would like to see me take
his position one day. Maybe don’t put that in there either. *laughing *

M: Okay, sure, that’s fine. What happens is that this information will get transcribed, but the
transcriptions themselves won’t go to anyone here at the hospital or be a part of the overall
research project.

I: That’s fine. You know, I’m gonna be 57 this year, and I know I’ve still got a lot of good
working years left, but I was see this department in its fullest before I leave, and if I become the
CNO, I would have a broader, more things to take care of. This is my baby, I feel like, and I just,
you know I just, you know I’m passionate about this and I don’t want more than… Commented [C30]: Wants to continue to influence culture
within department.

M: You own responsibility for the culture and want to continue to foster it, right?

I: Yeah. That’s right.

M: What are you currently doing to grow as a leader on your own?

I: Well, I do read my nursing journals and I’m active on list serves with other managers and we
talk about how to handle different situations or similar situations . I would say that’s probably
the biggest way and I, uh, we uh, share a book that William has for us at our nursing
management meetings. We do that also here. Commented [C31]: Team book reading.

M: That’s super important. Okay, what are your goals for your career as a leader?

I:Um, to have staff that want to work here and be happy. To have a happy staff um, you know,
provide excellent patient care that takes patient’s safety first. That would be my goal, um. Commented [C32]: Influence immediate culture within
department.

M: Great. What could the hospital do help your towards these goals?

I: Maybe uh, offering more incentives to get better, or uh different employees to come here.
Um. An incentive package to get nurses to come here. Commented [C33]: More quality employees needed.

M: That’s an excellent suggestion! That’s really good. Okay, well, that’s all I have.

I: That’s it?

M: Yep. Thank you for your time!

Interview 4
FINAL QUALITATIVE RESEARCH PROJECT 28

M: Okay, um, in what ways has your educational background prepared you to take on
leadership roles within your organization?

I: Well, um, I have my BSN, so that was a requirement for clinic nursing supervisor. We’ve had
uh, supervisors in the past who didn’t have their BSN and there were some concerns I think
maybe with, you know they didn’t have the educational background that maybe they had
struggles in certain areas. Um, there’s definitely the leadership piece of the BSN I feel, you
know, my education was 10 years ago and I just now am stepping into this role and its been like
6 weeks. But, I think it’s a mental shift for me to go from direct patient care to you know, my Commented [C34]: Bachelor’s degree includes leadership.
nurses are my patients now, essentially.

M: You’re managing the culture of patient care.

I: Right.

M: Good, okay. Um, what areas of leadership do you feel like your degree did not prepare you
for?

I: * laughing * HR. Oh, that’s a tough piece. There are, there’s a lot of… I mean, you’re trying
to deal with…um, dealing with disciplinary action plans, nurses who are not doing, providing
quality patient care, and nurses who are posting to Facebook while they’re on the clock and
that was not in my nursing textbooks. Commented [C35]: Unprepared for HR.

M: No, not at all. Alright, so you made mention of being in the role for 6 weeks, is that how
long you’ve been leading in any capacity?

I: Um, well, in this capacity, yes. I noticed that for quite a few months before switching over, I
noticed that a lot of nurses would come to me with random questions. Um, when I was in
Wyoming for four years, our school nursing program was more of a program than it is here.
There was a nurse for every building, we didn’t share buildings. But as a nurse there, you were
practicing on your own and it was required you have a bachelor’s degree and it was a form of
nursing leadership because you weren’t practicing under anyone. Which is interesting…

M: Okay, well that answers the back end of that question too. What did KCH do to prepare
you for your leadership role and in what ways was this sufficient or insufficient?

I: Uh, that’s a good question. I did not have much of an orientation, but they have really been
good about last week, with your dad, they sent me to a conference in Salina, next week I’m
going to Austin and in a month I’m going to Hays. They’re really good about send you to
conferences that matter, that have good education, with things that are important to your job.
Um, quality measures that we measure in the clinic, or mental health is a huge focus for us in
our community and um, so that’s where we’re going in November. They’re really good about Commented [C36]: Seminars beneficial to leaders.
sending you there, so they’re good about equipping leadership. Commented [C37]: KCH is good at getting leaders training.
FINAL QUALITATIVE RESEARCH PROJECT 29

M: Okay, think of a time you encountered a leadership challenge you felt prepared to tackle.
What was it and how did your training or education help you approach the situation. A time
when you were like, “Oh, I know what this is!”

I: * laughing * Um, this is probably a lame example, but recently, so flu shots are a big deal this
time of year in the clinic. We have ordered a lot, mucho flu shots. And we’ve received about
12 of them. It is not our fault, it’s the sender. It’s a government program that we order
through and silly details, but they’re just releasing them bits at a time and we don’t know
unless they just show up that they’re here. So uh, its caused some frustration for our nursing
staff and they’re coming to me like “I can’t give flu shots”. Its silly but it’s a huge deal in the
clinic and so, reiterating to them why we can’t and making a plan, so if you need stuff, you
come to me, and I can distribute it evenly. Dumb example but its right here and fresh in my
head.

M: No, that’s answering my questions. It’s fresh to you, so… On the other side of that coin.
Think of a leadership situation that you felt unprepared to handle and how did you resolve it
and where did you go for help?

I: * laughing * We currently have a situation with a nurse and I’m concerned with the level of
patient care that she’s providing. We’re concerned about some decisions she’s made. Um, and Commented [C38]: HR knowledge lacking. This reflects a
so, as far as who to go to…Lacey is a huge help (Lacey is the HR director) she does love stuff like departmental focus vs. an organizational one.

that, but really, where do we go? HR is helpful and also, your dad is incredibly helpful. Um, he
is so… its like, I don’ want to go into too much detail with her, but it will take some disciplinary
action, come up with a plan, you know, and I haven’t done that ever. And we had another
situation not too long ago, we had a new employee who was not meeting expectations and she
knew what they were, she was not doing them, and she was going behind our back on some
things, so we had to fire her. That is painful. And um, Lacey was really helpful with that. And
HR. But that is the stuff I don’t feel prepared for. I don’t know if you even have to fire anybody
in your line of work, but its awful.

M: I have actually. I had to fire employees and volunteers.

I: Oh yeah, well that’s…. *laughing *

M: Yeah, I feel that. I feel that for sure.

I: Uh huh.

M: What, uh, leadership training have you had beyond your degree? You knid of mentioned
that when you talked about seminars that are topic specific to your job. Anything else?

I: Yeah, The seminars, reading a book with the nursing leadership meetings. Commented [C39]: Seminars and books seen as
investment.
FINAL QUALITATIVE RESEARCH PROJECT 30

M: Okay, cool. Do you hope to be promoted beyond where you currently lead? And do you
feel safe enough to express that to your direct report? Why or why not?

I: Uh, well… I don’t really know. I just started in this position.

M: Laughing *

I: Uh, I, so. My point of view is, how much time am I currently investing? I started working
here three days a week, increased to four, now I’m at five. And I really wanted to be part time
and now I’m not part time anymore. And so, if I …I like this, and I don’t know if I’d even want to
be any higher or not. Commented [C40]: Comfortable in current leadership
position. This may be reflective my relationship with the
CNO.
M: That’s a fair answer.

I: I feel like I could express that to my leaders though. I have no issue with that.

M: Okay. What are you currently doing…..what are you…I can’t talk. That will be fun to
transcribe. Let me start over *laughing * What are you currently doing to grow as a leader on
your own?

I: I: Um, well, our nursing management group is doing a book study, on a leadership book.
Um, I definitely take mental notes. I go to an insane amount of meetings on …for all different
kinds of reasons. I take notes on what people are doing, how they address certain issues, um
what we can do to avoid this or that kind of scenario. Um, ask a lot of questions. I don’t mind
asking a lot of questions. I think that’s important to learn to grow.

M: Absolutely. Super important. What are your goals for your career as a leader?

I: Um, you know, I think gaining trust with my little nursing minions *laughing *, gaining trust is
important to me. Because I want them to know I care about them. And I will take care of them Commented [C41]: Gaining trust. Creating culture.
well, that I have high expectations of them. If they take care of our patients well, I will take
care of them well, you know?

M: Okay. That’s cool. Then what …as you think about your goals, what could the hospital do to
help you towards those goals.

I: Um, uh, I mean, I don’t know that I could think of anything specific. But if there was a
nursing leadership seminar or opportunity to go to something like that, I’d do that. They’re Commented [C42]: More value on Seminars.
pretty good about answering my questions and nursing leadership above me is always ready to
help. So far, they’ve been very helpful. But I’m still really fresh *laughing *

M: Yeah, well, I appreciate you taking time out of your day to meet with me.
FINAL QUALITATIVE RESEARCH PROJECT 31

Interview 5

In what way has your educational background prepared you to take on leadership roles within
the organization? What areas of leadership did it not prepare you for?

I: I think part of just going to school to be a nurse teaches you to be a leader. I think that’s part Commented [C43]: She has a BSN. Bachelors teaching
of what our education provides us with is some leadership ability because you have to be able leadership.

to work by yourself, following orders or whatever. But you have to be able to make some
decisions on your own. Um, what areas did it not prepare you…. I just can’t think of…Um…

M: Is there some…I’ll dig in a bit later, maybe that will help.

I: Okay.

M: Um, how long have you leading in any capacity?

I: Um, well I started over at the clinic and I worked there for several years and then became the
clinic nursing manager. And had that position for several years until I stepped down. And I
stepped down for personal reasons, not for any other reason. But I feel like that position was
given to me because I was one of the only nurses. Or the only RN and I’d been there the
longest. So then, you know. When it came down to the fact that I didn’t want to do it
anymore, then I stepped down. And um, continued to work over there, and then um, when I
applied for the position over here, I wasn’t aware it was a nursing management position, but
Sue made it a management position…

M: And there you are again..

I: * laughing * Exactly, Here I am again. But its different. Just because I’ve been here for so
long.

M: Okay. So were you leading before you were employed at KCH?

I: Just in the nursing capacity, not with the title of leader.

M: Gotcha. Okay. What did KCH do to prepare you for your leadership role?

I: I think that …I mean, just the support that I’ve had from my supervisors, has given me a lot of Commented [C44]: Mentors
the leadership skills that I have.

M: Okay. In what ways was this sufficient or insufficient?

FINAL QUALITATIVE RESEARCH PROJECT 32

I: Um, I think that its gotten better. Um, when I was um the nursing manager over at the clinic,
you didn’t have any backing any of that kind of stuff and I didn’t want that position anyway.
But I feel like since I’ve come over here its just gotten a lot better.

M: Okay. So you feel like you have more people to go to?

I: I do. Over here.

M: Think of a time you encountered a leadership challenge you felt prepared to tackle. How
did your training or education help you approach the situation well. So, something came up,
and you were like, “Ooh, I know how to deal with this because blah, blah blah.”

I: Well, the most recent one that I can think of was probably when I walked out to the desk and
two of our staff members were arguing with each other. I asked them both to go into the other
room, or the other office, because that was when my office was over by the nurses desk. And
you know, we discussed it and I told them that yelling at each other at the nurses desk was not
appropriate . We don’t do that, and if we have a problem that they need to take it to , you
know they don’t need to sit out there and squabble, because it causes hard feelings with the
other nurses, with everybody . Because if we allow them to do it, then we have all the
bickering between the nursing staff and that’s something that I just don’t want. Commented [C45]: Lack of mentoring at this time led to
leadership failure.

M: Everybody takes sides?

I: Yeah, it seems like it, and I feel like that’s what they were doing out there. And so I had to, I
felt like I was able to take care of it. Um, I got them both calmed down, figured out what the
problem was um, explained to them, talking about other people, and um, making snide
comments about each other was just not acceptable.

M: Okay. So think of another situation where you encountered a leadership challenge that you
felt unprepared to handle. How did you resolved it and where did you go for help?

I: Um, it would have probably been when I was at the clinic and I had my own issues with of my
staff members. And its kind of the same situation and maybe somebody should have said,
“Monica, that’s enough” * laughing *

M: * laughing * That’s fair. That’s totally fair.

I: So I didn’t handle it, you know. I think a lot of that comes with age, you know. Um,

M: What is it they say about experience? Its that thing you get just after you need it?

I: * laughing * Yeah, yeah! So, I didn’t handle it as well as I probably should have. Because
what I wanted to do and what one of the girls that was sitting next to me that’s a good friend
said to me “I thought you were going to go over the table at her”. And I told here, I wanted to ,
FINAL QUALITATIVE RESEARCH PROJECT 33

but you know that’s…but you know with age comes that…you know. So I don’t know if…I think
partly the age, and partly having the support from my supervisors helps with that. Commented [C46]: Mentors

M: Yeah, absolutely. That’s an excellent source. What leadership training have you had
beyond your degree?

I: Just the stuff from my supervisors. Meetings and books, that kind of stuff.

M: Okay, Okay. Um, do you hope to be promoted beyond the point you currently lead? Do
you feel like you could share that with your direct report? Why or why not.

I: I don’t necessarily need to be, you know, I don’t know that I want to be promoted. I like
what I do, where I’m at.

M: Okay, do you feel like you’d be safe to express that to your direct report if you did?

I: Mmmhmm… Absolutely, yes.

M: Okay, Um, what are you currently doing to grow as a leader on your own?

I: Um, like in our nursing management meetings. We were reading crucial conversations.
We’ve read some other books that have really helped me personally, because we read, one
person reads a chapter and talks about it. Then we kind of have a round table about it.

M: Okay, cool. And then, what are your goals for your career as a leader and what could the
hospital do to help you achieve them.

I: I mean, just to continue to make myself um, I mean, my biggest thing is I want to support the
staff that’s out on the floor. And if me being in the nursing management role helps that, then I
want to continue to do that. Um, and I think that like, my direct supervisor has been great,
because these books he’s brought to the table and given us to read have helped a lot. I think
just continuing to do that will help immensely.

M: Cool. That’s good to hear. What else can the hospital do to help?

I: Just continue to be supportive.

M: Okay. Well, that’s all I’ve got.

I: Alright.

M: Thank you so much for your time!

FINAL QUALITATIVE RESEARCH PROJECT 34

Interview 6

M: Okay, in what ways has your educational background prepared you to take on leadership
roles within the organization?

I: You know, in school, actually, and you’ve gotta remember this was back in the 70’s, early
70’s, so, um. Okay, when I was going to school there wasn’t a lot of leadership classes that we
took. You know what has probably helped me the most is um, the organization having some Commented [C47]: Associates, no leadership training.
leadership type programs, and also, Iv’e gone to several outreach classes. Um, to do leadership Commented [C48]: Seminars, conferences.
through these 45 years I’ve been working. So um, I would say that’s what’s probably prepared
me the most.

M: Okay, those are good. Um, how long have you been leading in any capacity?

I: Um, 40 years. Since 76, so uh, 42 years.

M: Right on! Um, were you leading before you were employed at KCH?

I: Oh yes. I uh, I did worked at Syracuse at the hospital. I worked at Ulysses at the hospital.
And I also did sales about 5 years and then I came back here.

M: Okay. What did KCH do to prepare you for your leadership role?

I: We had several leadership um, at first when I came probably there wasn’t a lot. But since
I’ve been here we’ve had several leadership seminars that we’ve done in-house and um, I’ve
gone to several outside the hospital and you know, my association. Commented [C49]: Leadership seminar and professional
associations.

M: Okay, awesome. In what ways do you feel like this was sufficient, and what ways do you
think it may have been insufficient?

I: most of them I’ve went to have been pretty sufficient, gave me good information, you know,
um, to um, take back.

M: To help you lead in the role that you’re in?

I: yeah, certainly.

M: Okay, think of a time in your life when you encountered a leadership challenge that you felt
prepared to handle. What was it and how did you training or education help you approach the
situation.
FINAL QUALITATIVE RESEARCH PROJECT 35

I: you know I think I see that pretty much daily. Um, with new people coming to work. We
have the millennials coming in and not that millennials are bad, but they just have a different
take on what it takes to be an employee. So that’s been a challenge. But its also been Commented [C50]: Experience and seminars beneficial to
something they’ve talked about in our different meetings, so I think tackling some of those leading

problems with people not wanting to come to work, that have a different idea of work, or that
they don’t feel like they have to come to work is challenging.

M: Sure, I bet it is. Okay, think of another leadership challenge that you weren’t prepared to
handle. How did you resolve it and where did you go for help to manage it?

I: You know, I guess there’s at times theres some things you’re just not quite sure of. I have
one employee that sometimes gives me some problems and I uh, usually go to upper
management and ask for help. Sometimes several different people in upper management.
Human resources, my direct supervisor, um I’ve gone to other supervisors and said, “help me
here, what would you do?”. And so, I would say upper management and other supervisors. Commented [C51]: Upper management helpful.

M: Okay, that’s good. What leadership training have you had beyond your degree?

I: Um, what other leadership training? I’d say going to outreach programs and uh, also my
association.

M: Define what you mean when you say your association.

I: It’s a ANFP and American diatetics association. I belong to two different associations, so I
usually go to their meetings. In their meetings they will sometimes have stuff on leadership and
the role as a leader and that kind of thing.

M: Awesome, that’s good to have. Um, do you hope to be promoted at some point beyond
where you currently lead and would you feel safe enough to express that to your direct report
and why or why not?

I: Do I? Um, in my education probably I’m as high as I’m going to go * laughing *. And uh, um, Commented [C52]: Comfortable in leadership role, but
you know, I guess I stepped out of the box when I started working for Ben and Keith with would consider advancing.

nutritional services, but at my time right now, ehh, I’m getting close to retirement. I’m not sure
I’m really interested in stepping out of my box. I mean…

M: That’s fair.

I: If it came up, I might. I would have to see. I don’t feel 64, but I am. You know, so, um, I
might consider something else.

M: Okay, so would you feel safe expressing that to your direct report if you want to make the
jump?
FINAL QUALITATIVE RESEARCH PROJECT 36

I: Oh yeah. I think so.

M: What are you currently doing to grow as a leader on your own? You made mention of
attending association meetings…

I: Yeah, and networking with other people doing the same thing. You know I uh, we also
belong to Pioneer health network here and I’ve been involved with that since it started. Plus
my two associations I belong to, um right now I’m president of west district ANFP and so I’ve
done that before, so I think I’ve been a leader in lots of ways.

M: That’s great. What are your goals for your career as a leader and what could the hospital
do to help you towards those goals?

I: Um…You know, like I said, I’m doing…I’m the president of ANFP and so, once I get my term
over with, I’ll be past president for a couple more years, but I’m not looking for anything major
because of my age, okay? But if it came about, if they wanted me to run for president of the
state association or even the national, I don’t know that I’d want to do that. Isn’t that terrible?
*laughing *

M: Nope. Not at all.

I: Partially age, and partially health. I have a heart condition and heart problems and um, I
don’t know. I’m not sure I want to go ahead and go on, I might. And it did come up and I
turned it down um, about a year ago, because I didn’t feel like, health-wise, I wanted to take
that on.

M: Yep. Okay. Well, that is all I’ve got and I really appreciate your time.

I: Well thank you, this was fun.

Interview 7

M: In what ways has your educational background prepared you to take on leadership roles
within the organization?

I: Well, with my newest degree, a masters in public health degree, they know they really did Commented [C53]: Masters focus on leadership of
emphasize it. They had classes every semester on things like negotiations, dealing with organization. Reflected in her career goals.

differences, but it was really more like leadership traning to me. We learned how to do
presentations, oral presentations, written paper presentations, um powerpoint presentations.
Just how to present information to people. Which I found really helpful because I do that all
the time here.
FINAL QUALITATIVE RESEARCH PROJECT 37

M: In what areas of leadership did it not prepare you?

I: Hmm…

M: So like, things you’re currently doing, you’re thinking, “I really wish I would have learned
“X””.

I: Yeah, I think mainly like the technical medical stuff. I really still don’t understand accounting.
When I’m trying to track money, I don’t really know how I’m supposed to be doing it. That’s
probably the most…I really don’t understand billing… Commented [C54]: Job specific training needed.

M: Does anyone, really? Laughing

I: * laughing *

M: How long have you been leading in any capacity?

I: Well, I mean I did some leadership a long time ago. But mainly since we’ve started
LifeGroups. Has that been four years?

M: It has. Can you believe it?

I: Yeah, and then when I started here, which was almost 3 years ago, I was working on a grant
project within the first 3 months. So I consider that to require some leadership as I’m gathering
information from everyone, making sure they’re getting what they need to get done.

M: Okay, good. So what did KCH do to prepare you for your leadership role?

I: Um, I don’t think …Yeah, the hospital did offer leadership training through Kansas leadership
center back when I was first here, and that was definitely helpful. And through my grant Commented [C55]: Leadership conferences and training.
projects I’ve gotten more leadership training. In that way the hospital allowed me to grow by
giving me these projects to work on. I know the hospital is kind of weak in teaching people
management skills. We don’t really have any in-house leadership training. They tried to get
that going with Karma when she was here, but it just didn’t really materialize. Commented [C56]: In-house leadership training desired.

M: So in that way, its somewhat insufficient.

I: Yeah, I’ve been lucky since my office is right next to Ben’s, I get to see a lot of stuff that a lot
people wouldn’t get to see. So I learned a lot that way.

M: Sure.

I: More like an apprenticeship, almost. Commented [C57]: Mentoring found to be beneficial

FINAL QUALITATIVE RESEARCH PROJECT 38

M: Yeah, or a mentoring role. Think of a time when you encountered a leadership challenge
you felt prepared to tackle. What was it and how did your training or education help you
approach the situation.

I: yeah, I think… I feel prepared for the grant that we’re doing right now on mental and
behavioral health. I feel like at this point now I have some experience and kind of know how to
motivate, mobilize people. Um, yeah. I’ve had a lot of trial and error experience with the Commented [C58]: Masters degree
wellness coalition because when I took it over it didn’t really function and was just in name
only, so to speak, so, just trying different things and seeing how people respond in meetings. Commented [C59]: Experience
We had a meeting last night and only one person showed up, so that’s going to change how we
communicate, it needs some readjustment. But yeah, its mainly experience. I guess maybe
another example was the walking and biking plan when we needed to present to the city
council. I feel like through my education I was able to create an effective presentation that was
tailored to my audience. And would interest them and bring them on board.

M: Yeah, okay. You briefly mentioned the second part of this question which was when you
encountered a leadership scenario where you didn’t feel prepared. How did you resolve it and
where did you get help?

I: Well, they haven’t all been resolved yet either. *laughing * I do have technical assistance in
my grant writing processes, but they tend to be vague and less specific.

M: Okay. We’ve kind of touched on this a little bit, but what leadership training have you had
beyond your education?

I: Uh huh. I actually started getting leadership training when I was in high school through the
youth group. And that was…to me at the time, I was unsure why it was happening. * laughing
* I sort of started to understand it later in life, and began to understand why it was helpful. The
concept of leadership and understanding that it was an activity and not a position. It was
something that anybody can do. You don’t have to be THE pastor to do it.

M: That answers that well, thank you. Do you hope to be promoted beyond where you
currently lead and do you feel safe to express that to your direct report. Why or why not?

I: Um, yeah. I mean, I have recently been promoted and Ben, he talks about…you know Ben,
he wants to grow, grow, grow! * laughing * His concept is that my department will include
more than just me and that will allow more staff to come up underneath me to do more
projects. So yeah, we’ve been able to talk about that. Commented [C60]: Not only does she want to be
promoted, but her leaders want her to as well.

M: That’s good. So what are you currently doing to grow as a leader on your own?

I: Practicing regularly. LifeGroup. Training other leaders. Reading books. Just getting to talk
to a lot of leaders. With where I’m at here, in a lot of the different projects, I get to connect
with a lot of experienced leaders and I love to ask them questions about how they approach
FINAL QUALITATIVE RESEARCH PROJECT 39

things, what they see is going on, what are the problems they see, you know. That’s been really
helpful. Commented [C61]: Team book reading, seminars,
meetings.

M: What are your goals for your career as a leader and what could the hospital do to help you
towards those goals.

I: Yeah, Um. My goal is to avoid climate change, long term, and that requires much more
leadership than I can handle at this point. Um, yeah. Really, my strategy and its kind of a
secret…is that the powerful listen to the powerful. So if you want to have influence on people
who are powerful, then you need to be powerful. I mean, I never believed in climbing the
corporate ladder or you know, that kind of thing. I really don’t care about the yuppie lifestyle,
but I really found that if you want a seat at the table where these people are, you need to have
status and a high position in leadership and that’s really part of my long term leadership goal. Commented [C62]: Organizational thinking.

M: That’s a good thing. You want to influence the influencers.

I: Mmmhmm.

M: Well, those are the questions I have. Looks like you have a ton going on here, and I greatly
value your time. If you have any questions, you have my contact information.