Q&A with Meredith Lahl Foxx: ACNO of Advanced Practice Nursing

Leadership development advice for APRNs

Advanced practice registered nursing is one of the fastest growing facets of the nursing profession. The American Association of Nurse Practitioners (AANP) says the Bureau of Labor Statistics projects there will be 10,000 to 49,999 new jobs created in this profession between 2014 and 2024. At Cleveland Clinic advanced practice registered nurses (APRNs) have quadrupled in number since 2012, with nearly 1,200 APRNs throughout the health system today.

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Advanced practice nursing is also currently known as one of the most promising careers in the country. In fact, according to the U.S. News & World Report Best Jobs Rankings for 2017, advanced practice nursing ranks as the No. 2 profession, touting the tremendous growth opportunities of the career.

Meredith Lahl Foxx, MSN, MBA, APRN, Associate Chief Nursing Officer (ACNO) of Advanced Practice Nursing at Cleveland Clinic agrees.

Foxx has been in her newly created role now for nine months, and prior to that she led Cleveland Clinic’s APRNs for five years as executive director. When speaking of the numerous opportunities available to APRNs she says, with the right approach and proper leadership development, APRNs can successfully develop and grow their careers while making a tremendous impact in the nursing profession.

To help APRNs develop into strong leaders, Foxx offers the following advice.

Q: What should APRNs consider as they look to develop as leaders?

A: First and foremost, APRNs need to keep in mind that to advance you have to continually refine and develop your leadership skills. Leadership is a journey, not a destination. For example, I’m always looking to other leaders for attributes that I can emulate. After a crucial conversation or meeting, I immediately ask those in attendance for feedback. Sometimes I’ll ask each person to give me at least one piece of constructive criticism.

I also believe in leading by example and holding myself to the same standards that I set for my team members. Over time, if you don’t do the work, your competency can go by the wayside. So, if I ask someone to do a new education module, for example, I also complete the module to ensure I understand the concept as well. Speaking from my own experience, being a leader means continually learning and improving. It’s not one-size-fits-all. Through the years, I’ve met wonderful leaders with entirely different styles and collected pearls of wisdom from each one.

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Q: Is there a way in which you categorize APRN leadership?

A: Yes, there are two main categories for APRN leadership – formal and informal. Formal leaders serve in the official role of a manager or administrator and are tasked with meeting the goals of the organization. Informal leaders may not be in a position of authority, but they naturally gain the respect of their peers. These individuals generally have a high level of clinical competency, good problem-solving skills, and they collaborate well with others.

Q: If an informal leader wants to move into a formal leadership role, what do you tell them?

A: Every nurse has a personal professional drive, and moving from an informal leadership role to a formal leadership role is something I highly encourage. The advantages to being in a more formal leadership position include increased recognition, career growth and higher compensation. But you’ll also gain the satisfaction of advancing the profession and making a positive impact on the healthcare system as a whole. For those informal leaders seeking more formal leader positions, I say: Ask yourself what you envision for your future and what you want to get out of your career. And don’t get discouraged if you aren’t exactly sure what you want.

Personally, I credit my journey to a willingness to take on more work and say yes to things I never did before. Throughout the years, I volunteered to be on various professional or association boards that put me in touch with different professional leaders. These leaders all had different leadership styles, abilities and experiences that influenced me and helped me open new professional doors to more leadership opportunities.

Q: What aspects of leadership development do you view as most important?

A: As an APRN leader, patient care should always come first. However, it’s also important to develop the other aspects of your role. You need to participate in activities like performance improvement, medical education, training, committee work and research. Physicians are expected to have non-patient care responsibilities as part of their roles as well. Although APRNs aren’t always held to that standard, we need to participate in these settings to gain visibility and elevate the Advanced Practice Provider (APP) role in the healthcare industry.

Q: How do you suggest APRNs approach further development of these key areas?

A: Look for opportunities to get involved. For example, at Cleveland Clinic, we’ve developed onboarding courses we call: “Leading and Learning Beyond Patient Care.” These courses are peer-developed by APPs in our organization on topics that include: “How to be a Preceptor” and “Ways to Get Involved in Research.” Participants don’t receive incentives, but involvement is recognized during annual performance reviews. Your organization may have a similar program, or there may be an opportunity for you to begin one as part of your own leadership development.

Q: What are other important ways to grow as an APRN leader?

A: There are several other ways APRNs can grow as leaders. One important way is to work collaboratively with staff at different levels. In our organization, we expect all APRN leaders to have both administrative and clinical time so they understand the work they are asking their teams to perform. Our physicians are all working leaders as well.

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Another thing APRNs can do is to ask questions. For example, rather than assuming one of your colleagues has the right answer because of their authority or position, discuss the situation in question to give everyone a voice and foster collaboration. This will bring people along and generally result in the best answer. Along these same lines, it is important to learn to be professional, confident and assertive in working with all members of the healthcare team. In our organization, we have had less conflict between physicians and APPs over time through participation in collaborative initiatives. Physicians serve in many leadership positions in the organizational structure, so when they recognize APP leaders as peers on the same team, it elevates the role and moves us all forward.

APRNs can also grow as leaders by becoming involved as mentors or preceptors. Cleveland Clinic’s APRN leaders go to schools and talk to students before they come to our clinical site. We onboard new clinicians to all care settings and discuss different roles and teams. In many settings, APRNs educate the fellows and residents. Although these examples are specific to Cleveland Clinic, they are not unique. I believe any hospital or clinic has opportunities for APPs to develop leadership skills if you’re willing to look for them.

Q: In your opinion, what is APRN leadership success based on?

A: I believe success boils down to a few basic things:

  • How well you communicate
  • How well you relate to people at all different levels
  • And your ability to be a decision-maker in healthcare beyond patient care

Foxx has been in nursing leadership for the majority of her extensive nursing career. In her current role, she has the privilege of helping to develop APRN leaders every day and is happy to assist new and emerging leaders to further develop their careers. Feel free to contact her with questions or for additional advice.