Heather McKenzie

HeatherMcKenzieSenior Director of Clinical Education and Quality Initiatives, Visiting Nurse Associations of America

Deborah Brownstein held this conversation with Heather on July 19, 2010.

Deborah: Tell me about the Visiting Nurse Associations of America, about the organizational culture in which you work, and your role in it.

Heather: Perhaps this is a familiar image: A nurse in a seersucker uniform, carrying a little black bag, walks into the home of her patient. She is the eyes and ears for the healthcare community, functioning independently while still providing medical services under the authority of a doctor. She does not have technology at her finger tips or a closet of supplies at her disposal. She must respect the property rights of her patient’s family; she relies upon voluntary compliance for requests as simple as moving a rug that is a tripping hazard. She draws upon her training and everything experience has taught her to respond to the needs of her patient in a relationship based upon respect. And in some environments, she may be concerned about neighborhood violence just getting to the home of her patient. She is a visiting nurse.

Deborah: And today these clinicians are women and men…

Heather: …and the seersucker uniform has been traded for scrubs or business casual attire with a lab coat. And, therapists and aides have joined the home healthcare and hospice workforce. The Visiting Nurse Associations of America is a trade association whose members are non-profit home health and hospice agencies in communities across the country whose mission it is to bring health care services to the most vulnerable in their communities whether it is seniors, the disabled, the poor, or the chronically ill.

I refer to myself as an information broker. I connect nurses, therapists, aides, and agency leaders to one another so that they can discover the best practices for delivering care in the home environment and the best business practices to support their mission driven organizations. I am facilitating a network face-to-face in conferences and remotely by teleconferences, webinars, and emails. When they come to me, I have an opportunity to help grow the intelligence of the network.

While we do use experts in some of our educational programs, VNAA is member driven and relies upon a peer-to-peer format for many of its programs. A challenge is to get members comfortable with sharing information; they do not always see that their tacit knowledge and experience is of value to others. My job is to remove barriers to the use of their knowledge.

Just prior to talking with you today, I was on the phone with a member inquiring whether we have a policy and procedure on reportable findings. She is looking for grant funding to support a pilot project. With healthcare reform in the news, all of us are aware of the cost of hospitalization. This member has a pilot project for an alternative model of transitioning patients from the hospital into the home environment for their recovery. It is exciting because her model has not been explored. Only a couple of different models have been published and followed. It is a tremendous opportunity to find a way to use existing resources that would help the patient move from the hospital to the home environment and also support the home health agency and meet the needs of the hospital; it would be a win-win for everyone.

As I heard about this pilot, my excitement grew. I wanted to write an article; I wanted to have a teleconference to let others know of this work. By the end of the conversation we were talking of a panel discussion among our membership to share alternative models and discover answers that are not widely known. Immediately she was willing to participate on such a panel; before, she had felt she was out there alone. I will be following this pilot and be the messenger to spread the news.

Deborah:  You were open to learning; and as you interacted, you were both engaged and committed.

Heather: The members I work with are truly committed to elevating the level of professionalism for their specialty. They are committed to providing the best home or hospice care they can deliver. They are always looking for ways to improve; they are not happy with the status quo. The conversation I had with this member today was enlivening. She was excited; I was excited to hear of her work. As the dialogue flowed, we learned more about each other; needs we should be addressing were revealed.

Deborah: You are working on significant social problems; genuine solutions will come from your level of engagement.

Heather: It wasn’t until I actually got into home care that I experienced that. I’m in love with nursing again, with healthcare again, because I see there is a different, better way.  In my current work environment there is a sense of organizational community—each individual within the organization shares the responsibility of leading from his or her respective role. There is much information sharing among the team; it flows up and down and around and envelops us. We throw out an idea and it continues to evolve into what could be; everyone is looking at the opportunities.

Before coming to VNAA most of my experience was in organizations where the leadership was in command; everyone was expected to march along. Some called themselves leaders, but that didn’t mean anyone was following. Where bureaucracies are built, good ideas are stalled or not discovered. I have seen the ineffectiveness of that.

It has taken time for me to appreciate where I have been and where I am right now—to find this happiness with this sector of healthcare. I see how positive home health and hospice can be, not only for the patient, but for the families and caregivers involved.

I chose to join this organization and do this work because it is aligned with my personal vision, mission, and values; I want to help relieve suffering. I chose to do this interview because it is aligned with my mission to be of help to others. However, if it was not for the inner-work I’ve been doing, I may not have been open to this opportunity; I would not have identified this as an alternative work environment.  And, I would have said no thank you to this interview.

Deborah: You had started your inner-work before you took this position.

Heather: My inner-work prepared me for this work. Before I started my inner-work, anytime someone wanted to talk to Heather, the Heather ego interfered. My ego was so strong telling me I am an introverted, private, insecure person. I believed that story. I felt extreme isolation—self-isolation. I wanted to have friends but was afraid of being friendly. I wanted to help more, but was afraid to give more. I felt paralyzed. My ego was paranoid; if people were talking, I feared they were talking about me. In response, I did not share much of myself with anyone. So, early in life, I did not connect with other people.

This ego story of mine started in my childhood. My father, protecting us, told us to never let anybody get within an arm’s reach of us physically or psychologically; people could hurt you.  And, for so long, I heard people telling me who I was. We all hear this from parents, teachers, and friends—they may be well intentioned. They may say, You are responsible. You should want to do this. We take these ideas along with us, never questioning them. We believe the story.

What I didn’t know and what I had to discover was that the person I projected as Heather wasn’t the true me. I had to come to know that I am of value; I am of worth in the world. If my true intention is to share and help, I need to share and help. In The Inner-Work of Leadership Barry quotes Gandhi, “Be the change you want to see in the world.” It is my nature to be genuine, loving, helpful, optimistic, and connected with people. I had to see this as my True Self. When I changed my mindset to accept who I really am, my actions and behavior began to change. I felt better—more alive. And now I am building relationships with other positive people. I had had many negative people around me; most of the negative people are no longer around.

I had to find my own vision, mission, and values; this had to come from a deep connection with my True Self. First, I had to accept myself for who I am.

Deborah: Our conditioned thinking and everything we’ve taken for granted for so long becomes a tight knit, internally consistent story. You had to challenge the fundamental story of your personal identity.

Heather: I have been uncomfortable at times along this journey of inner-work. I’ve looked at how I was raised, at the counsel my parents and teachers gave me. There was a point in time when the blame game was easy to play, but that doesn’t get you far. I had to come to say I am accountable for who I am, for the beliefs I carry, and for the actions I take.

Deborah: You had to become a neutral observer of yourself.

Heather: To be neutral, to be objective, that is one of the first things you learn as a clinician in the healthcare field. Taking that concept and apply it personally was a challenge. My motivation to discover my True Self came into focus more acutely, more intensely, with the birth of my first child. Suddenly I was looking at this new face in the world. If I didn’t know who I was or where I was going, how could I help this other person and guide him along? I stepped up my inner-work to move quicker in the process so that I would have a foundation. I know my work is incomplete; I am still discovering who I am alongside my children as we go along. When I feel overwhelmed or uninspired I remind myself that it is OK not to have all the answers. My work is to be open minded to receive guidance. I give myself permission not to know.

Deborah: What a relief to find that we can receive inspired ideas.

Heather: When I get caught up in the 9 to 5 routine and keeping up with the Jones, it is very easy to forget what is important. We can get caught up in our thinking. My dad used to say the problem is always the stinkin-thinkin. Just recently my mother reminded me that Albert Einstein believed the world we create is a product of our thinking; it cannot be changed without changing our thinking. I need to be vigilant about thoughts that enter my mind and choose which thoughts to take seriously; my thoughts affect my beliefs and behaviors. That is the biggest challenge at this point—to be mindful of what comes into my mind, whether it is something I watch on TV, the books I read, the radio I listen to.

One of my other favorite lessons from Barry is that we have to subtract the clutter in our minds in order to be receptive to new ideas and inspiration. It is so true. When I find my mind cluttered with old beliefs, I remember I can choose to drop them and move on. With practice it gets easier to see my thinking, my accumulation of old stuff, the baggage.

Deborah: In dropping the baggage you are also dropping judgment.

Heather: I had to learn to drop judgment. Barry writes about the difference between judgment and discernment.

Deborah: Standing on the curb you can discern that a truck is fast approaching; you stay on the curb, but don’t judge the truck. You discern that a mistake has been made; you address it, but don’t judge the person who made it.

Heather: I found that enlightening. Along the way that difference has been important. What you think turns into your actions. When I judge another people, I send a negative vibration out into the world. I have found that as I have become less judgmental, I’ve become more optimistic and positive.

Deborah: Your effectiveness as a leader, has that changed?

Heather: It has made a tremendous difference. When I am having an important conversation or engaging others in dialogue, when I take judgment out, the intent of my message is more honest and  true. There is no negative charge. My mind is not chattering How could they do that? That was so stupid. What were they thinking? They’re not making any sense. Instead, I now have the thought This isn’t what I expected. How can I see this differently? How can I help this person see things differently or perform differently? My purpose becomes one of seeing more clearly and of helping that individual, not tearing them down with criticism. When I approach others without judgment, they are more willing to listen to me.

Deborah: Are you able to tap their intelligence more readily?

Heather: As I step back, the other person has more room to respond.  I give them an opportunity to talk about how they approached the project, or whatever the issue is; and I get a perspective I have never thought about.

Deborah: You mentioned earlier that your inner-work brought to light the importance of working in an organization whose values are aligned with your own.

Heather: When I started my career, I didn’t give values and alignment much thought. There were many things that I didn’t give much thought—until I wanted to be happier, until I needed to be in a different place. That is when my inner-work started. Once I recognized that there were changes I needed to make, I couldn’t do it half-heartedly. All aspects of my life—my family, my profession, my career—had to be in alignment. It doesn’t take much to be thrown off track and derail. It doesn’t matter what I am doing or who I am with, I want to be my True Self and uphold my core values and beliefs. It is a matter of integrity. I have seen many people living parallel lives, one at work and one at home and the two shall not meet. And that is when problems arise.

Deborah: Integrity is alignment of all aspects of our lives around core values. Finding our True Self, we get in touch with guiding values that have always been there. They need space to come to the surface, to be recognized, and honored. Are others in your organization also exploring their inner-worlds? Is it something that is talked about?

Heather: Recently the education program coordinator was promoted; we were recruiting a new person into our organization. I was amazed at the number of people who had studied our mission and vision and talked about how VNAA was or was not aligned with what they were interested in doing. Others on the team noticed this as well, and we discovered that everyone of us had come to this organization after looking at its vision and mission. The mission has evolved as the organization has grown, but the premise is still the same. The mission of helping the most vulnerable in our communities seems to have touched every person who has come to our door looking for employment. They understand it; they know it and want to support it. Vision, mission, and values make a difference.

Deborah: Each one of us faces our own unique curriculum of inner-work. We start at different places; we face different challenges. People ask, What is inner-work? There is a different answer for each person. Yet, we have some things in common. We look honestly at ourselves and others without judgment. We look, even when it is painful, at mistaken beliefs that we’ve labored under. We allow ourselves not to know but to discover who we are. Heather, you have pointed to all these fundamentals of inner-work.

Heather: It has taken awhile to get here; I’ve been on my journey probably for ten years. Now that I have taken the blinders off, I am clarifying my vision and finding a new focus. Early in my life I had well defined goals—finish my education, establish my credentials, marry, have children—all very linear, much coming from my conditioning. Having met those goals, I am in what can be an uncomfortable space—I call it floating. I have never floated for this long. As I open to the possibilities of discovering more of myself, to align with the True Heather, I’m realizing how many interests the True Heather has. It is exciting to rediscover old loves, like art and music making. I am getting in touch with an urge I have felt for some time to create a start-up business and watch it grow. I just do not know yet what that business looks like. Part of my inner-work is to have the silence and the patience to allow ideas to flow through. When I decide to move forward, it will be on a path discovered by inner-work.

The Visiting Nurse Associations of America (VNAA) is a national association that supports, promotes, and advocates for the nation’s network of community-based, nonprofit Visiting Nurse Agencies, home healthcare and hospice providers. Their members provide cost-effective and compassionate home healthcare to some of the nation’s most vulnerable individuals, particularly the elderly and individuals with disabilities, regardless of complexity of condition or ability to pay. The VNAA’s services include advocacy, education, and collaboration. They provide members with products and resources to help them accomplish their nonprofit goals. The VNAA has its office in Washington, D.C.

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