Regina Health Center

I never set out to be a director of nursing. I walked in the door at Regina Health Center 14 years ago and was hired on the spot as a night-shift LPN (licensed practical nurse). I moved through second shift, then first shift and then became a care coordinator, a clinical nurse manager, an assistant director of nursing and, finally, a director of nursing. What I’ve come to understand along that path is that the title changed more than I did. I'm still that same nurse who came in on nights, still willing to do whatever it takes to help a resident, no matter what else is happening that day. That, more than anything, is what I think leadership in elder care requires.

Leadership doesn’t happen in an office or at the top of an org chart. I've worked in places like that earlier in my career. I promised myself I would never lead that way. Leadership, to me, isn't a title. It’s a constant, physical presence on the floor, in the halls and in the small moments that make up a resident’s day.

Presence is the job.

People ask what makes Regina Health Center stand out. It always comes back to the same thing: direct involvement at every level of leadership. Not occasional rounding, but genuine, constant availability to staff, residents and families alike. I have a resident with terminal stage 4 cancer who needs to be disconnected from a 48-hour chemo infusion every other Sunday evening. Rather than have him make the trek back to Cleveland, I come in myself, bring him McDonald’s and we visit while I take care of it. Those small things, repeated consistently, are what tell a resident and their family they are truly cared for and not just clinically managed.

I believe culture starts at the top and moves down and staff notice when it does. That fosters collaboration because there is a high level of trust. I tell our team if they think something should change, come and talk to me. It’s not just to make them feel better because they’re able to tell me. It’s actually taking action on their suggestions. They can see their idea is being used.

You Can't Lead People You Don't Know

Somewhere along the way, someone decided efficiency meant treating everyone the same way. I understand the appeal. It’s easier to manage a large staff when everybody does things identically. I’ve found the opposite is true when it comes to quality. Care and compassion improve when you trust staff to decide their best way through the day and simply be there to support them.

I tell my staff, "I don't care how you get from A to B to do what needs to get done in your day." What matters is getting where you need to go and knowing I'm available to help however you do it. When given room to work in the way that fits them, people feel trusted and empowered instead of managed. That shift has done more for morale and retention on our floor than any policy change could.

That same philosophy extends to knowing people, not just managing them. I keep an open-door policy and give staff my personal cell phone, day or night. I want them to see me as a resource, walking alongside them through a hard moment at 2 a.m. if that’s what’s needed. The same goes for residents, many of whom stop by my office just to say hello or show me a photo of a new grandchild. Those relationships aren't separate from the job. They are doing the job.

Leadership Means Learning What You Don't Know

When I became director of nursing, I didn't fully understand our Minimum Data Set (MDS) process, the reporting system tied to how we’re paid and evaluated for quality. Rather than trust someone else had it handled and pass it through, I learned the manual and worked with our advocacy partners until I understood it well enough to genuinely support the team responsible for it. The same happened with something as unexpected as our facility’s water management plan, which I partnered with our maintenance staff to rework after a state survey flagged it as outdated. I'm not an engineer, but nursing doesn't happen in isolation from dietary, housekeeping, maintenance, or any other department. If one of those areas struggles, it eventually shows up in resident care.

That’s the essence of what I mean by leadership moving from top-down to across and through. It isn't about issuing directives from above. It’s about being present enough, informed enough and humble enough to walk the walk beside every person in the building. When leadership shows up that way consistently, it stops being something imposed on people and becomes something the whole team carries together.