tion adjustment would be visited. The VNACJ funded the idea, and outcomes are being monitored.

Ms. Christopher said that the aims of such an initiative are both immediate and long term. In the short run, the VNACJ hopes to reduce rates of emergency room (ER) use and repeated hospitalizations—expensive and inefficient means of managing chronic illness. As for the long-term goal, the VNACJ nurses strive to give individuals as well as entire communities greater control over their health. After the telehealth kiosk was set up, for example, residents began paying attention to one another’s weight and blood pressure levels.

Ms. Christopher has secured grants to test a wide range of such ideas. For example, the Mobile Outreach Program has reduced rates of ER use among deinstitutionalized mentally ill and homeless patients; funded in the mid-1980s by The Robert Wood Johnson Foundation and the State of New Jersey, it is now supported by local governments. The Mobile Outreach Program is the VNACJ initiative Ms. Christopher is the most proud of and the one, she said, that may be the most replicable.

In 1998 the Balanced Budget Act resulted in a 15 percent reduction in revenues and left the VNACJ with only $100,000 in reserve. Now, even with $24 million in reserve, Ms. Christopher worries about declines in federal, state, and philanthropic funding, especially in light of the recent increases in un- and underinsured patients being seen as a result of the recession. Still, she said that the agency’s focus on providing services the community values, even as those values change, has kept the association fiscally sound.

I make decisions within the context of really understanding the impact of service delivery. I think I can see opportunities quickly, because I’m seeing it more from a nurse’s perspective, but also a nurse who grew up on a community-based side [of health care delivery].

—Mary Ann Christopher, MSN, RN, FAAN, president and chief executive officer, Visiting Nurse Association of Central Jersey, Red Bank, New Jersey

Not all CEOs of visiting nurse associations are nurses (those in New York City and Boston, for example, are not). Ms. Christopher said she can see why it matters that she is a nurse. First, she knows well what nurses can do. She has cultivated an atmosphere of honoring staff ideas (such as the cardiac monitoring initiative). As a result, the VNACJ has a turnover rate of less than 5 percent for nurses. Second, Ms. Christopher is sought after to serve on governing boards and advisory groups and is the only RN on the board of trustees at the University of Medicine and Dentistry of New Jersey. She believes that her nursing expertise, keen sense of community, and fiscal responsibility give her “legitimacy at any table I’m at…being a guardian for what’s best for patients and communities.”

community health systems found that nurses made up only 2.3 percent of their boards, compared with 22.6 percent who were physicians (Prybil et al., 2009).3


It should be noted that, while there are many more physicians than nurses on hospital boards, health care providers still are generally underrepresented.

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