Dorrie K. Fontaine, PhD, RN, FAAN, is a clinician, scholar, researcher, educator, and leader. During her tenure as the Dean of the University of Virginia (UVA) School of Nursing from 2008 to 2019, she was a strong proponent of mindfulness, compassion, and promoting healthy work environments. Among her many accomplishments, she founded the Compassionate Care Initiative at UVA. She served as president of the American Association of Critical-Care Nurses (AACN) from 2003 to 2004, the largest specialty nursing organization in the world.
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Q:
The theme of this year’s National Nursing Ethics Conference is Moral Agents in Action. In what ways does this theme resonate with you?
The theme is timely because being a moral agent is all about how we live, how we show up, how we take our values as a nurse and demonstrate them to patients and their families, as well as health care teams. Being moral agents is how our values are embodied to the public and how we can assist the institutions where we work to engage and behave compassionately.
– Dorrie K. Fontaine
Q:
In your 47-year career as a nurse, you have served in numerous roles as a clinician, educator, and leader. How has ethics been part of your journey? Do you have advice on how nurses practicing at the bedside can enhance their moral agency and be ethically grounded?
Ethics is doing the right thing, engaging in the right way, and having the courage to stand up for what you believe is right, not in a way that it demeans others, but in a way that excites others to go on a journey with you. For me, ethics has been about how I show up and how I make people feel when they are around me. When I look back, as a staff nurse, when things were not right, I didn’t always know how to label the situation. But I did know when people behaved in ways that didn’t serve the patient’s interest. For example, there were times when staffing levels were harmful in many ways for patients and nurses, and leaders were not acting in ethical ways. As an educator, I had to be a role model and demonstrate ethics and courage in action consistently. I was showcasing the values I believed in as the Dean of Academics in Georgetown and UCSF for almost 20 years as well as the Dean of the UVA School of Nursing and Chief Academic Officer. When I was being interviewed for the Dean position at UVA, I said we need to create a healthy work environment where faculty, staff, and students can thrive. A lot of people hadn’t heard of it like that. I borrowed the Healthy Work Environments concept from the American Association of Critical-Care Nurses (AACN) and brought them into the academic setting. In all of my roles, I tried to show up with empathy and compassion.I believe it takes courage and a moral stance to notice what is going on around us by paying attention and not jumping in to fix the problem right away by creating workarounds. We need to stand back (pause) and think about the action, which I consider wise action and creating wisdom. I know people at the bedside want to be the very best they can be, but they can get frustrated easily when if they see things that are not right. The best approach is to look at your values and think about a solution-oriented framework. Then it would be best to work with colleagues and nurse managers to change policies and procedures, and how we treat each other at the bedside. In my leadership journey, I have distilled everything down into noticing and pausing and then proceeding with wise action, which includes kindness. We just published “No time to be nice in the Intensive Care Unit” – it’s really about how we treat each other. We need to go back to kindness.
– Dorrie K. Fontaine
Q:
You just retired as the Dean of the UVA School of Nursing with a strong legacy. What are some of the highlights that you are most proud of during this time in your career?
When I first went to UCSF, I had the goal to be a Dean someday, and Kathy Dracup, PhD, RN, FAAN, took me under her wing, and I watched her in action. She was a superb mentor. I was told that an important part of being a leader is to have a few key messages that I believe in, can enact, and raise money as a cause. I had chosen three when I first came to UVA, and I worked on them for 11 years. My first message was to create healthy work environments where everyone could thrive. To me, this was about nurturing and nourishing faculty and staff plus students, which morphed right into the compassionate care initiative for the next ten years. Second, it was to focus on interprofessional relationships and collaborations, such as working with physicians and other health care professionals. Third, was to promote diversity and inclusion. All three work well together. If we have healthy work environments, then we are going to be able to collaborate better and reach out to our partners across the whole university and focus on inclusivity and diversity. The staff brought those three initiatives together and helped me lead them. Initially, the staff defined the concept of a healthy work environment in an academic setting, and they started measuring it over 6-7 years. Then the faculty got on board. Since we had data, the Institute for Healthcare Improvement approached us to be part of their rapid cycle process in studying “Joy in Work.” Over the last 11 years, I have raised 55 million dollars, and much of it was scholarships for students. The funds also enabled us to hire faculty, have a compassionate care program, and hire an Associate Dean for the inclusion and diversity role. Having resources is what you need to be a successful leader, so you have to know how to get them. People want to give to a worthy cause, especially if it is successful. There is no more worthy cause than a nurse caring for a patient and the patients’ family to feel supported. Isn’t it great that we have selected nursing as our profession? It’s a pretty wonderful way to have a meaningful life.
– Dorrie K. Fontaine
Q:
You founded a Compassionate Care Initiative for students, faculty, staff, and clinicians at UVA in 2009. The mission of the program is to alleviate human suffering by developing compassionate caregivers and systems. How did this impact the culture of the school?
As a new Dean for only six weeks, a wonderful benefactor invited me to go to Upaya Zen Center for the Being with Dying program. It was an 8-day retreat in the Santa Fe Mountains in New Mexico. The program had a big focus on ethics as well and Cynda Rushton, PhD, RN, FAAN, was one of the teachers. It was about how to better care for the dying. But what I learned is that caring for the dying is about caring for the living and caring for the self. That’s where I was exposed to concepts like mindfulness, meditation, paying attention, giving attention from the right place, and how you want to be as a leader. When I came back, we started the Compassionate Care Initiative with Cynda’s help and a physician named Monica Sharma, MD, who had previously worked with the United Nations in developing leadership capacity for 20 years. We started hosting workshops for faculty and staff at UVA. I also began sending physicians, nurses, social workers, and pharmacists to the Being with Dying program. We had over 70 people attend the program throughout the years. When attendees came back, they felt different, and they acknowledge the fact that you have to take care of yourself before you could take care of others. You also have to reach out and demonstrate compassionate action. Having been successful in this program with staff and faculty, we then started the process of teaching our students. We decided to create a curriculum that would focus on these concepts for students. We created four courses that we still offer: Leading with Presence, Foundations in Medical Yoga, Practicing Wisdom and Resilience, and Foundations of Mindfulness Practice. I build a mindfulness classroom with 40 yoga mats and movable furniture. Susan Bauer Wu, PhD, RN, FAAN, who now works for His Holiness the Dalai Lama as President of Mind & Life, was then the endowed professor who helped me conceptualize the plan and move it to action. We now have a curriculum for students from second to their fourth year, where they take courses and go on retreats. The students get a sense of how they can be their best selves. We talk about mindfulness as the ability to pay attention and notice things around us. The school offers free yoga, tai chi, and meditation, five days a week. I raised a lot of money for these programs, and I spent it. We also have Compassionate Care Ambassadors throughout the UVA Health System on all the inpatient units. The new Dean of UVA, Pam Cipriano, PhD, RN, NEA-BC, FAAN, is continuing the work that I started.
– Dorrie K. Fontaine
Q:
As a leader and champion for healthy work environments, what are some recommendations on how academia and practice can improve the health of their work environment?
As a leader, you have to show that compassion makes a difference. There are many examples where people feel that they are not treated well in healthcare, and nurses can be mean/unkind to each other with bullying types of behavior. We have to define what it means to be a compassionate caregiver in all settings. Mainly, how do we take care of ourselves so that we can be better in taking care of others? As a Dean, I taught students, faculty, and staff about creating healthy work environments and compassionate care. We all need to find places that value healthy work environments. We also have to showcase the great work being done in nursing schools and hospitals because most of the time, we have a negative bias for the things that are going wrong. The values of healthy work environments include respect for all, integrity, working with others, standing up for people, and not gossiping. It’s a moral stance to say that healthy work environment standards of skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition, and authentic leadership, are not negotiable. Right now, there is another nursing shortage on the east coast, and I see that new graduates have many choices. I tell them to take the Healthy Work Environment standards with them during job interviews and ask the managers if those standards are in place. For clinical practice, we have to talk about the difficult issues and have the courage to say if something is not right. People have to speak up.
– Dorrie K. Fontaine
Reference: Fontaine, D. K., Haizlip, J., Lavandero, R. (2018). No Time to Be Nice in the Intensive Care Unit. American Journal of Critical Care, 27(2), 153-156.