Kimberly Long 0:00

Hello, everyone. I am so excited to have Karen Ray here with us. She is the CEO of Correctional Improvement and Sustainability LLC. Welcome, Karen. Thank you. I'm glad to be here. I'm glad that you could take some time to spend with us today. I wanted to kind of get your perspective on a few things, if that's okay. But the first thing I wanted to do was walk us through your journey to the executive level leadership. And then if there are any defining moments that shaped your trajectory, share those with us.

Karen Rea 0:30

Oh, okay. Well, first of all, I consider myself a late bloomer. I really didn't start my career as a nurse until in my late 30s or mid-30s. And um I was I did that while I was working full-time. I also was a traveling nurse and I was raising a family. So I earned my AA, my BSN, my master's, and then I eventually got my nurse practitioner certification. And at that time, I never really stopped to think about how much I was taking on or what I was doing. I just simply was driven. And um I never believed there was a job that I couldn't do. And it wasn't out of arrogance, it was just how I saw things. I just kind of saw a gap that was needed, and I stepped in and loved problem solving. So, for example, in my early career, I was a neonatal intensive care nurse. And so as I was taking care of these infants, our neonates, I realized that many of them were drug addicted. And so I saw that there was a need for the babies and their moms to bond, but their moms were dealing with child protective services and those kinds of things. So I decided to start a program because the babies would have to be in the NICU for, you know, 12 weeks or longer, sometimes months. And so I went to Child Protective Services and said that I wanted to do a drug program in the NICU. So the parents would have to come to the NICU, bond with their children, and also learned about how to break the cycle of addiction. And so this actually worked out quite well because it reduced the cost of child protective services of having to send social workers and monitor. And we, you know, you reunited babies and their mothers and parents. And so that was one aspect. And then as I'm moving through my career, another defining moment for me was as a public health nurse in Fresno, again, I'm working with child protective services, and I realized that the social workers carried extremely high caseloads. And they did not have any type of structured quality management program to see how they were doing or what they were doing, and it was problematic in my mind. So I went and got a certification in quality management, asked, could I start a program? And I did. And over the next maybe two to three years, their error rate was dropped by 60%, which is a very high reduction in error rate. But it was just, again, saw something that I thought was needed and something that I could provide. And then moving on to my latest career, I was in Fresno again, and there was a new job for the California Department of Corrections, where they were being sued because they did not meet the Constitution, the Eighth Amendment, which was unusual, cruel and unusual punishment, only meaning that medical care was not up to standard. So they were hiring all these nurse consultants and new programs, and it was under the receivership. And so I joined. And then within a few months, I became a regional nurse consultant and eventually became a statewide chief nurse exec. And in this role, I was over 4,600 plus nurses at all different levels, from uh MA all the way, you know, to nurse practitioners for over 35 prisons. But one of the things that I really did that I value to this day is at that time, nurses were reporting to physicians. And in the C-suite, it was chief medical executive, chief psychiatrist, chief ancillary supports for labs and all other ancillary supports, chief psychologist, but nursing was not at the table. So it took some dealings and negotiations, and we got nursing to the table at CDCR, which was a major feat, and they're still at the table today. And that was back in 2009. So that was really, really something I felt really good about. Now, I do want to say though, that when I look back at these defining moments and how I got where I was, I made some mistakes. And so one of the things that I had to learn is that just because you see something doesn't mean you're ready to deal with it, even though you can see where you're going, the path is clear in your mind. So I went back and I started taking leadership development classes. I also went back and apologized to people and just said, I don't know if I handled that really well. And I would like to know how you feel about how I handled it. And I got some really hard lessons that I took to heart. And I also started surrounding myself with people that knew a lot more than I did. And that was difficult because, you know, you you needed to be the strongest person in the room, and you needed to show everybody you knew things, and that just was not the right perspective for me to become a leader. So all of those things made me who I am today, and all of those things were like, as you say, defining moments.

Kimberly Long 5:41

Oh, that's wonderful. And you know what, you describe an area of nursing that people don't realize is always there. How do you think that we can develop opportunities to strengthen the alignment between healthcare systems and healthcare locations and academic institutions to maybe broaden the perspective of exposure for the nurses who are going through academic training?

Karen Rea 6:10

You know, you bring up an excellent point that I really didn't touch on, is that the last part is that the correctional nursing is a people don't know about it, first of all. Um, prisons are little cities, and we have, you know, like over 100,000 inmates or incarcerated persons, and nurses handle everything in those prisons, just like at Sutter, Kaiser, or any place else. Anything you can think of is needed, those nurses are able to do. So one of the things that I think is that we have to quit looking at healthcare systems and academia independently. It has to be a collaboration, whether it's some type of internships or residency programs or whatever, but early clinical exposure for any level of nursing is crucial. So many people go through practicums because you have to as an RN, not so much for MACNAs. Most LVNs also go through those processes. But one of the things that I can remember in my career with the California Department of Corrections and Rehabilitation is that we have a group of nurses that are psychiatric technicians. And a psychiatric technician is like an LVN, where the LVN goes off to do OPGYN in their last semester, and LPTs go off. They're actually PTs, not LPTs, go off and they're do psychiatric nursing. So we did not have enough because our mentally ill population was just growing exponentially in the prisons, and we did not have enough psych techs to support them. So the receiver and myself went to Delta College, which is a college in Stockton, California, and um also where I got one of my degrees. And so we went there and we asked, how can we get more psych techs? Well, they said we have the curriculum, we have the space, we don't have the educators. So then we went back, and of those 4,600 nurses, there were nurses that had teaching credentials, they had their doctorates. And so we found four that were willing. We found more, but we took four that were willing to go add additional classes to Delta. And that's how we started doing that pathway. So they not only learned how to be a psychiatric technician, they also did their practicum in the prisons. They also had a job when they graduated and passed their test. So it was a major, major win-win. And so that's probably one of the most, for me, a defining idea of how to put healthcare and academia together. But I wouldn't have thought about it if we hadn't been in dire straits of being under receivership and then seeing the need and then working together. So it was a definitely a win-win for both sides, both organizations.

Kimberly Long 9:04

You know what? That is amazing. You describe a lot of innovation related to workforce and things like that. Can you tell us a little bit about how you navigate the competing priorities? You know, you talked a little bit about workforce investment, you talked about innovative programs, and you know, I'd like to hear a little bit more about that as well as, you know, how do you do that in a cost containment manner?

Karen Rea 9:32

I think the most important thing is that we put so much emphasis on money and technology and we forget the basics. And the basics are educate the right discipline for the right job. And that is how you do cost containment. You don't want to put a CNA in a position of an RN. They don't have the same skill sets, lawsuits will occur, and you're not supporting your nurses. I mean, you're putting them in very vulnerable positions. And that's why it's important that nursing leadership is at the table. So there's a certain role for a CNA. That role is not the same for an MA. And many organizations just say, oh, well, you know, they kind of go through the same thing. So we'll put the MA. MAs there to help the provider. CNAs are there to help the patient. And their training is totally different. But when you have organizations that have leadership that do not understand or not willing to understand the role of nursing, it really costs you more in the end. So those are the kind of things that I look at. So training, curriculum development, don't be afraid to do competency testing a lot with your nursing. You know, when they come in and they have to take a competency test or go through a checklist and on-the-job training and other didactic trainings, it doesn't stop there. Do it again every year. Change it up. Look at different evidence-based practices that keep your nurses sharp. You look at some of their curriculums and they haven't been changed for two or three or four years. Why? We don't have the money. Well, this is where you kind of figure out a way to do that. And I think investing in your staff development is probably the top priority for me for cost containment, investing in your workforce and retention because they know that you know. And as a nurse leader, get out there yourself and go past medications. Get out there yourself and do an assessment and show them that this is not something that I just say. This is something that I do. And I understand the complications and I understand the trials and tribulations that you're going through. So celebrate your little wins, celebrate your staff, and all of that will bring it all together and it costs nothing to care.

Kimberly Long 11:51

I tell you, this has been so informative and so enjoyable. And Karen, thank you so much for taking some time out of your morning to share your expertise with us. We really appreciate it.

Karen Rea 12:05

I appreciate being here and thank you. Thank you.