Kimberly Long 0:00

Hello, everyone. We are honored to have Dr. Leah Gary with us. She is the Chief Nursing Officer at Queen of the Valley Medical Center in Napa, California. Welcome, Leah. Thank you, Kimbrelli. I'm excited to be here. We're honored to have you. I just have some questions that I wanted to ask you so that you can share your expertise and experiences with the people who are listening and with emerging nurse leaders and others. So the first thing that we're curious about is can you walk us through your journey to executive level leadership and the defining moment that shaped your trajectory?

Leah Gehri 0:39

Yes. So I started my career as a med search nurse, went to ED and then or ICU and then ED. And so those early experiences gave me a really strong foundation in the clinical experience and taught me that safe care and good patient outcomes result from a combination of education and training, teamwork and a professional accountability. When I stepped into my first manager job, it was a very challenging time. There was tremendous turnover in my organization. I agreed to do it for a year. And that was the beginning of my leadership journey. And as I progressed through various leadership roles, I found myself increasingly drawn to solving system level problems rather than individual episodes of care. And so I went from resuscitating patients to departments to divisions and service lines. And so my journey had been expanding, has been about expanding my influence in supporting patient care and nurses. So there wasn't necessarily, the second part of your question, a defining moment, but rather a series of realizations that there are multiple barriers that nurses face. And hardly ever are they purely clinical. They tend to be more systemic, organizational, operational, structural challenges that individual nurses just are not able to solve on their own. And so nonetheless, the frustrations arising from these challenges can lead to feelings of helpless, hopelessness, and burnout. And so that became sort of my why.

Kimberly Long 2:08

Oh, I love it. Now, you know, there we have so many partners in the nursing world. And I'm curious from your perspective, what are some of the greatest opportunities for us to strengthen alignment between healthcare systems and academic institutions in light of our pipeline challenges that we're facing?

Leah Gehri 2:30

Yeah, I think that's going to be key in the future, especially when you look at the projections for nursing and allied health professionals that are coming up. One thing that I've seen is that healthcare systems often say that graduates are not fully prepared for the realities of practice and academic institutions are balancing the accreditation requirements, the faculty shortages and curriculum demands. And so the solution here, I think, is to get together and be really intentional about co-designing. When you think about what kind of nurses will our patients will need in five to 10 years from now, thinking about that, you know, what are those pathways from student to new grad, bedside clinician to advanced practice clinician, educator, nurse leader, and then in the nurse leader realm from manager, director, uh, associate director, executive director, CNO, and so on and so forth. I think those are really good opportunities for thinking strategically about that pipeline.

Kimberly Long 3:26

Oh, I'm telling you, absolutely. And the next question has to do with as a nurse executive, we have a pretty broad budget. We have a lot of responsibility and capital and nursing, labor, the whole nine. How do you navigate competing priorities like cost containment, workforce investment, innovation, things like that?

Leah Gehri 3:49

I think the key is understanding how these various priorities actually influence one another. And I would actually argue that workforce investment is cost containment. So there was a study, 2025 study by Nursing Solutions, the National Healthcare Retention and RN staffing report, found that the average cost, this is in the United States, of replacing a bedside nurse is about $61,000. In California, it's much higher. It can go up to $125,000 for a single experienced bedside nurse. And on the average, for every 1% in reduction in or worsening of RN turnover, it's about $300,000 impact nationally. In California, it could go up to nearly a half a million dollars per 1% change. So that is huge. And so when you look at the biggest bang for your buck, making nurse retention, it's one of the highest yielding strategic strategies or strategies, cost containment strategies available. In that thinking about what we should actually do. And so I always use the framework of structural empowerment for opportunities for advancement. These are making sure that your nurses have these things that are going to keep them whole, keep them working, keep them engaged in their work, and ultimately have an impact on our end turnover. So opportunities for advancement, access to information, support, and resources, and then both formal and formal power, meaning the authority to make decisions within their defined roles, such as in the shared governance structure, and then influence built through relationships and trust. Now, the second part of your question had to do with innovation. And I think that we get a little tricky there because there's a lot of innovation out there and it's it's coming at us rapid fire. And not every innovation deserves investment. But those that improve workflow, reduce administrative burdens, such as the time that nurses document, give nurses back patient care time at the bedside, and enhance or improve patient outcomes, then those should be considered strategic investments rather than expenses.

Kimberly Long 5:50

Absolutely. Now, another area that we're facing right now has to do with legislation and regulatory. We've looked at the removal, for lack of a better term, of nursing as a professional degree, which impacted funding and that sort of thing. So, how can leaders more effectively influence legislative and regulatory decisions that impact nursing and healthcare delivery from your perspective?

Leah Gehri 6:19

So we always hear about nurses need to get involved, and nurses are primed to have a legislative impact. Nurses are the largest workforce in healthcare. We're the ones that spend the most time at the bedside. And so I think there's really probably three key things. First, we need more nurse leaders at decision-making tables. Second, we have to become better storytellers supported by data. So data establishes that credibility, but the stories are what actually illustrate that the world, there are real world consequences to policy decisions. And then third, we need to develop relationships with our legislators. It's too late once we wait for a crisis to start reaching that to them. So we need to be involved at the grassroots level, really engaging with our legislators so that when we come to the table with questions or issues, we're able to weigh in and impact those decisions because they impact us. I don't believe we were asked about whether or not we should be downgraded from professionals.

Kimberly Long 7:19

We were not. Yeah. And, you know, I think that I agree with you 100%. We have being the largest labor uh pool in healthcare, we have opportunity that we really need to coordinate on how our voices can be heard. I'm gonna ask you one other question that I just want you to pause and think about. If you had advice that you would give to your younger self, what would that be?

Leah Gehri 7:47

Advice to my younger self. Don't be afraid. Don't be afraid. And just sponge in every single thing that can come your way. I think sometimes nurses are very afraid about making errors, and you should be, right? We should be, but don't be afraid to ask questions. Don't be afraid to try something new, to check, check out other specialties. Don't be afraid to tap into other people. You only have one life, and this is an amazing career, and there's so many things that you can do with it. And so try something. If you want to try education or try leadership, dabble in other things. It's just the world is your oyster, and you should do as much of it as you as you possibly can.

Kimberly Long 8:36

Oh, that's wonderful. Dr. Gary, thank you so much for taking some time this afternoon to share your expertise, wisdom with us. Thank you so much. I appreciate you. It's been a pleasure.