Leader to HonorFranklin A. Shaffer, EdD, RN, FAAN

June 201414 Nurse Leader

Frank Shaffer, EdD, RN, FAAN, began his nurs-

ing career as the first male graduate from the

Mercer Hospital School of Nursing. Today, he is the

chief executive officer (CEO) of The Commission on

Graduates of Foreign Nursing Schools (CGFNS)

International, expanding and diversifying their scope

of services and influencing healthcare on a global

level. Along the way, Frank's career has been filled

with unique experiences, all guided and influenced

by his passion for learning (learning for himself and

helping others learn), collaboration at all levels (one

to one, between organizations, and between health-

care professions), building relationships, and mov-

ing nursing forward in all practice settings.

BU: When did you decide tobecome a nurse and what influ-enced your decision?FS: My father died at the age of 32from a rheumatic heart condition. Ican remember helping my mother carefor him in many ways—and I thinkmy passion for nursing began there.Our family physician urged me tobecome a physician, but he realizedthat we did not have enough money topay for medical school, so he urged meto become a nurse, thinking I could“work my way up” to being a physi-

cian as they didin Russia (I wassurprised as I hadnever heard of a

man being anurse). I made the

decision to enter anursing program

when I was in the lastmonths of my senior year in highschool—and it turned out that I wasthe first male ever to enter MercerHospital School of Nursing. The nursetheorist who had the greatest impacton me was Virginia Henderson, whomI was privileged to know. MissHenderson said that “The nurse istemporarily the consciousness of theunconscious, the love of life for thesuicidal, the leg of the amputee, theeyes of the newly blind, a means oflocomotion for the infant, knowledgeand confidence for the mother, and the

mouthpiece for those too weak orwithdrawn to speak.” BU: Your career has included lead-ership positions with a hospital, anursing association, a for-profitnational professional journal, afor-profit staffing company, andnow a not-for-profit organizationthat works globally with migrat-ing healthcare professionals. Whathave you learned from each ofthese experiences? FS: At its core, leadership refers to thecapacity to release and engage humanpotential in the pursuit of commoncause—and that is the common threadrunning through all of these positions.I learned so much from each experi-ence that I would have to write abook to answer this questionadequately. Each experience builds onthe other—and each experience offersunique perspectives which then

Beth Ulrich, EdD, RN, FACHE, FAAN

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became a part of who I am as I jour-neyed through my professional career.Therefore, I will confine myself toidentifying only 1 major “learning”from each experience—as long as I addto each one, “Among many otherthings, I learned...this and more!”

Working in hospitals, first in a staffand then in a management position,and eventually as a CNO, I learnedthat, no matter how hard you try andhow skilled you are, you cannot do itall alone—not even for 1 patient noless for all the patients in the institu-tion. Care really is multidimensional aswell as multidisciplinary—and myprimary role as CNO was to ensuresafe, quality patient care. I have listenedand learned from my mentors, most ofthem women, throughout my careerjourney. I learned very early in lifeabout the importance of relationships,and I think this might be based in thefact that I grew up in a large family.

When I was in a deputy director ofthe National League for Nursing[NLN], I learned how—and how diffi-cult it is—to write, interpret, and espe-cially to implement educationalstandards, accreditation, and educational

outcomes. I accepted this positionbecause I thought the League would bean excellent platform for bringingnursing education and nursing adminis-trators together again, and for ensuringcollaboration among professionals. Ibelieved then—and I still believe—thatcollaboration among education andservice organizations is essential for thegood of the patient and the advance-ment of the profession. I experienced,first hand, how the Tri-Council workedtogether as one for the profession.From an organizational perspective, theNLN provided me with my first expe-rience with nursing beyond our bor-ders. It was also at this time when I wasintroduced to The Commission onGraduates of Foreign Nursing Schools,the NLN, along with American NursesAssociation, was represented on itsboard of trustees. It is there that Ideveloped an interest in global nursing.

As the chief education officer for thejournal, Nursing Management, I honed myskills for planning, organizing, negotiat-ing, coordinating, and running large andprofitable professional conferences—andevaluating both their quality and theirimpact on the learner. What I learned

there reinforced my understanding of thepublishing industry as well as the impor-tance of relationships, and the real returnon investment (ROI) garnered throughpositive customer experiences—and theinterrelatedness of relationships across thecompany’s product lines.

As an executive with Cross CountryHealthcare, I learned the primacy ofquality in recruiting, educating, maintain-ing, and improving the critical thinkingand clinical skills of healthcare person-nel—and the essential components ofonboarding people, not only to CrossCountry, but also to each institution inwhich the professional would be practic-ing. I was the first doctorally preparednurse executive to work for a nationalstaffing firm committed to differentiat-ing itself based on quality. This positiongave me, in the words of CrossCountry’s president, Joseph Boshart, a“bully pulpit” for the industry. Amongother things, I made the business case forThe Joint Commission (TJC) to developa certification for the healthcare staffingindustry. Once launched, it grew quicklyand influenced the industry, making TJCcertification the best business choice forthe industry as it put them on an equal

June 201416 Nurse Leader

quality footing with their client hospitals. It was also during thistime that I was asked to consult with the American StaffingAssociation’s marketing committee who believed they neededto do a glitzy marketing campaign for hospitals to take notice. Iconvinced the group that a better approach would be todemonstrate through research the quality of care rendered bytraveler nurses. The findings of a study by Dr. Linda Aiken andher colleagues supported the quality of care provided by travelernurses. These 2 initiatives alone changed the industry forever.

As the chief executive officer of CGFNS International, mylearning curve has been steep and multidimensional—and Iam not sure I can yet identify the most important thing Ihave learned, at least not yet, because I am learning moreeach day! This position is challenging on many levels. Due toUS policy and a global economic recession, migratory oppor-tunities for healthcare professionals diminished. Consequently,the ability of CGFNS International to generate revenuediminished. Although we began as a single-focus organizationdealing solely with evaluating internationally educated nurses,we have become a multifocused entity serving healthcareprofessionals in a variety of fields. CGFNS is the only organi-zation written into the law for performing visa screening forinternationally educated nurses and members of 7 otherhealthcare professions who seek to practice in the US.Nonetheless, for the organization to grow, we had to navigatethe nuanced changes associated with the educational andevaluation needs of multiple clients and customers.

During my first 3 months in office, CGFNS contractedwith Canada’s National Nursing Assessment Service (NNAS)to assess the FEN’s nurses seeking to practice in Canada. The

NNAS represents all Canadian Provinces except Quebec.This also presented CGFNS with an opportunity to shiftaway from the process-oriented approach to assessing learn-ing to an outcomes-oriented approach, laying the ground-work for a real paradigm shift in the credentialing evaluationscience. Currently, the organization has 3 operating platforms:CGFNS, ICHP (The International Commission onHealthcare Professions), and ICD (The InternationalConsultants of Delaware). CGFNS International is clarifyingand diversifying, cross-selling and bundling its current portfo-lio to include a broader range of services—and of healthcareprofessions. Further product diversification adds both opera-tional flexibility and financial security.

Working closely with our president Carol Bradley and theboard of trustees, we were able to shift CGFNS to customer-centricity and redesign our technology infrastructure to providecontinuous communication with applicants and ease of theirself-monitoring across the steps in the process. Today, we are theworld's largest credentialing evaluation organization for nursing!As I look to CGFNS International’s future, these and a myriadother opportunities, await! Thus, at least so far, my great learn-ing from this role is the importance of—and the ability toadopt—an agile leadership style.BU: What have been the biggest challenges in yournursing career?FS: I think the most difficult challenge for me has been toharness my enthusiasm, which, coupled with my passion andentrepreneurial spirit, pushes me to make rapid changes in aworld in which many people are very risk averse. My enthu-siasm can be threatening for those who prefer to move slower

or who have a more limited view of the world (and itsopportunities). In the global world in which I live every day, Iam amazed at the high degree of convergence there is in thepractice of nursing. As a leader in a globally oriented organi-zation, I am frequently astounded by the strong and effectiveleaders in nursing found all around the world. BU: Learning has been at the core of many of yourcontributions to the nursing profession. What shouldnurse leaders know about learning?FS: Learning is a part of my DNA, and I strive to create alearning organization that promotes the potential of eachperson within the organization. Learning is at the center ofevery healthy person and organization. Adapting to the vari-ous learning styles of each person helps them achieve success.Today, learning is at your finger-tips...for example, with theshift to learning apps on smart phones and iPads. I think thatlearning and networking go hand in hand, at least for me.Every learning experience I've had gave me an opportunityto build a stronger network. Today, I can look back and readi-ly identify key members of my network and how and when Ibegan building the bonds that strengthened the network. Therelationships I have developed have lasted a lifetime, and eachis invaluable for its unique contribution to my life. The net-work that I appreciate the most is what I call “the TCConnection” of people I met at Teachers College ColumbiaUniversity. This network extends beyond borders, and I amalways amazed as I travel around the world and find a TCalum —and we both recognize the TC bond.

I would tell aspiring leaders, “Don’t hesitate to go back toschool for more formal learning: it may be a sacrifice, but it iswell worth it!” However necessary, academic learning is alsonot the same as experiential learning. Nursing is a practiceprofession, and it is through practicing the profession that youlearn more about it—and you learn even more when youfind ways to enable nurses to practice effectively. Then there isthe learning you need to understand what it takes financiallyand organizationally to sustain nursing practice. And then youmust continually learn how to advocate for nurses and nurs-ing in the political and social arena. To put the matter simplyand briefly, remain open to learning...and then translate whatyou learn to the benefit of the profession.BU: What have been the defining moments in yournursing career?FS: I don’t think there is one defining moment in anyone’scareer, and certainly not in mine. The decision to take each newposition is, de facto, a defining moment! Going back to schoolto earn a baccalaureate, a masters, and then a doctorate wereeach defining moments...but it was the relationships I made overthe years that have had a huge impact on my career trajectory.BU: You have a wide network of nursing colleagues.What advice would you give a novice nurse leader onnetworking?FS: A profession is more than a job—it is a service, a com-munity, and a culture. Professions serve society by poolingknowledge among their members and creating incentivesto synthesize new knowledge. They also help their mem-bers build networks, find jobs, recruit staff, find collabora-

tors, and organize around the issues that affect them. Everyprofession has leaders. In a formal sense, the elected officersor appointed officials of a professional society, college, ororganization are the leaders of that profession. However,because a profession is fundamentally about knowledge, thetrue leaders of a profession are the thought leaders: theindividuals who synthesize the thinking of the profession'smembers and articulate it, and those who create newknowledge—the researchers. Sometimes a profession willelect or appoint thought leaders to official positions, butthey rarely are interested in or successful in such positions.Thought leaders prefer to lead through writing and speak-ing, conducting research, organizing conferences, andengaging in dialogue. Leadership means both talking, lis-tening and it encompasses both vision and consensus.Successful leaders build a web of relationships within theprofession for many reasons, but most importantly in orderto learn the themes that are emerging in the thinking ofthe profession as a whole.

Continue to build on your work. Publish what you havelearned. Offer to give an address at state and local meetings.Eventually, you will be invited to speak at meetings, and byall means, accept the invitations. Keep in touch with peoplewho contact you after reading your work. If you hear aboutsomeone who is working on the same or a similar issue,contact them. Let them know that you have read their work,give them due credit, and explore how you could worktogether. Continually expand your network to include yourprofession’s clients and peers.BU: What have you learned about international nurs-ing that you didn’t know before you began your workwith CGFNS?FS: Fortunately, my various other positions is nursing havehelped prepare me for this position. Sometimes I reflect andcan see how each position I have held has prepared me forthis position, almost like putting a puzzle together. Somethingfrom each helped prepare me for my current role. But therestill is a lot more for me to learn. For example, I have knownfor most of my professional career that politics and politicalagreements are important and have an impact on nurses,nursing, and healthcare in general. However, being CEO ofCGFNS has certainly broadened my knowledge of politicsand its impact—and US policies are only the beginning.Trade agreements and the migration of health professionalshave enormous impact—and are highly political. My rolerequires cultural sensitivity, and also a deep appreciation forthe history of the country, its healthcare system, and the roleof nurses within its system. Working with global organizationsrequires an understanding of each organization's mission,history, and interrelatedness. Being in the right place with theright agenda at the right time with the right information andbackground is extremely important. Certainly the underpin-nings include being fully grounded in US professional organ-izations, as well as our own government's role in the globalarena. I rely heavily on relationships with professional nursingorganization around the world, and I will forever be gratefulfor their willingness to share information and to collaborate.

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It’s the national and international professional groups workingtogether that really make a difference for nursing globally. BU: You are well known for your passion about nurs-ing. What advice would you offer nurse leaders tokeep their passion alive and ignite passion in others?FS: As you become known in nursing, you will be interact-ing with people in more sophisticated ways around moresophisticated issues. You may well be working with nationalorganizations and even federal and state governments. Yoursphere of influence will expand beyond nursing to hownurses and nursing interact with other disciplines, with thelaw, and in the society at large. As such, it will be importantto cultivate your intellectual life. Leadership is a process,and the whole point is that you are part of an intercon-nected, interrelated whole, and no one—you included—knows enough to answer all the questions or deal with allthe issues. Accordingly, you will need to become knowl-edgeable about many things (poetry, the arts, policy andpolitics, and so forth). And your network must expandalong with your ability to influence others. Fearlessly assessyour intellectual strengths and weaknesses, and then seekout those whose intellectual strengths complement yourown. Build a brain trust—surround yourself with smart andknowledgeable people whom you can turn to when youneed expert information to inform your judgments—or toinfluence their judgments.

You will also face ethical issues, well-defined by your own“comfort zone.” Many “leaders” prefer to surf on their pastaccomplishments, extracting everything they can for them-selves and their own particular set of friends. The people whohave helped you along the way or those who may no longerbe of use to you are left behind. Once you've built a reputationand evolved a network, you can get away with a lot of selfish-ness. You can grow accustomed to exchanging favors formutual advantages among close knit colleagues going throughthe motions and never giving a serious thought to the nursingcommunity as a whole. This is precisely why many peopleassociate leadership with nepotism, manipulation, and “sellingout.” So you “coast” along, exchanging all the honors andinfluential appointments among your colleagues, and youngprofessionals languish.

You have no doubt heard inspirational speeches aboutunselfish leaders. I have not said much about this because it isuseless to tell people to be unselfish. They either are, or theyare not. However, if you hope to keep your passion alive, youhave to do more: Reach out to others, especially the youngones full of enthusiasm and passion. Help the “young ones”find a way to influence current leaders. Use your connectionsto help people who you may not even know, and who maynever be able to “return the favor” but whose ideas interestyou. Don’t be afraid of people who have challenged your pastwork or taken it to new places. Promote all ideas you findvaluable, whether they reinforce you and your premises ornot. Keep learning. Keep working. Keep encouraging—andwrite down what you learn along the way. Who knows?Perhaps someday someone will need it to write his disserta-tion about you and/or your body of work!

Hometown: New York City

Current job:CEO, CGFNS International Inc.

Education:Diploma from Mercer Hospital School of Nursing; doctoratein nursing administration, EdD, and MA from Teacher’sCollege, Columbia University

First job in nursing: Critical care nurse at Mercer Hospital in Trenton, NewJersey

Being in a leadership position gives me the opportunity to:influence the present and future of our profession and alsothe opportunity to help develop young professionals

Most people don’t know that I: was the first male accepted and graduated from MercerHospital School of Nursing

Best advice for aspiring nurse leaders: Believe in yourself and have the courage to address the chal-lenges: you'll be better because of it

One thing I want to learn: Flying a plane

One word that best describes me: Passionate

June 201418 Nurse Leader

BU: What is the best advice you have received duringyour nursing career?FS: Quite frankly, “love it or leave it!” If you love the profes-sion, you will love your work. If you do not, it becomes ajob—and sometimes a very irritating and demanding job atthat!BU: What is the thing you have done in nursing thathas made you the most proud?FS: Perhaps those moments—and you know it when theyhappen—when you know you’ve made a difference in some-one’s life. For example, a young man for whom I was caringwanted to take a bath. In the midst of the bath, he had anepileptic seizure, and I was able to pull him out and pull himthrough it. Then there were the times that family membersspecifically asked that I be assigned to the care of their dying

loved ones. As my positions changed to a different kind ofleadership, using my knowledge, experience, influence, andabilities to ensure safe patient care everywhere—though lesspersonally satisfying—has given me something of which tobe proud. These are the things of which I am most proud. NL

Beth Ulrich, EdD, RN, FACHE, FAAN, is a senior partnerat Innovative Health Resources in Pearland, Texas, a consultanton Healthy Work Environments for AACN, and editor of theNephrology Nursing Journal. She can be reached atbethulrich@aol.com.

1541-4612/2014Copyright 2014 by Elsevier Inc.All rights reserved.http://dx.doi.org/10.1016/j.mnl.2014.03.007

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