Marissa Johanson, RN, CCRN, CEN, CFRN

I attribute my success to putting my arms around my decisions and acting on them, rather than just passively waiting for something to happen. I learned this approach from healthcare, where we gather information, make a diagnosis based on results, create a plan, implement it, and then watch the results closely. If things aren't improving, we go back and figure out what we missed. We need to be doing this in our own personal lives too. You can't just fling headlong into decisions without doing your homework - whether it's buying a house or choosing a career path. We need to pay attention to the quality of our decision-making and really own our decisions once we commit to them. Nobody just decides to be a surgeon one day without preparation. It's about making deliberate, well-thought-out decisions and then putting your arms around them and executing them, adjusting and pivoting as needed.

The best advice I ever received came late in my career from a colleague who had been in the ICU for over three decades. Her instructor told her that every quarter of every year, you need to take one week off. She said she would not be here in the ICU now, at this time in her career, if she hadn't taken that advice. When I heard it, I knew it was absolute gold. It's another way of saying practice healthy self-care - take care of yourself one week every quarter. If everybody was given one week every quarter to just rest, rejuvenate, relax, repair, and reset, we would have much healthier nurses out there, and doctors, and people at all levels in the healthcare system. Because if you're whacked out and burned out and stressed out, are you good to anybody? No. You cannot effectively get anything accomplished for your boss, for your home, for anything.

When you're right out of school and you're full of energy and interest and excitement, go to the largest, most robust medical center you can land a job at. Don't waste your time. If you're young and you don't have a family and things holding you where you went to school, go get yourself a job at that large medical center. Get that experience. It will prepare and set you for the rest of your career in a way nothing else can. That's what I did when I took a job at Loma Linda University Medical Center right after spending just a few months getting my feet wet in a small hospital, and I have zero regret. I was young, I didn't have kids, I was very portable and able to move, and it was the right thing to do. To this day, I still use things I learned there in my career. I would also advise women to stretch themselves - make yourself stretch a little outside of where you're comfortable. That is how you grow and learn. Don't just throw yourself into something that feels familiar and comfortable. Get a little uncomfortable. Get curious. Ask all the questions. What made the difference for me at Loma Linda was that I was asking questions, and a charge nurse noticed that and told me they wanted nurses like me there. She said I would be amazed at how many people come to work and never lift an eye of inquiry. Remain curious and remain teachable - those two qualities are going to get people very, very far, and they make people leaders. The leader isn't automatically the person that knows the most about anything - the leader is the person that goes to find the information about everything and shares it with others. You don't have to be named to a leadership position to do that. You can lead right straight from the middle.

The biggest challenges in my field right now are funding and helping patients navigate the third-party payer system. One of the biggest frustrations in our work in healthcare is navigating and helping patients to navigate the third-party payer system. Insurance is just endlessly confusing to people. So much now has come down to not a case of what's best for your condition or how you've presented, but more like, well, what will my insurance allow for, and what can I afford? That's a big block to getting meaningful work done sometimes - a doctor saying you can do this, but your insurance won't pay it, and it's going to cost you thousands of dollars a month. This leads to a funding shortfall, and funding is what's driving a lot of the challenge in healthcare. It doesn't matter if you're working in a hospital, a clinic, a doctor's office, or on a helicopter, or for an air medical service - they're all running into fiscal issues from lack of funding. The third-party payer system and all of its hiccups definitely make a contribution to it. This has actually opened up a whole new discipline within healthcare called patient advocacy, with entire certification programs now available for nurses, physicians, and paramedics to become certified patient advocates to help guide people through the confusion. While it's good that people are being innovative and creating that, what kind of comment is it about our healthcare system that something like that had to be developed?

Integrity is the most important value to me in both my work and personal life. I think that's just a real key foundational piece. You're not going to get good quality patient care coming from a position of lack of integrity. Same with your personal life - you're not going to get good relationships without integrity. You're not going to have good business interactions with anybody in life unless you've got integrity. You have to live honestly and truly, as you can, and put that out in the world and share that with others.