Good Nurse, Great Leader: Both ‘Make Things Better’
Deborah Rubinson, DNP, RN, reflects on more than four decades of service to children
By Malinda Mason Miller, PRN
In 1978, young Deborah Rubinson and her husband David were expecting their first child, and decided it was time to move back to Texas from Saint Louis. The Rubinsons looked for a place where they could settle down and raise a family. Deborah applied at what was then called Fort Worth Children’s as a nurse. The rest, as they say, is history.
It wasn’t a difficult decision to pick Cowtown for starting a family. Fort Worth is where the Rubinsons met, and where Deborah received her undergraduate degree in nursing from TCU. It felt good coming home.
It also felt good coming to work at a place that embraced Deborah's pioneering spirit and desire to make things better, beginning with her patients and ending with a system that grew up around her.
“I like to make things better,” Deborah said of her more than 40-year tenure of bringing ideas, challenges and upgrades to Cook Children’s Health Care System (CCHCS).
Deborah credits the Cook Children’s Medical Center and system leadership with allowing her to continue to “make things better,” providing resources and support, where needed, to do so.
In October, Keith Holtz, Chief Administrative Officer and Deborah’s boss, announced her semi-retirement. The announcement included the operational fundamentals of all those that would be promoted in the system to continue Deborah’s trailblazing work. The list of those taking the reins for her many roles was almost as jaw-dropping as the list of folks she hired and led over the years.
New lens on leadership
Over the years with CCHCS, in addition to serving children, Deborah would impact nurses, physicians and other health care professionals. Her main goal was simple: to help these professionals grow and improve their work so they could best serve patients.
“Deborah’s leadership style means she accommodates lots of generations and backgrounds, which is a huge current competitive advantage,” said Cami Dragomirescu, Assistant Vice President, Organizational Development and Team Experience.
In addition to developing and keeping talent at CCHCS, Deborah’s colleagues mentioned her singular ability to find and hire the right talent.
“Deborah finds the diamonds in the dark mining,” Cami said of Deborah’s discerning, awe-inspiring hiring abilities.
Deborah believes there are many ways to develop leaders once they are on board and connection and recognition are important elements.
“If recognition means the employee moves out of your department because they were promoted, you have succeeded as a leader,” Deborah said. “Instead of dreading the effort of finding a replacement to fill that position, I look at it as an opportunity to develop a new leader.”
When Cook Children’s University – a program created to train and coach front line employees – began, there was only one position for a trainer. Now, due to the program's success, demand and the virtual presence of training that came as a positive result from the COVID-19 pandemic, there are three fulltime positions for coaches/trainers.
“Development of leaders can be both strategic and behavioral,” Deborah said. “We have found ways over the decades to provide emotional support to our health care professionals through personal coaching, a program designed to support patient care workers in the trenches.”
Supporting these employees was clearly an important priority before the COVID-19 pandemic hit. The industry turnover during the pandemic shined an even brighter light on the difficulties of working in patient care, and the need to continue to provide emotional support, coaching and helpful resources for employees.
“Well-developed, well-trained employees make for better quality of care at Cook Children’s,” said Joann Sanders, MD, Chief Quality Officer. “I love when I get to be part of a work team with Deb, because the outcome is always improved quality for patients.”
According to Deborah, in addition to better quality, fewer risk issues and medical errors, a workplace’s culture can also be improved by supported employees who feel valued. One of the most important impacts of emotional support is the overall well-being of caregivers, she said. And employee well-being can mean better care for patients.
“Increased self-awareness is one example of an outcome of Cook Children’s coaching sessions,” Deborah said. “That can be a gift both in someone’s work life, and a positive outcome that improves home and family life as well.”
Considered by many to be Deborah’s professional legacy is the inception of the Advancing Healthcare Leadership (AHL) program, a partnership with TCU created in the same vein as many other CCHCS employee development programs.
Deborah helped design AHL to develop and train physicians on the medical staff at Cook Children’s into leaders.
“The AHL program is one of the most outstanding legacies of Deborah’s marvelous career,” Keith said.
New challenges bring change, change requires leadership
Deborah’s time in healthcare serving Fort Worth area children from the late 1970s to today saw both technological break-throughs and culture changes industry-wide. Deborah recalled some of her greatest challenges and spoke candidly about an example of where leadership made a big difference to making critical changes in newborn healthcare.
In the early 1980’s, there was no ground transport for babies needing neonatal intensive care in the Cook Children’s service area. In an era when a regular Fort Worth ambulance was used to transport newborns, Deborah and another nurse served as the ground transport team that later became known as Teddy Bear Transport.
Deborah saw something that ‘needed fixing.’ High-risk newborns were not getting to Cook Children’s fast enough. She helped CCMC leadership realize that rural hospitals needed extra help and training to best serve struggling premature babies. Many rural hospitals did not have the resources needed to stabilize a neonate for ground transportation.
Deborah quickly realized that to save more babies’ lives – when mere moments mattered – she would need to help the rural hospitals be ready. She wrote a grant to the March of Dimes to begin a program that would train rural hospitals on what was needed – from medical supplies to health expertise – to enable newborn patients to be stabilized and transported to the Neonatal Intensive Care Unit (NICU) at Cook Children’s. The grant included onsite trainings and equipment reviews, led by Deborah and a team from CCMC.
“We developed the outreach program based on The Guidelines for Perinatal Care,” Deborah recalled. “Doing the groundwork in advance saved critical time for infants needing quick access to special medical care.”
It worked. The rural hospitals developed their internal systems so earlier intervention with premature and high-risk babies meant more survived over the years.
It wouldn’t be the only time Deborah would face a challenge, write a grant, or start a program at CCMC. And it would not be the only time she touched lives beyond the walls of CCMC.
What a leader does next
After four decades serving young patients, now Deborah may have a bit of extra spare time for some other children in her life that call her “Nan” – her nine grandchildren.
Deborah sparkles with pride when she thinks about her family.
But when Deborah looks back at the jobs she held before her time here, in addition to college professorships along the way, the jewel in her nursing cap points to CCHCS.
“Cook Children’s is a gift to this community,” she said with a smile. “I am humbled to have been part of making it that much better.”
That’s what a good nurse and a good leader does. They make it better for all who come after them.
Did you know?
There are two programs for which Deborah Rubinson said she is especially proud: the nurse residency and the simulation programs.
The simulation program began in 2009 with one high-fidelity manikin and a closet to store some equipment. The program now includes a lab with more than 17 simulators and has logged upwards of 28,000 hours. Simulation bridges the gap between education and real-life clinical experience, which was critical during the pandemic. In 2020, Cook Children’s simulation program became the first free-standing children’s hospital in the world to obtain accreditation in all five areas evaluated by the International Society for Simulation in Healthcare.
The nurse residency program began in 2008 as part of Deborah’s doctoral project. The program developed in response to the Institute of Medicine recommendation for 12-month transition program for newly-licensed nurses. In 2011, it became the first accredited pediatric nurse residency in the United States. CCHCS has hired more than 900 newly-licensed nurses and improved recruitment, engagement and retention through a curriculum that builds confidence, competence and fosters connection.