By Matt Skoufalos

The first time Elizabeth Sparaco completed nursing school was in 1981. It would be another 30 years and two careers before she returned. After graduating from Camden County College with her nursing certificate, Sparaco began working in critical care, eventually rising to positions of administrative supervision before she left the profession for consulting opportunities in the mid-2000s.


“When I first started, nurses were not autonomous,” Sparaco said. “They weren’t really a part of the decision-making, and there was no such thing as shared decision-making with patients. I remember when EHR [electronic health records] first came in, in the 1980s, and we were using pneumatic tubes to send orders to the pharmacy.”

Sparaco eventually decided to return to nursing because she wanted to get back into active patient care. She started by going back to school. In 2012, she completed an EHR certificate program to familiarize herself with technological advancements in the field, finished a second certification as a medical health coach and spent another two years completing a bachelor’s degree program at Rowan University to support a move into the field of population health.

In August 2016, Sparaco became manager of population health for the Kennedy Health System in Cherry Hill, New Jersey, heading up a program with 10 RNs, two LPNs, a health coach, and a social worker to manage an active patient population of 80,000. She had begun that work only a few years earlier when she was chosen to implement a special, chronic care management initiative for patients with two or more illnesses. After three decades in the field, Sparaco felt like she was where she’d been meant to be all along.

“I feel like I’m hitting my stride now, where it’s all starting to come together,” she said. “The senior administration at Kennedy, they really do get it. It’s helping move the whole transition of care team, and encouraging communication and shared management of the patient. We have an established medical neighborhood and lots of care contacts to come in with our patients.”

In the years since she entered the field, Sparaco said she’s seen health care institutions make the necessary evolution to empower nurses to be more autonomous. The philosophy of partnering nurses with physicians and nurse practitioners for the care and management of their patients wasn’t part of her education the first time around, but since its arrival, the field has been amidst a necessary transformation.

“We always said as nurses we wanted this kind of care coordination for the patient, and here we are,” Sparaco said. “When you do get that and you can establish workflows so we’re working together to manage the patients, it is a whole different world. We can capture our patients before discharge to make sure they get what they need. That’s a really huge leap from where I started.”

In the early days of her career, nurses relied on episodic care, Sparaco said; patients weren’t tracked, their progress or deterioration charted against baseline measurements. In the intervening decades, systems for the delivery of care have transitioned into a longitudinal approach that not only feels more like what she set out to do as a nurse from the beginning, but is “what’s keeping me in the game at my age,” Sparaco said.

“I know more nurses than not who have said over the decades, ‘If only this doctor knew what that doctor was doing, they wouldn’t be repeating tests; running [patients] to different specialists,’” she said. “You pretty much had to have somebody in the family who knew about medicine or the redundancy would be crazy.”

Sparaco also shares this perspective with the nursing students she speaks with, reinforcing for them not only how important they are to their patients, but how their ability to practice health care independently and to advocate for their role in patient care is critical to the health outcomes they offer. As health care has evolved to identify and treat patients with complicated comorbidities and psycho-social needs, every level of care that a nurse can deliver – medication, education, support, health coaching – is necessary to help them self-manage their conditions and live their best lives.

“When I see that happen, it is just the best,” Sparaco said. “I went into [medicine] for that exact reason, to be able to do that for a patient, and I think it’s happening now. Three years ago, most people didn’t know what a medical neighborhood was, and now everybody gets the idea of how to manage a patient. It’s real exciting to see the teams working together now and getting it.”

Sparaco is a staunch advocate of continuing education for nurses. She tells her young charges to pursue the highest levels of learning that they can; to not stop until they have earned at least a master’s degree because “it’s never going to be any easier.” As nurses are called upon to be more independent in their practices, and are no less in demand to care for the patients they serve, their input will only be more valuable. That’s why Sparaco emphasizes leadership training for her staff and works to help them feel empowered in their practice.

“I tell my team, ‘You are the leaders out there. Take initiative, make sure you’re proactively approaching the staff to see if they need any clinical assistance, any education. Never stop believing or acting as a leader,’ ” she said.

As the demands of the profession escalate and become more complicated, Sparaco believes those nurses who seize upon their profession as a career and not just an occupation will be the most successful in the field. With the tremendous variety of specialties and job openings available, nurses who empower themselves to be self-sufficient practitioners will have the greatest opportunities available to them.

“I would like to see nurses focus on their passions and what type of nursing they would focus on in order to develop that [career],” Sparaco said. “We have so much to offer in so many different ways that I think we can benefit society and our patients by being more autonomous.”