By Matt Skoufalos
Situated at the mouth of the Portage River on Lake Erie, Port Clinton, Ohio is a community defined by “the lake life,” said Rebecca Votino. Its population fluctuates seasonally, boosted by fivefold in the summer months, when vacationers flood the county seat to visit the Walleye Capital of the World.
Serving them year-round is Magruder Hospital, where Rebecca Votino, its new director of perioperative services, supervises 30 direct employees who perform some 3,000 cases a year on average. The position at Magruder reflects a significant change from her prior appointment at Bon Secours Mercy Health, where Votino oversaw perioperative services and pre-admission testing for a 12-bed operating room, performing 7,500 cases annually with 80 direct employees.
“My experience is in other larger, busier, OR arenas, but I’m helping to take Magruder into the next level of perioperative health care and what we can do in that arena – and on top of that, I got to transition in the middle of a pandemic,” she said.
Votino began her tenure at Magruder on April 4, 2020, “right in the thick of the halt to elective surgery in the state of Ohio” because of the novel coronavirus (COVID-19) pandemic. Her first introduction to many of those 30 new direct reports was over the telephone, as she began calling to see who among them would consider being voluntarily furloughed.
“I knew there was no way I was going to be able to keep people on the clock,” Votino said. “It offered me a really good opportunity very early on, to demonstrate my leadership style, and the way I’ve chosen to try to lead folks with as much autonomy as you can give.”
With the support of senior hospital leadership and the human resources department, Votino engaged her staff about their individual circumstances, trying to discover what considerations were best for them, reassuring them that their positions were secure and offering guidance about available options.
“I’m not just coming in here with a broadsword and making decisions, not giving people choice or autonomy,” she said.
After the surge in COVID-19 cases in Ohio retreated from its spring peak, Votino transitioned staff back into the surgical setting amid ever-shifting pandemic guidance. In managing those leadership challenges, she has drawn upon the example set by one of her nursing mentors, Mary Jane Patterson, her former supervisor at Fisher-Titus Medical Center in Norwalk, Ohio.
“[Patterson] was fair, consistent and transparent about her leadership style,” Votino said. “I’ve carried that with me. She was never one to talk out of both sides of her mouth; she was going to give the same answer to her staff as she would to the physicians. She held you highly accountable for your word, but she also would back you if she knew your work was good, your character was good.”
Patterson’s approach to leadership reflected some of Votino’s first experiences with the “Just Culture” concept, which emphasizes isolating systemic points of failure rather than assigning individual blame when something goes wrong in the hospital. Votino views the Just Culture approach as emblematic of a professional transition to ownership and accountability from the blame and finger-pointing that reared its head earlier in her career.
“It was terrifying to be a new nurse when I was young,” she said. “There were a lot of nurses who tried to trip you up, who thought that was how to make you better. Then there was a point in which it almost became too forgiving, too soft, to where we weren’t quite keeping people as accountable as we should have. Now we have found that happy medium.”
“I like to give nurses my expectations, and follow it up with the promise that when they follow them, I will back them to the carpet,” Votino said. “That empowers them; I’m a conduit and an insulator.”
Votino has seen the profession evolve significantly over the 24 years she’s spent in it. In high school, she worked as a candy striper even as she considered a career in medical school. Her time in the hospital made Votino realize that what she was really seeking was the nurse-patient relationship, not the physician-patient relationship, “and that switched my gears,” she said.
Out of high school, Votino completed an eight-semester BSN consortium program led by Bowling Green State University and the University of Toledo Medical College, and began her nursing career in the summer of 1996. Subsequently, she attained certifications in neonatal resuscitation, critical care, obstetrics, advanced cardiac and pediatric life support, and orthopedic nursing, and presently helps write certification questions for her fellow nurses with the Orthopaedic Nurses Certification Board. Nonetheless, “I’ve come to realize that OR is where my heart is,” she said.
“It’s a tough arena,” Votino said. “You’re in cases with physicians sometimes four, five, six hours in one case; see them day in and day out, hours at a time.”
“It’s a much more collegial teamwork arena,” she said. “It can become challenging; it can become charged. You have to have a thick skin, so it’s not for everyone. But no specialty of nursing is for everyone. That’s something I’ve always told students is great about nursing: you can find a specialty that you’re drawn to, and you can find a schedule that fits your lifestyle.”
Votino is living proof of that tenet: she’s worked in various care settings, from labor and delivery at Providence Hospital in Sandusky, Ohio to the intensive care unit at Fisher-Titus, where she met Patterson, to University Hospitals Elyria Medical Center, in Elyria, Ohio, where she built relationships that bridged the perioperative services center with the patient care side of the business.
As she begins her new position at Magruder, Votino has high hopes for where the future of her nursing career will take her.
“It’s a strong community hospital,” she said; “they have a focus on their patient population and their staff. I really feel like it’s a great place to be, and I’m hopeful that I continue to feel that way.”