I have always been involved with ONA, but not legislatively. I read up on various policy initiatives over the years as a young nurse, mostly to keep up with current events. It wasn’t until I was involved with AORN that I really got into legislation.

When I was president of AORN in 1992–1993, I learned how critically important it was to be involved legislatively. When I was done with my presidency, I was voted in to be vice chair of the Nursing Organization Liaison Forum (NOLF). This was an organization within the American Nurses Association that represented specialty organizations. There were 78 specialty organizations from men in nursing, critical care nurses, nurse anesthetists, OR nurses, and so on. I had outreach to a lot of different nurses.

In 1994, I was asked to come to Washington DC and help the Clinton administration with healthcare reform representing nurses in specialty practice. That immersed me in the legislative process. I came home and helped ONA set up a statewide NOLF, which is now called The Alliance. That means ONA has outreach to specialty organizations and even to presidents or chairs of nursing programs throughout Ohio. That is great outreach that still goes on today.

Working legislatively means helping each other prosper in a collaborative adventure. One of the last things I did as president of AORN was collaborate with the American Society of PeriAnesthesia Nurses and the American Association of Nurse Anesthesiology. We worked so closely together that our three organizations had a national conference in San Diego in 1993. It put those three organizations very closely in tune to each other, and to this day they still are very close.

Leaders have to be aware of what is going on legislatively in their states as well as nationally. We have people looking to us for direction, and we will fail in carrying our people forward if we are not well informed.

Right now, I am the chairman of the Ohio Nurses Association Health Policy Council, and we mainly keep track of legislative activity in Ohio. We are currently working on workplace violence legislation, which is needed more now than ever before. And of course, a good part of my career has been my drive to enact smoke evacuation legislation. Nine states are now smoke free because of the passion of perioperative nurses.

Legislatively, it is so important for nurses to get involved and stay involved. I am now setting up a “Candidates Night” for Ohio House and Senate candidates in the Mid-Ohio District to come and answer questions from nursing professionals. We will have a room full of nurses, and my hope is that they leave the experience with an understanding of the legislation we should be supporting and how easily they can have relationships with their legislators themselves.

Our representatives will listen to nurses, and they are available as resources to us. I text my Ohio legislators all the time to ask, “Well, what’s going on with this or that?” And in turn, I am a resource to them. They think of me when they come across healthcare issues they do not understand, and I honestly feel like my input helps them draft legislation that is more conscientious and effective to solve real healthcare issues.

A leader has to have that awareness of what is going on to survive because that knowledge will get tested at some point. Nurses say they want a seat at the table all the time—when they get it, they have to show why they are meant to be there.

My leadership style is shared governance. I feel that leaders should enable their followers to make decisions based on their knowledge and skill levels on important decisions regarding patient care and their workplace environments. If the decision is too radical or not practical, then the leader needs to explore the root of the decision and make corrections as needed, especially if there is false information.

Exciting people about going back to school is part of mentoring. Education and experience are key for leaders. I continued to evolve in my leadership abilities as I gained more education and experience. This, in turn, elevated my skill level in a variety of different areas. I have had mentors who actively participated in helping me advance my strengths and identify and work on my weaknesses. As a mentor, I too try to help my mentees realize their strengths and weaknesses so they can work on becoming better nurses. A mentor who is not afraid to constructively discuss a mentee’s short-comings is critical for the mentee to become effective and successful.

Mentoring is at the center of what shapes leaders, and mentors can have a huge impact on exciting people about furthering their education. I got my PhD, but I know many nurses who do not want to pursue a doctorate. What can we do to encourage people to continue their education? Even if it is just taking a class, or going to an AORN chapter meeting, or attending an OR Manager conference, or participating in a state association—these are valuable educational opportunities that should be encouraged.

I have always shared my career path with nurses: I got an associate degree in nursing, went right into working in the OR, and then I got my bachelor’s degree in nursing. And then I got my master’s, and then my PhD. I had been in the OR about 8 or 9 years when I thought, “There’s so much in the OR. There are so many specialties. I want to do something well. I want to really become an expert in something.” That is what drove me; I wanted people to Google search “Kay Ball” and see that I was clearly associated with and leading an area of expertise.

My proudest moment was when I received in print my first laser book. I wanted to share my passion for laser technology in healthcare, and writing a book was the ultimate pathway in accomplishing that.

I achieved what I set out to do. When people want to know what Kay Ball’s specialty is, they will find it is laser technology. I have written four books on lasers, and my name is associated with various articles, books, and other materials. I wanted to share this new technology that I had mastered with my colleagues. Now when people look up Kay Ball, they see lasers, they see surgical smoke, and I am seen as an expert. I am immensely proud of that.

And that is all part of leadership because even if nobody calls you an expert, you still get called in as an expert when it is time to advocate for something. That is why I said earlier that all leaders need to be well informed because their knowledge will get tested at some point.

Another very proud moment was when I walked, as national president of AORN in 1993, into the opening session. My board walked before me and I was the last person to walk in. This walk was critical because it symbolized the trust that the AORN members had in me to conduct the business of our professional organization and represent our perioperative nursing universe to the world during my presidency.

The toughest part is allowing your staff members to make mistakes so they can learn from them, but only as long as patient safety is not compromised.

I think nurses realize there is so much in the nursing field. Some of them get overwhelmed and say, “I can’t put one more thing in my brain. I can’t learn one more activity.” They burn out, and because of that constant push to learn more skills, they leave the OR.

If you can inspire these nurses to take on new tasks and new abilities, in a way where they continue to invest in themselves, then they will become tomorrow’s leaders because they are going to learn how to teach.

Mentors are role models, too. There is so much in healthcare that can be very exciting. A good mentor helps people focus amidst so much information and opens venues for sharing.

I remember when I first started in the OR, there were some nurses who did not want to share what they knew. They wanted to be the ones who got called upon for a case because nobody else knew how to do this or that.

But there is enough for everybody to be able to share and not hog knowledge within yourself. I have seen nurses even hide special instruments in their lockers because they want to be the ones to provide them for a procedure. That is not conducive to a team-focused culture and leaders should not encourage that.

The most difficult lesson I learned in my first year was that the human body was very durable but also very fragile at the same time. I wanted to learn everything about every surgical procedure immediately to be the best perioperative nurse I could be, but I had to learn patience because this is something that can only be conquered over time.

I also quickly learned there are different approaches you can take to accomplish your tasks. The biggest myth in the OR is that there is a “gold standard” for everything. The surgical environment is so dynamic and everchanging with new products and devices, procedures, skills, safety measures, and so on, that a gold standard does not last for very long.

Just think of how laparoscopic cholecystectomy evolved. Some felt that a long upper right abdominal incision needed to be made to remove the gall bladder—that was the gold standard. Then laparoscopy in general surgery became so popular that making a long incision was no longer needed in most cases. Surgery continues to evolve and advance, making many gold standards outdated.

I admire leaders who value outside input and are not afraid to listen to others’ opinions on issues. I also admire healthcare workers who are members of their professional organizations along with their state associations. After all, I am a nurse first, so I belong to my state nurses association; and I am a nurse in specialty practice second, so I belong to AORN. And I am very active in both.

Leaders need to know what is going on in the nursing community within their state and also within their specialty areas. These memberships provide that awareness and knowledge. These associations are globally thinking of issues that the nursing community should be interested in when it comes to policy, legislation, and other important areas like diversity, equality, inclusion, etc.

So many nurses leave nursing school and have no idea that there are even specialty organizations out there. Organizations and publications like OR Manager and AORN do a lot to inform new nurses of all these available resources. That has formed my career. You just don’t do this a certain way because that is the way you were taught; you do it this way because research says you need to do it this way.

Evidence-based practice is the foundation of perioperative patient care. I admire those nurses who are actively involved and want to help make things work better. They are leaders in healthcare.

I always tell people who express to me that they want to be president of a specialty organization that they need to be a member of their state nurses association. AORN leaders need to be actively involved in their state nurses associations because they are going to be representing me as a perioperative nurse at those big meetings that the American Nurses Association has.

When I think of leaders, one other element that is glaring—in a good way—is the impact of mentoring. I was mentored all through my career. When I started mentoring, I found that the more I mentored, the more I was exposed to education. And I realized that I basically secured my legacy in being a mentor.

Mentoring is so rewarding. Whether it is through teaching my perioperative nursing students who are seniors in the nursing program at Otterbein University, or taking a novice nurse at an AORN convention under my wing and saying, “This is what you need to do to achieve excellence,” I am finding ways to share my passion.

I get to teach, which I love, and I get to practice leadership. Mentorship is a major, major part of leadership. It is an expectation.

The appropriate, most effective mentors are the ones who not only look at the professionalism of the nurse, but also at the personal aspects because they go hand in hand. It is not just teaching nurses a new trick for their trade and putting another egg in their baskets. Mentors need to show nurses how to adapt and how to survive within the culture in which they exist.

A true mentor is one who helps support the nurses under his or her care and helps make sure they are all right. Nurses are so busy all the time. We are advocating for our patients, learning new clinical skills, time managing our days and our ORs, and we forget about ourselves. No matter how expert you are in healthcare, you still need to have a mentor. You need someone who you can openly discuss things with; someone from whom you are not afraid to hear, “You’re wrong,” sometimes; someone whom you trust when they say, “This is what you need to do.”

The value of being a mentor is exponentially greater right now with so many nurses leaving the profession and burning out. Mentors are also needed now more than ever for the new generation of nurses entering the profession because these new professionals will only stay if their leaders show they care about their mental health and general well-being.

Hospitals need to recognize the value of mentors and have formal mentorship programs. Facilities that have that in place do better in their satisfaction surveys because the nurses are not as stressed out. Their patients do better. I can’t emphasize enough how valuable it is to have a safe place, a person who can help you blow off steam, someone to whom you can say, “I’m confused,” or, “I think I did something wrong today,” and not fear punitive actions.

Mentorship programs can be quite casual; they do not have to be super elaborate. It can be as simple as catching up with mentees every now and then just to see how they are doing.

I know a nurse who graduated about 6 years ago, and she is now working in the OR. I hear from her every once in a while, and we usually say, “Let’s get together and catch up.” Easy as that. Our conversations can be as casual as they come, but I have also taken her through tearful times. I guided her through switching work environments, for instance. I do not mean to minimize the importance of these conversations when I say they can be casual.

You may not realize it, but you do become part of that person’s support system. Being there to be a sounding board, a coach, and the person who helps them get on with how they need to handle a situation, that is all part of leadership.

You can be a mentor even in the role of educator, that is a type of professional mentorship. I teach a lot on surgical smoke, which is not just a problem in the US. I have mentored many nurses around the world, guiding them through how they can achieve a smoke free environment and how to handle this workplace safety issue.

They depend on me to help them go through the steps of becoming a leader, essentially. When you step into the role of an advocator and fight for safer working conditions, you are leading.

No, because many issues in healthcare are universal issues, even if the politics behind solving them may be a little different. I am thankful that I have regular teaching opportunities overseas. I may be teaching via videoconferencing to students in Singapore one day, and then jump on another virtual nursing conference to an audience in China the next day to talk to them about surgical smoke and leadership.

Surgical smoke, for instance, is 100% a global issue. My research studies show that nurses who work in surgery are reporting twice the incidence of respiratory problems as compared to the general population. That data is probably consistent globally. Those working in surgery are breathing something funky that is giving them problems like respiratory conditions, twice as many as what you see outside the profession.

What can be challenging is the language barrier. I try to make my presentation slides tell a story to help them visualize what I am saying and help them follow along with pictures, images, graphs, and charts. But that is the only difference in teaching an international audience because the passion is always there. The passion from nurses worldwide is very evident. They want to have a safe workplace environment, and they want to have safe patient care.

And leaders globally are thinking through how to fix the same problems we have in the US. How do you deal with unruly surgeons? How do you get rid of surgical smoke? How do you continually update your nursing population so they understand new devices on the market? How do you ensure your department is adequately staffed? How do you keep your people safe? These are universal issues.

When I travel, I see that everyone wants the best quality of patient care. They all have their evidence-based guidelines backed by research. We compare guidelines and research a lot. When we update our own guidelines in the US, we need to be looking at research from other countries because it may be applicable.

When I was exploring articles that were recently published on the latest research on the impact of surgical smoke, I found that many nurses in Turkey were doing the same sort of research. I compared the Turkish research on the subject with my own, and it was refreshing to be able to talk to these nurses, see how they solve their problems, and learn from them. Like I said before, I respect people who are willing to share their knowledge. That is how we grow.

I go to New Zealand a lot on my own, for instance. When I am there, I always seek out the heads of nursing organizations and educators I know and say, “I’m in town if you need me to speak.” Somebody usually takes me up on that. The offer is always there.