September 8, 2006

VUMC Reporter Profile — Caring for caregivers defines Dubree’s career

Featured Image

Marilyn Dubree, center, is surrounded by some of the Magnet escorts, bottom row from left, Brenda Wallace, Lisa Eason, Marie Glaser and Ann Hurley, and top row from left, Georgette Smiley, Rebecca Hacker and Barbara Brown.
Photo by Dana Johnson

VUMC Reporter Profile — Caring for caregivers defines Dubree’s career

Interactive leadership is a hallmark of Chief Nursing Officer Marilyn Dubree’s Vanderbilt career. Here she chats with Martha Bland, R.N., during rounds in the NICU with other administrators. 
Photo by Dana Johnson

Interactive leadership is a hallmark of Chief Nursing Officer Marilyn Dubree’s Vanderbilt career. Here she chats with Martha Bland, R.N., during rounds in the NICU with other administrators.
Photo by Dana Johnson

Having fun at work is crucial to Dubree. Here she portrays Paula Abdul, one of the judges at the Vanderbilt Idol contest held Tuesday as part of the kickoff of Employee Celebration Month.
Photo by Susan Urmy

Having fun at work is crucial to Dubree. Here she portrays Paula Abdul, one of the judges at the Vanderbilt Idol contest held Tuesday as part of the kickoff of Employee Celebration Month.
Photo by Susan Urmy

Dubree and friends, from left,  Adrienne Ames, Carol Etherington and Sara Hampshire, at a New Year’s Day celebration in 1999.

Dubree and friends, from left, Adrienne Ames, Carol Etherington and Sara Hampshire, at a New Year’s Day celebration in 1999.

Dubree with her mother, Elsie, 92, who still lives in the family home in Bowling Green, Ky.

Dubree with her mother, Elsie, 92, who still lives in the family home in Bowling Green, Ky.

Susan Jones, Ph.D., a professor at Western Kentucky University, still remembers the time 34 years ago Marilyn Dubree and fellow student nurses came to the aid of an elderly man from the next county who had a serious illness.

He had no family or friends except for his trusted dog who, for obvious reasons, was not on the hospital's approved guest list.

But somehow, some way, the patient's beloved mutt mysteriously showed up on the unit one day.

“Seeing that dog was better than any medicine we could have given him,” said Jones. “I never found out exactly who made that happen, but I know Marilyn was involved. It was a holistic approach to medicine even before the term was widely used.”

To this day, Dubree won't own up to her role in the story. But it really doesn't matter. What does matter is that the patient received support and care in what were his final days.

Now, as Vanderbilt University Medical Center's Chief Nursing Officer, Dubree oversees more than 3,000 nurses and nursing managers. She interfaces with the leaders of each of the Medical Center's hospitals and clinics and has dedicated 30 years of her career to taking care of VUMC's caregivers.

Ask nurses and organizational leaders to describe Dubree and the same words keep coming up: passion, enthusiasm, advocacy.

Kentucky Roots

Dubree's understanding of the health care process started at age 15 in a Kentucky community hospital where she worked in many different departments as a candy striper.

“The times I worked the information desk were where I learned firsthand the impact that hospital staff can make at a time of joy, desperation or confusion in someone's life,” said Dubree. “I believe nurses have a very powerful role and special privilege to intervene in a person's life and make a profound difference.”

Dubree refers to this as “sacred space” and this perspective drives her approach to patient-centered care.

She is the only child of Travis and Elsie Dubree of Bowling Green, Ky. Her mother worked in the dietary department of the town's only hospital and often took Marilyn with her to work, where she discovered a warm and appealing environment. Her father worked as a painter in plant operations at Western Kentucky University.

With the upbringing her two hard-working parents gave her, it is no surprise that daughter Marilyn grew up to be a nurse administrator at an academic medical center.

Her mother was one of 10 siblings and Marilyn's childhood was filled with aunts, uncles, cousins, extended family and, eventually, her grandmother came to live with the family. Those closest to Dubree during childhood credit her mother, father and grandmother with teaching her a strong work ethic, integrity and an enormous sense of caring for others.

Dubree continued her work at Bowling Green Warren County Hospital as a candy striper and worked various part-time jobs throughout high school and while pursuing her associate's degree at Western Kentucky University (WKU).

In addition to the information desk, she worked in the lab, in the admitting office and remembers fondly that her first leadership role in health care was when she and her friend became supervisors of the candy stripers at the 200-bed facility.

Jones was a second-year instructor at WKU when she met Dubree, then a student. Jones has taught nursing for 36 years, but remembers Dubree's inherent sense of caring and empathy that is difficult, if not impossible, to teach. Jones was with Dubree when the Kentucky Nurses’ Association named her as the outstanding student nurse in 1973.

When she graduated from WKU, Dubree worked at the hospital for a year helping to open its new eight-bed ICU, which was a big deal in a small town. Then, at the urging of her professors, Dubree pursued her baccalaureate at the Medical College of Georgia. She discovered there that the more she learned about nursing, the more she wanted to learn.

She studied medical surgical nursing at Vanderbilt University School of Nursing to give her a broader base of experience. She graduated with a master's of science in Nursing from the school in August 1976 and officially joined VUMC as a clinical nurse specialist in the surgical department that same year.

The Early Years at VUMC

At her core, Dubree is a staff nurse. That identity is arguably what makes her so effective in her leadership role during the past 12 years. She recently marked her 30th anniversary at VUMC and can't believe it's gone by so fast. She has seen much change and worked with many people.

One of those is Edie Vaughn, R.N. 2, who has worked at VUMC for 33 years and remembers the first time she met Dubree. Then, Medical Center North was home to the hospital and Vaughn worked in a private surgical area. Dubree worked as a clinical nurse specialist on the surgical area with several bed wards. Through smiles and giggles, Vaughn recalls meeting Dubree when the first professional medicine carts — with drawers and rollers — arrived at the hospital. The two worked together to learn the new equipment, which at the time was a vast improvement in medicine protocol.

“I can still see her smile and remember how nice she was,”said Vaughn, who has seen Dubree in a variety of roles since their first introduction.

“She's one of the most caring people I've ever met. She has a heart for patients and values staff nurses. I think what I do with patients is important and so does she.”

For Ann Luther, the call to join VUMC nursing came 24 years ago and the voice on the other end of the phone was Dubree's. Dubree was recruiting for a nighttime clinical nurse specialist position unlike anything else in the country. Luther came on board and through the years has watched Dubree take on more leadership roles.

“She loves nurses and nursing,” said Luther. “She always has our best interest at heart, and I've personally seen her stick up for nurses.”

In addition to the professional connection, Luther has also enjoyed Dubree's fun-loving style. In the late 1980s, Dubree and Luther were traveling to a nursing convention in Memphis, with Dubree in the driver's seat. They planned to visit Graceland before the conference started.

“About 40 miles outside of Memphis, Marilyn surprised me by popping Elvis songs into the stereo and we sang “Don't Be Cruel,” “All Shook Up, “Hound Dog” and other favorites all the way to Memphis,” said Luther. “We were goofy, silly and primed for our tour of Graceland.”

Leadership Style

Dubree admits she feels the same excitement and enthusiasm as she did when she first started at the Medical Center.

“This is a place that has always held great stimulation for me because it's been full of bright, knowledgeable people and it's constantly evolving,” said Dubree. “You want to be at a place and to work hard with people like Harry Jacobson, Norm Urmy and Colleen Conway-Welch who have a vision and challenge you to be your best.”

Dubree avoids labels because she thinks it's unfair to neatly fit people into categories. So she can only describe her management style as valuing the power of what a group can collectively achieve.

“I surround myself with really talented people and listen to them to create a vision of the future,” said Dubree. “I am struck by how often people take you beyond what you can dream on your own.”

Most people comment on Dubree's high energy level, but she promises she has no secret vitamins or exercise routine to credit. She admits that she's always been an optimist and draws inspiration from the dedication and expertise of those around her.

“If you're lucky, you're able to covenant with people by doing good work and partnering in a meaningful way,” said Dubree. “Not every day is perfect, but the work is amazing and Vanderbilt nurses are constantly amazing me. Those experiences change you.”

A Culture of Nursing

Dubree values relationships and tries to engage with people on a deeper level. She remembers people's names and references their personal lives because she wants to dig below the surface with each person she encounters.

While rounding recently with Martin Sandler, M.B., Ch.B., on the NICU, she was innately drawn to each nurse. She struck up conversations, asked each about their specific duties and thanked each for their commitment.

Dubree feels that working toward Magnet Recognition is important, but she more readily acknowledges the years of laying groundwork that was necessary to even start the accreditation process. She said its required expertise and input from virtually everyone in the Medical Center to develop and embrace shared governance, professional practice, “Be the Best” recruitment and retention efforts, and the evolution of the case management model.

“I'm very proud of the nursing culture that we've created,” said Dubree. “We have created a culture of excellence in nursing and we've raised the bar for patient care.

Everything builds on what came before. It's dynamic without an endpoint,” she added.

Dubree's mark is not only within the walls of VUMC. Her impact can be seen at the School of Nursing as well. VUSN Dean Colleen Conway-Welch, Ph.D., and Dubree work together to integrate the two areas whenever possible.

“Marilyn did pioneer work in the re-design study on the round wing in ortho service in early 1990s, which served as a foundation for best practices and clinical care delivery in Vanderbilt University Medical Center,” said Conway-Welch. “This was cutting edge work 15 years ago and Marilyn made it happen.”

Dubree consistently provides input and advice as the nursing school shapes its curriculum, particularly with the health systems major. She also works closely with the faculty to help determine the curriculum and the skill set needed in today's rapidly changing academic health setting. She has been a regular guest lecturer and preceptor for VUSN students.

“Marilyn challenges the students to be visionary and forward looking as they gain in their leadership abilities,” said Conway-Welch.

Collaboration in Action

Every Tuesday, Larry Goldberg, Jim Shmerling, David Posch and Dubree meet for breakfast to discuss coordination and major issues at VUMC. Aside from making sure the group eats a well-balanced breakfast, Dubree sees this as an opportunity for collaboration and another way to advocate for VUMC nurses.

“Marilyn sees situations through the eyes of a nurse, which is a wonderful perspective,” said Shmerling, executive director and CEO of the Monroe Carell Jr. Children's Hospital at Vanderbilt. “It often happens that Larry, David, Marilyn and I are talking about different options on the table. They might work from a financial perspective and a physician perspective, but Marilyn will let us know if it doesn't work from a nursing perspective.”

Posch, chief operating officer of Vanderbilt Medical Group, believes that nurses are knowledge workers who fundamentally understand what patients need to manage their disease process.

He cites Dubree's leadership in shared governance as a big component to the positive nursing culture at the Medical Center.

“The underlying idea that individual floor nurses can influence their work environment and make changes to further enhance patient care is remarkable,” said Posch. “Marilyn exemplifies supportive leadership.”

“There are not many chief nursing officers in the country who have the experience, longevity and passion that Marilyn brings to VUMC,” said Larry Goldberg, executive director and CEO of Vanderbilt University Hospital. He feels under Dubree's leadership, VUMC simply “does it better than any other medical center.”

A Family of Friends

Connecting with people is very important to Dubree in her private life as well. Although her only immediate living relative is her 92-year-old mother, who lives in the house Marilyn was raised in, Dubree has surrounded herself with a family of friends that she met during graduate school and in her early career at VUMC.

Adrienne Ames, Carol Etherington and Sara Hampshire are the cornerstones of Dubree's “family.” Each person is a master's-educated nurse who has made significant contributions during her career. This foursome represents almost every aspect of nursing including administration, community health and women's health.

Ames, then associate director of Ambulatory Care, and Dubree met at work and soon realized their common philosophy of patient-focused care and empowering staff to work through any barriers that impeded quality care.

“She advocates for nurses in every way possible and she cares deeply about nursing at Vanderbilt,” said Ames.

VUSN faculty member Carol Etherington became friends with Dubree in the mid 1980s. Etherington feels the friendships within the group have grown in large part because each brings a variety of experiences to the role of nursing.

“Marilyn never forgets that it's living, breathing human beings with all their strengths and all their frailties that make up this extraordinary place we call VUMC,” said Etherington.

Seeking New Adventures

Most may think a card game and travel have little to do with one another, but in Dubree's world there is a strong connection. Dubree and close friends quickly dropped a casual monthly bridge game and started planning international and domestic travels together.

Between “bridge” club trips and her other adventures, Dubree has logged thousands of miles visiting Ireland, Australia, France, Italy, New Zealand, Scotland, China, Peru and several areas within the United States. Her goal isn't to cover the most ground in the fewest number of days. She focuses on one main location to get a thorough understanding of the place and the people.

“When traveling, I'm so struck by learning about history and learning about these places,” said Dubree. “It makes me so appreciative of where I come from and from whence we all came.”

Dubree has an enormous capacity for learning about people wherever she goes. It's the human experience she strives to witness, learn and participate in. Dubree recently returned from a 10-day Alaskan cruise which gave her perspective.

“I was so taken with the vastness of glaciers and mountains and the smallness of us as humans against that,” she said.

Dubree keeps a list of places she has yet to visit, and won't name locations, but says it's in the double-digits. One thing she's sure of, whether it's talking about her next trip or the next nursing initiative, the best is yet to come.