Overview. Julie Willems Van Dijk, PhD, RN, has helped hospital patients transition to home, educated pregnant women, supervised nursing care for the elderly, and made sure southeast Asian refugees received health care. Eventually, she moved to an even larger stage, helping to answer questions like: What makes people sick? What keeps them healthy?
“I chose nursing.” Though she wasn’t raised in a family of health care practitioners, Van Dijk never wavered in her decision to be part of what she called “a helping profession.” After briefly considering a career as a music therapist, she focused on nursing and earned her undergraduate, master’s, and doctoral degrees in nursing at various campuses of the University of Wisconsin.
“I saw physicians as diagnosticians and detectives while nurses assisted through the healing process and that part of health care that makes people whole. That was what interested me. And I would say 32 years later, that’s still true.”—Julie Willems Van Dijk
Van Dijk’s nursing career began at the bedside in 1982 at Wausau Hospital Center in Wisconsin. A bedside nurse, she decided, “occupies very holy space... with the people that you serve. It’s a very holy, personal place to be with someone.”
But Van Dijk discovered that she did not fit very well into a hospital setting. “I always tried to customize care for patients,” she said. “Back in the day, you did baths and walks and got the beds changed and it was a very regimented way to take care of the patients. I had to do what was on the day-shift list. But I remember thinking, ‘Aren’t we here, aren’t we about the patients?’
“I was into the social determinants of health before we called them that—thinking about social, emotional, and environmental health, not just physical health. I loved having patients who were going to be discharged. I loved to set them up for transition to home. I had this ‘what-happened-before-they-got here’ and ‘what-happens-after-they-leave’ focus with patients. And I was always involved with the community, thinking about those who come to our door. So it was natural that I ended up in public health.”
From bedside nursing to public health. After a brief stint as director of nursing in a private nursing home, Van Dijk became a public health nurse at the Marathon County Health Department in Wausau, Wis., in June 1988. Four years later, she was appointed director of public health services at the health department, responsible for a range of programs that included parent, child, and refugee health and chronic disease prevention. Van Dijk also served as the health department’s director of nursing, a multiple-path career opportunity that Van Dijk found rewarding and unique to nursing.
“One of the greatest things about nursing is your opportunity to serve in lots of areas that can be very rewarding to you,” she said. “If you are a physician, you have to go down one track, you do a residency and a fellowship with a specialty. You don’t easily later say, ‘No, I don’t want to be a pediatric gastroenterologist any more.’ But as a nurse, you can say, ‘I’ve done this’ and go apply those skills over here.”
In early 1999, while juggling two sets of responsibilities at the health department, Van Dijk applied to Robert Wood Johnson Foundation Executive Nurse Fellows, a three-year, advanced leadership program to address the needs, opportunities, and challenges of registered nurses in senior leadership roles. Through coaching, education, group training, and individual initiatives, the fellowship builds capacity among nurses to help transform health care at the local and national levels. It enrolled its first cohort of nurses in 1998; its final cohort starts in 2014. For more information, read the Program Results Report.
A self-described life-long learner, Van Dijk knew the RWJF program would expose her to critical executive skills necessary to one day lead the county health department as its chief health officer, an ambition she hoped to fulfill. Van Dijk was also interested in the program’s financial support, which would help her design and implement a leadership project to address a problem in her home community.
Van Dijk was selected for the RWJF Executive Nurse Fellows 1999 cohort. At first, she felt like an “imposter, like I’m not qualified to be here. But we all showed up that way. The program pulled us up and said, ‘Why do you have THAT self-image?’ Part of the program is getting past that ‘poor, little old nurse, what do I have to offer?’ attitude.”
“I had huge imposter syndrome... Just that [fellowship] interview was a life-changing experience. I’d never gone anywhere where someone paid for my hotel,” said Van Dijk.
Evaluating the Marathon County Home Visiting Program. In 2000, a year after Van Dijk became a fellow, the health department achieved its target goal for an initiative it had launched five years earlier: every Marathon County family with a new baby received a home visit through its comprehensive parenting education and support program.
In the “Right Start” program public health nurses visited every family for an initial assessment and reached out to identify additional services they might need. “We did not do this on a risk-based model, but [instead] if the families wanted the services they could take advantage of them. We thought it was important that this was available to everyone, and not just to someone who was [seen as] a ‘bad’ parent. It was a program that was well loved but poorly evaluated.”
Van Dijk saw lack of evaluation as a sustainability issue for Right Start, and designed her RWJF Executive Nurse Fellow leadership project around creating one. She hired an outside evaluator to review the program’s outcomes and processes, including its relationships with as many as 17 funders at a given time. “We had collected a lot of outcome data, but we never looked at it,” she said. “And we needed process evaluation about governance. It was touchy, and there was a lot of fear that this evaluation would uncover some bad news and put the program at risk.”
Such fears, however, proved unfounded. The evaluation confirmed the benefits of the visitation program with data and through stories and testimonials from both families and providers. “Overall, it was a big success,” she noted. “It provided “something very tangible for the community, and it was a leadership learning opportunity for me.”
More responsibility, more education. Less than a year after finishing the nursing fellowship program, Van Dijk put her new executive leadership skills to use when she accepted the job she had always wanted: chief health officer of the Marathon County Health Department, responsible for programs in environmental health, parent-child health, communicable disease control, and chronic disease prevention.
The RWJF Executive Nurse Fellows program, “taught me to think big and to think in terms of possibilities. That really empowered me,” said Van Dijk.
About the same time, Van Dijk started an online PhD program in nursing that called on many of the skills she had acquired through the fellowship. In 2009, with her newly minted PhD degree in hand, Van Dijk ended her 21-year career in public health nursing and accepted a job as associate scientist and deputy director of County Health Rankings & Roadmaps, an RWJF-supported program at the University of Wisconsin Population Health Institute.
County Health Rankings & Roadmaps offers an annual snapshot of what makes people sick or healthy in nearly all 3,000 counties in the nation, and provides resources to support local leaders and residents in working together to improve health in their county. RWJF has supported the program with $16.3 million from January 2009 to mid-2014, with plans to continue that support through 2018. For more information, read the program’s Progress Report.
“Roadmaps is not a ‘rank ‘em and spank ‘em tool,’ but an empowerment tool. We had no idea that the rankings would be so powerful in terms of doing just that.”—Julie Willems Van Dijk.
The RWJF Executive Nurse Fellows program, said Van Dijk, was “incredibly grounding and instrumental in preparing me for this work—from both a skills perspective and a networking perspective.” And accepting the new challenge, she said, was “both my own call to action, and a little bit of the burden of the mantel of leadership, knowing that RWJF made that investment in me.
“I don’t know where I would be without that accountability, that call to action that resonates so deeply within me. I often told them, ‘You know, you made a good investment in me, back in 1999.’”
RWJF perspective. The RWJF Executive Nurse Fellows program was created in 1997 to capitalize on the profession's strengths and build the leadership capacity of nurses. The leadership development program was designed to prepare a select cadre of registered nurses in leadership positions for influential roles in shaping the U.S. health care system of the future.
“Because of their front-line experience with patients and families, nurses bring a unique and valuable perspective to local and national efforts to transform our health care system," says Maryjoan D. Ladden, PhD, RN, FAAN, RWJF senior program officer and program alum. "The Executive Nurse Fellows program is part of the Foundation's building human capital strategy to develop a diverse and well prepared workforce and leadership.”