Robbin Moore is CEO of Northlake Medical Center in Tucker. "I'm still a nurse and I'm still in the business of taking care of patients," she said.

As they have been for generations, today's nurses are caregivers who make a difference in people's lives - but how and where they make that difference has expanded far beyond traditional bedside nursing.

Nurses like Mary Lambert, MN, RN, CS, CNAA, who have assumed many jobs and leadership roles, no longer have careers that fit neatly into a one-page résumé.

Lambert entered a basic nursing program in 1978, where an "awesome clinical experience" made her choose a public health specialty.

After graduation, she worked in hospital and public health nursing, earned her clinical nurse specialist degree, joined the Army Reserves, helped found a two-year nursing program in Mississippi and was associate chief nurse for Veterans Administration Medical Center in Memphis.

She was a corporate occupational health nurse, served in the Army and medically screened personnel deployed during the first Gulf War. In 1992, Lambert started a health service program for migrant workers on the East Coast and, later, became a food and safety officer for the Food and Drug Administration.

After civil war in Rwanda eliminated 80 percent of the country's health care workers, she was assigned to assist in rebuilding health care training programs there. As a White House science adviser, she watched the Pentagon burn on Sept. 11; then helped develop the nation's Volunteer Medical Reserve Corps to respond to terrorist attacks.

As a captain in the U.S. Public Health Service Commissioned Corps, she has worked with the Department of Homeland Security, tsunami relief efforts and is the director for the office of work force and career development at the Centers for Disease Control and Prevention.

"I feel so blessed to have done what I've done, but if you'd told me in 1979 that a nurse could do all that, I'd have said, ‘yeah, right,' " Lambert said. "I envisioned a career of hands-on work with a few patients, and discovered that I could help many. Along the way, I've had wonderful role models and almost unlimited opportunities.

"Those who try to steer bright, young people into medical school [instead of nursing school] have a very limited view of what nursing is. I tell young nurses that the world is their oyster," she added.

An evolving health care system has opened new doors, at the same time that better education and training has equipped nurses to go through them. The number of nurses with master's and doctoral degrees has tripled since 1980. In 2000, one in 10 registered nurses held an advanced degree. By 2015, the American Association of Colleges of Nursing wants all advance practice nurses to hold a doctorate degree.

Mary Lambert is the director for the office of work force and career development at the Centers for Disease Control and Prevention. "I tell young nurses that the world is their oyster," she said.

Management roles

Clinician and faculty shortages, decreased reimbursement practices, shared governance models in hospitals, an aging population needing health care services and older nurses retiring from the profession have contributed to propelling more nurses into management roles, said Mary Gullatte, RN, MN, ANP, AOCN, FAAMA, director of nursing for oncology services at Emory Healthcare. Her text, "Nursing Management: Principles and Practice," was written for the growing number of nurses called to leadership.

Nurses always have been problem solvers, and that skill is needed more than ever by a changing health care system, she said.

"Historically, nurses weren't always at all the tables to help make decisions in health care, but that's no longer the case," Gullatte said. "Today's nurses are delivering health care to underserved populations, leading teams, managing major projects and excelling in new fields like informatics and risk management."

For almost 17 years, Patricia Stowe, RNC, FNP, has been the manager and family nurse practitioner at the Warwick Healthcare Center in rural South Georgia.

"You never know what will come through the door, but I love it because you're helping people who wouldn't otherwise have access to health care, and over time you get to know them and their families," Stowe said.

Nurse practitioners are the primary health care providers in many underserved areas and practice in a variety of medical specialties. In every state but Georgia, they have some degree of prescriptive authority.

"Our patients love us because we spend time with them and I love having responsibility for my own practice," Stowe said. "When I started in nursing 35 years ago, there wasn't such an animal as a nurse practitioner . . . As soon as I heard about it, I knew that's what I wanted to do."

Mary Lambert is the director for the office of work force and career development at the Centers for Disease Control and Prevention. "I tell young nurses that the world is their oyster," she said.

Leadership skills

Robbin Moore, RN, MBA, traversed increasing levels of health care responsibility to become CEO of Northlake Medical Center in Tucker.

"I go crazy when people tell me I used to be a nurse. I'm still a nurse and I'm still in the business of taking care of patients," she said.

Moore planned to always work at the bedside, because she thought people in hospital administration were out of touch.

"My clinical background and business training allow me to see both sides of the house. I can go in the ER and speak the language and I'm used to working as a team with doctors," Moore said.

Nursing taught her to adapt quickly to changes and lead people on the run - both necessary skills for a hospital CEO. Moore is proud that since she took over the troubled 120-bed hospital, it's running in the black and under budget. Bed census and patient satisfaction are both up and there's a new Women's Oncology Unit, better training and more services.

"I just went to see our first radio frequency tumor oblation," Moore said. "We may be a small hospital, but we're pushing the envelope."

Health care information technology changes daily, which keeps Dee Cantrell, RN and chief information officer at Emory Healthcare, on her toes. Asked to take a leading role in nursing informatics 11 years ago, she made the switch from nursing director to information technology specialist.

"I thought it would be a great learning opportunity and a chance to stretch my horizons," Cantrell said.

Sitting in the command center that monitors technology operations which are moving steadily toward paperless documentation and recordkeeping, Cantrell said, "If you'd have told me that I'd become a CIO, I never would have believed it, but I've enjoyed the adventure. Moving to the technology side was one of my best career moves."

Cantrell has been nominated for 2005 Woman of the Year in Technology (for nonprofits) by the Technology Association of Georgia, but what really pleases her is knowing that the technology she puts in place helps nurses and doctors do their jobs better.

"They have access to test results and lab reports at their fingertips," she said. "Soon we'll have computerized physician order entry with built-in checks and balances for patient safety."

According to Cantrell, it's important for someone in her position to have a clinical background. "It allows us to understand how the technology impacts patient care, because we've been there," she said.

Debra Meadows, RN, BSW, MSN, has taken her nursing background into the legal arena as a legal nurse consultant for King & Spalding.

"If you'd told me that I'd end up working at a law firm, I'd have laughed, but many of my nursing skills - being detail-oriented, being responsible for what you do and having strong work ethics - carry over," she said. "I've had the opportunity to enhance my knowledge base and even thought of going to law school."

Meadows uses her nursing knowledge to analyze medical records and write reports that attorneys need to investigate and try cases.

"As a nurse, I can pull so much more information out of a record than a lay person," she said. "I can tie things together or offer alternatives as to what may have happened."

Risk management

Critical care nurse Jan Dawson, RN, BSW, ARAA, assistant director of risk management at Northside Hospital in Atlanta, moved into risk management before it was a recognized nursing specialty.

"It's important for risk managers to have a clinical background, because they understand why health care is a high-risk business," Dawson said.

Striving to eliminate risk and injury to patients, staff, the organization and guests, Dawson focuses on putting pro-active safety measures in place across the organization. Education and safety initiatives lower insurance and litigation costs and increase patient satisfaction and safety.

The risk-management process is much like the nursing process, Dawson said. "You evaluate a situation, implement a plan, assess its effectiveness and correct the plan as needed. Always looking for ways to improve, we rely on nurses who are the frontline experts," she said.

As a clinical nurse specialist in oncology, Delcina Brown, RN, MN, APRN-BC, AOCN, loved the cutting-edge research and making a difference in the lives of cancer patients.

"I never thought of getting into the pharmaceutical industry, but after five years in an acute-care setting and then an oncology clinic, I wanted to be learning new things and feel like I could grow," Brown said.

As an oncology clinical coordinator for Genentech Inc., she uses her nursing knowledge and educator skills to explain the science behind new drugs to clinicians, doctors and pharmacists in five states. She values the good pay and benefits, setting her own schedule, knowing that she's helping people and the prospects for future advancement.

The company values her expertise.

"I think people are beginning to realize that the problem-solving and critical-thinking skills you learn through nursing are valuable in almost any area," Brown said. "Whatever nurses decide to do, and there are so many opportunities, they will always bring their experience to the job to help people."