She has always affectionately been called Evelyn or simply as Mrs. M. by both colleagues and staff. Of course I am referring to Mrs. Evelyn Malowany, a leading figure in nursing who dominated the Montreal and Quebec scene for almost 40 years up until her retirement in 1997 as Director of Nursing of the Montreal Children’s Hospital (MCH) and Associate professor in McGill School of Nursing. Evelyn Malowany reshaped and transformed nursing and brought new meaning to the word leadership. She was a transformational leader both in style and what she was able to accomplish. She was unique—one of a kind.
Let’s cast back to the 1950s and 60s when Mrs. Malowany began her career. Nursing was very different then than it is today. Calling a nurse by their first name or a contracted version of their last name, let alone a Director of Nursing, was unheard of. When Evelyn began her career, nursing was formal, deferential, followed a rigid hierarchical structure and was very task oriented. There were strict rules and procedures to follow. On the other hand, nurses administered to the health needs of their patients with compassion, commitment, and great skill. This was also the time when significant number of nurses went to universities and when the knowledge underlying nursing practice was articulated. Mrs. Malowany was in the first class of McGill School of Nursing’s Master’s program. Her studies at McGill and its unique perspective of nursing (later formalized under the rubric of the McGill Model of Nursing) gave her direction of what nursing could become. She could preserve the best of the old order to create a new order. And this is exactly what she did in her position of Director of Nursing of the MCH.
Evelyn Malowany was an unorthodox and bold leader who knew how to get things done. Guided by her values and with courage, conviction, intelligence, and integrity, the Montreal Children’s Hospital became the place to be. It was the ‘magnet’ hospital of its time attracting the brightest and the best and became the “training” ground for the next generation of nursing leaders. As Evelyn recently told me of her philosophy, “Hire the best people and then don’t get in their way.” It was at the Children’s that young graduates were given the autonomy to practice, encouraged to be innovative and creative, provided the educational opportunities to develop their knowledge and skills to address the complex needs of patients and families, and celebrated for what they achieved. As Valerie Shannon, the former director of nursing of the MUHC recalls: “Evelyn was my mentor. What I appreciated most about her was her ability to find the right person at the right time for an important role and then to let that person flourish. She was always there in the background for support, a timely intervention with difficult people, and a listening ear. She radiated pride when you told her stories of the accomplishments of nursing which she loved to hear.”
Evelyn’s leadership style could not be found in a textbook. In fact, Evelyn wrote the textbook as she went along. Evelyn was guided by what was important and what made sense. As she explained “I didn’t let the bureaucracy get in the way. I looked to see whether things made sense. If it didn’t make sense, I wouldn’t do it because that would have consequences.” She calls her management approach “adhocracy”--responding in the right way as the situation required. She also told me of the two sets of books she kept: The first set were the principles that guided decisions and the second set were the bureaucratic rules that she and her staff only used when absolutely necessary. Valerie Shannon reaffirms this approach: “Her sense of humour was much appreciated as she poked holes in the flavour of the month theory or “new idea”. She had a Dilbert-esk view of management and regularly challenged managerial dictums that never really impressed her.”
Mrs. M’s staff once told her that they dreaded Monday mornings. She returned to her office having spent the weekend reading broadly from philosophy, economics, political science, or business that would inspire her to try things differently. As Celeste Johnston, professor at McGill and the first director of nursing research at the MCH explains: “Evelyn used to say that she was 'abnormal'. To be normal was to be usual, everyday, inside the box, and Evelyn was none of these! Her vision 'outside' the box was extraordinary. She often said that she was right-brain thinking using the creative side of the brain. Her bookshelf had only a few nursing or nursing management references among philosophy, economic, or political ones.”
Evelyn was guided by what the philosopher Charles Taylor calls “social imaginings”. Some of her imaginings included that nursing was complex and required the most educated nurses to provide direct patient care and thus she hired a disproportionate number of direct entry Master graduates and university graduates to be at the frontline. Another imagining was that nursing needed to have a strong voice in decision-making arenas and provided every opportunity for nurses to be on boards and at the decision making table. She believed that knowledge and education held the key to quality care and imagined a unique partnership with the McGill nursing network and McGill School of Nursing to create a “virtual” system between the university and hospitals. She also imagined that nursing research and evidence was a key to quality care and created the first nursing research unit in a hospital in Canada when she appointed Dr. Celeste Johnson to head this initiative. As Celeste recalls: “The idea of having a research division in the nursing department was at least a decade ahead of other Canadian hospitals. When confronted by financial people about operating funds going into something as frivolous as nursing research, Evelyn simply ignored them and continued to fund it!”
Evelyn’s “social imagining” gave her direction. But having imaginings was not enough. It required courage, commitment, conviction, and chutzpa to win the critical battles. As Celeste recounts: “She supported nursing in many administrative battles. When administration wanted to continue to admit to a critical care unit when the nurses felt to do so would be unsafe, she closed the unit to admissions. There was a lot of fallout from this decision but Evelyn held her ground. She was a real trooper who actually enjoyed battle where she could confront, outmaneuver, or outwit arbitrary bureaucracy or any person or group who would dare diminish nursing's role in providing care to children and families. If there were nurses or nursing units who did not share her forward vision, she would refer to them as 'corridors of indifference' and move on ahead with those who were early adopters to change. Sure enough the other units would eventually recognize that they were being left behind something pretty exciting.”
I asked Evelyn what advice she would give to future nurses. After some thought she sent me the following message: “Given that people choose our profession because they want to be of service, I would encourage them to take risks when necessary to ensure safe and effective care. I found that reading extensively to stay up to date on new developments in organizational arrangements in health and illness was very important. Having information and insight into developments in many diverse fields leads us as nurses to see how the world and its inhabitants are interrelated and health and illness are impacted by continual change in so many knowledge areas. We need to keep in mind that bureaucratic, institutional arrangements often work against our values for delivery of appropriate care and these arrangements need to be challenged. However, this requires good evidence and insight in presenting ones' case in order to be heard. Finally, nursing presents such a great opportunity to provide a significant contribution to the lives of others that, in retrospect, I would have chosen no other field for my career.”
In thinking of Evelyn I am reminded of the words of the 12th century theologian and author John of Salisbury "We are like dwarfs sitting on the shoulders of giants. We see more and things that are more distant than they did, not because our sight is superior or because we are taller than they, but because they raise us up and by their great stature and add to ours."