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Pat Little-Upah, RN

As a young Army nurse serving in an evacuation hospital in Vietnam during the Vietnam War, Pat Little-Upah, RN, MA, never imagined her career would take her into an executive suite. After leaving active military duty in 1968, Little-Upah worked the next 17 years as a staff nurse before taking her first nurse manager job. Today she is the chief executive officer of the 112-bed Banner Behavioral Health Center in Scottsdale, Ariz.

“It was not something I planned,” she says. She assumed some leadership roles informally. And it wasn’t until she had earned both a three-year nursing diploma and a bachelor’s degree that she went back to school and earned a master’s in health care administration.

Little-Upah took the leap into management because she felt she could make a difference in patient care. When it comes to running a hospital or health system, she says, nurses bring a wide range of understanding to the table and are well equipped to handle the leadership challenges. Yet she doesn’t find many nurses excited about the management side of health care.

“As I’m looking around for people to mentor and move into management, it’s not like nurses are lined up here saying, ‘Gee, I really want to get into management.’”

There are about 700 nurses filling the job of chief executive officer and another 540 are chief operating officers, according to the American College of Healthcare Executives.

While many nurses will choose to spend their working days in direct patient care, executives such as Little-Upah see the need for an all-out effort from health systems and nurses themselves to bring more RNs into the top management jobs.

“There needs to be a dual track for nurses: one for nurses who want to remain in direct patient care and one for nurses who want to go into management,” Little-Upah says. “We need nurses to step up to the plate.”

Benefits of leadership

Besides the intrinsic rewards of improving patient care and the higher salaries, Little-Upah says, there are more benefits nurses need to know about: more flexible hours and the opportunity to work in philanthropy and community projects with bright people in and out of health care.

She says her company has encouraged women and nurses to take leadership roles. Four of the CEOs who run Banner Health’s nine Arizona medical centers are nurses. The Phoenix-based Banner Health is the largest health system in Arizona.

Nurses might hesitate to take that giant step up the career ladder because they don’t know what CEOs do.

“They think you go to meetings all day,” Little-Upah says.

Nurses who have reached the CEO and administrative levels need to reach out to other nurses to let them know what the management side of health care has to offer and to give them a true picture of the job.

“If we were to do that, we might have people who would not have thought about it become willing to consider management,” she says. “We’ve got to get out there and actively recruit people.”

Mentoring new leaders

Linda Kresge, RN, BSN, MPA, chief nurse executive at Sequoia Health Services in Redwood City, Calif., was instrumental in developing a mentoring program for chief executive nurses as part of the succession planning for Catholic Healthcare West. The program matches nurse executives from CHW’s 40 hospitals with health system administrators who will act as career coaches, role models, and sounding boards for those considering moving into high levels at the hospital. The program was scheduled to kick off in January with a celebration where the mentor matches would be announced.

“We have this rich supply of leaders and talent,” Kresge says. “This is to further expand the horizons of nurse executives.”

While Kresge is open to the idea of moving into a CEO position, she believes nurse executives can have great careers in their current positions. A mentoring program such as the one she is involved with can strengthen the leadership skills of nurses, she says, even if they decide not to move into higher administrative roles.

“Our fondest hope is that this is a tool kit that others can use,” Kresge says. “I’ve had calls from hospitals outside CHW. This is a model that can be used elsewhere.”