On Top: Nurse CEOs Lead the Way
By Donna Hemmila
March 28, 2005
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.”
Balancing act
Personal responsibilities outside of the job could be one reason more nurses don’t think of entering upper management.
“I think management is really hard and there are a lot of competing demands even if nurses aren’t in the traditional family role at home,” says Theresa Carroll, RN, PhD, a professor at the University of Texas School of Nursing at Houston. “Women may be more likely to seek something that allows them to find balance in their lives. I think women do a lot more thinking about that.”
Carroll specializes in nursing workplace issues and is a career coach for Memorial Hermann Hospital in Houston. She believes nurses are uniquely qualified for the top leadership roles in health care. A recent study she conducted examines the attitudes of 169 women executives, 11 of them chief nursing officers. While all of the women had similar attitudes about what it takes to be a good leader, the nurses all rated personal integrity as the most important attribute of leadership. Those personal qualities and patient care experiences, she says, need to be bolstered by an understanding of business and finance for nurses to succeed as administrators. For many nurses, that means going back to school.
A head for business
“Nurse executives have to be bicultural,” she says. “They have to have one foot in the patient care arena and one foot in the business world.”
In 1986, Carroll, then associate dean of graduate programs in nursing at Duquesne University in Pittsburgh, started a combination master’s in nursing and business administration program. Nurses take courses in the business department and can either receive an MSN with a business certificate or study for both an MSN and an MBA degree. Either option gives them a foundation in financial administration.
“I think most nursing administration programs are seeing the writing on the wall that they need to include the MBA courses,” she says.
Going back to school can be a difficult choice for nurses, says Marilyn Stevens, BSN, MSA, MBA, founder and CEO of Procel, a health care staffing firm in Los Angeles. She’d like to see hospitals offer financial support for nurses who want to receive a business education.
Nurses need to know how to run a business if they want to move into a CEO- or vice president-level position, she says. They need to know accounting and understand cash flow, balance sheets, profits, and losses. The way to gain that understanding is through a business education.
Making that transition from patient care to high finance isn’t easy, Stevens says, but she’s never regretted it. Nurses who want to move into upper management need to find a mentor, someone they can emulate. If their employer doesn’t have a formal mentoring program, she suggests nurses take the initiative and find someone they can go to for career advice. Let someone in upper management know you are interested, she says. Nurses already in management positions need to scout for people who show leadership qualities.
“When you see someone who has the ability, give them some projects,” she says. “That’s what I used to do when I was a nurse manager. Let them head a committee or give a presentation. Maybe start them as a charge nurse. They have to get their feet wet so they can see what it’s like.”
The only people who don’t succeed, she says, are the ones who give up.
Donna Hemmila is a freelance writer for NurseWeek.