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The path to the chief executive officer's suite is far
from smooth for many nurses, women in particular. Many
of them spent years, if not decades, juggling the responsibilities
of frontline health care jobs and raising families before
establishing a clear career path to the top.
As senior vice president and area manager for Kaiser
Permanente Northern California Region, Sandra Small,
MSN, RN, is the CEO of two Kaiser hospitals in Vallejo
and Walnut Creek. However, it took 26 years for her
to reach that position. During the first part of her
career, she worked as a nurse at hospitals in Santa
Cruz, two public health departments, raised two daughters
and obtained her master's degree.
When Small and her husband moved to Stockton, Calif.,
in 1977, she took a job at the San Joaquin County Health
Department as a family planning nurse practitioner.
A large farming town 90 miles east of San Francisco,
Stockton has long had an edgy reputation, and Small
was assigned to one of its rougher neighborhoods. She
made rounds in East Stockton in a county-owned Ford
Pinto, visiting rundown neighborhoods that seemed to
be filled with large, barking dogs. "The [residents]
would see the Pinto, the dogs would bark and everyone
knew there was a county worker coming," Small recalled.
In 1978, she took a hospital job at a Kaiser facility
in Sacramento, Calif., running the ob/gyn department.
She's been with the organization ever since.
Catherine Fickes, MHA, RN, who's been both permanent
and acting CEO of several hospitals in the Los Angeles
area, spent 14 years working at the Hemet Valley Hospital
District, a facility in a small desert town about 100
miles southeast of Los Angeles. Fickes had followed
her physician husband to the position in Hemet. During
that time, she raised a family and began a longtime
avocation of performing relief work in Nicaragua while
working up to the position of nursing director in charge
of special services. Although Fickes likes the work,
it had its share of frustrations. "There always
had to be somebody representing nursing to the administration,"
she said. "You needed to keep advancing patient
rights and keep that focus."
Moreover, even though Fickes was overseeing many aspects
of hospital operations, as a nursing director she found
herself all but cut out of the budget process as late
as the mid-1980s. Discrimination was among the causes,
Fickes believes. "The senior administrators were
men who came through college courses in management,
and there weren't a lot of nurses in senior management.
Mostly, the budget was worked out by somebody else,
and we had to accept it as it was presented," she
said.
At about the same time, Fickes began to focus on making
the transition to health care management. She earned
a bachelor's degree in business from the University
of Phoenix in 1986, and an MHA from the University of
La Verne a year later. Nearly 20 years into her career,
she took a job as an assistant administrator at a hospital
in Los Angeles.
Catherine Kutzler, MHA, RN, CEO of St. Joseph's Hospital
in Philadelphia, went through an accelerated nursing
program in the early 1970s while raising an infant,
then worked at a variety of staff nurse and nurse manager
jobs at Philadelphia-area hospitals for more than two
decades. Although her husband, a lawyer, was supportive
in family matters, there were just as many days when
she was worried about finding baby sitters as she was
caring for patients.
Kutzler didn't think she would become a CEO until 1996,
when St. Joseph's then-CEO left and she was promoted
from vice president of patient care into a newly created
position, vice president of operations/associate administrator.
"I knew then there would come a day," she
said. "I knew then I would be a CEO." That
day came just a year later.
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