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Many paths are being blazed from nursing to top management. Nurses fill about 700 chief executive officer and 540 chief operating officer positions, according to the American College of Healthcare Executives.

In 30 years of nursing, Becky Kuhn, RN, MSN, CHE, has held numerous staff positions, was promoted to management, and gradually took on increasing responsibility. She became chief operating officer of a 400-bed hospital, then chief executive officer of the 320-bed Banner Mesa (Ariz.) Medical Center.

Ron Stutes, RN, MSN, started out in critical care nursing, joined the Navy Nurse Corps, then worked as a shift supervisor while earning his MSN. He ultimately became executive vice president and COO of JPS Health Network, a 22-facility system in Fort Worth, Texas.

Operating room nurse Linda Groah, RN, MSN, FAAN, climbed the ladder from staff nurse, head nurse, nurse director, and nursing supervisor to her present position as COO and nurse executive of the 247-bed Kaiser Permanente San Francisco Medical Center.

Many paths are being blazed from nursing to top management. Nurses fill about 700 chief executive officer and 540 chief operating officer positions, according to the American College of Healthcare Executives. After all, the core business of a hospital is patient care, and nurses have a solid understanding of that care, said Kathy McDonagh, RN, MSN, FACHE, FAAN, president and CEO of the six-hospital Christus Spohn Health System in Texas.

“I don’t think there is one decision I make that I don’t think about the impact on patient care,” Groah said. “Without the nursing background, the tendency could be to look at cost or return on investment. But I look at patient satisfaction and quality of care.”

“Because I came up through the ranks, at one time or another I’ve been in all the different departments or had them report to me,” said Rhonda Dean, RN, CHE, chief executive officer of El Dorado Hospital in Arizona. “I have a great understanding and empathy for what those folks do every day because I’ve done it.”

Clinical assessment skills — the ability to organize, prioritize, and delegate — come in handy at the executive level, as do the communication and interpersonal skills nurses learn at the bedside. The nurses’ clinical perspective helps balance the financial focus that is already present in the executive offices. The nurse executives’ clinical perspective also gives them credibility in the eyes of the nursing and medical staff.

Experience working as part of a team of health care providers, including physicians, is also an asset.

“I’ve seen wonderful CEOs who were somewhat daunted by physicians, and physicians who were frustrated with a CEO,” said Dolores Horvath, RN, BSN, MHA, chief executive officer of St. Luke’s Medical Center in Phoenix.

Nurses are often more successful at connecting with physicians because of their experience doing so in a clinical setting.

Time is valuable to physicians, said Nancy Cychol, RN, MSN, president of Cook Children’s Medical Center in Fort Worth, and it helps that physicians at her hospital know she values their time. Establishing and maintaining good relationships with physicians is one of the toughest challenges hospitals face today. This makes the clinical and collaborative skills these nurses bring to management particularly valuable.

Nurse executives tend to spend time out in the hospital and to keep their clinical hand in practice — simply because they enjoy it. Making rounds is personally grounding for Colleen Hallberg, RN, MSN, CHE, chief executive officer of Banner Thunderbird Medical Center in Glendale, Ariz. “When I am out and about in the hospital, it is not for the sake of visibility as much as to know what people are dealing with and how things are going. I make it part of my routine every week. That keeps me balanced and aware of what we do.”