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| Dramatic
differences |
| As
hospitals recognize the value of clinical
experience in the executive suite, they
seek it from physicians as well as nurses,
although in smaller numbers. The American
College of Healthcare Executives found 217
physicians among the 5,765 CEOs at listed
hospitals. But nurse executives said there
are important differences in the two backgrounds.
“Physicians aren’t as inclined
for the business end of things,” said
Linda Groah, RN, MSN, FAAN, COO and nurse
executive at Kaiser Permanente San Francisco
Medical Center. “They pretty much
have a different perspective on health care
than do nurses.”
“If physicians have a broad base of
exposure, a track record of involvement,
diverse experience, and leadership positions,
then they can move into those seats and
do well, just as nurses can,” said
Colleen Hallberg, RN, MSN, CHE, chief executive
officer of Banner Thunderbird Medical Center
in Glendale, Ariz.
She added, “If they have a narrow
background and not much experience in leadership,
different clinical settings, or in associations,
then it becomes a difficult match. The preparation
for the position is the most important.”
A strong physician leader appeals to the
medical staff, she added, just as a nurse
CEO is appealing to the nurses in an organization.
“CEOs can come from a multitude of
backgrounds,” said Kathy McDonagh,
MSN, RN, FACHE, FAAN, president and CEO
of Christus Spohn Health System in Texas.
“Some physicians bring another dimension
that is positive, and I’ve seen business
people who brought good things. I like the
fact that people have diverse backgrounds.
I think when you get to a CEO level, what
is important is that you’ve had a
multitude of experiences and can relate
to all levels of people in your organization.”
Rhonda Dean, RN, CHE, chief executive officer
of El Dorado Hospital in Arizona, sees physician
CEOs becoming more common.
“They bring that unique clinical experience
to the hospital and can relate to the physicians,”
she said. “I think they can relate
to nurses and other clinical caregivers,
too. People bring different personalities
no matter what their educational background.
We all have to put our business hats on.”
Melissa Gaskill
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It also helps break down the myth that a nurse
executive will support only nursing, said Rhonda
Anderson, RN, MPA, CHE, FAAN, COO of Banner Desert
Medical Center in Mesa. “You do that by
making sure you get out to all the departments
to know and understand their needs. This gives
two strong messages: that you do want to learn
and that we’re all here for the patients.”
Although few of these top managers expected to
end up in the executive suite, their experiences
show that just about any nurse can do so. “I
think nurses should go for it and dream big,”
McDonagh said. “There is a tendency for
women and nurses to limit themselves.”
Gaining know-how
Nurses can gain leadership skills and experience
through participation in professional organizations,
and should pick mentors in areas where skills
are needed, such as finance, communications, or
interpersonal relationships.
“Do a skills inventory,” Stutes said.
“Look at who you are, where you are, and
what you’ve done. Compare that with where
you want to go.”
While master’s degrees in business or health
care administration are valuable credentials,
they aren’t necessarily essential. Still,
nurses must be able to talk the financial talk,
regardless of how they learn it, Cychol said.
“The financial guys have a different lingo,
just like nurses do.”
Hallberg, who learned the business side of things
on the job, supplemented by information and skills
from seminars and conferences, said, “I
don’t think you have to bring expertise
in everything to the job, but you have to be able
to hire a strong team and be willing to rely on
them.”
The American Organization of Nurse Executives
reports that 39% of senior nursing officers completed
formal continuing education in business or finance,
while about 40% gained executive skills through
experience.
Formal credentials are becoming easier to come
by, with the typical master’s in nursing
now covering more business subjects, said Carole
Shoffstall, dean of Beth-El College of Nursing
at the University of Colorado at Colorado Springs.
“Graduates are ideally positioned with the
mix of clinical skills and administration to run
large units.”
Volunteering or serving on committees also offers
valuable experience, Hallberg said, as does taking
a change in the scope of work or leading a different
department. Nurses should form a broad network
of people as a source of feedback, information
about opportunities, and invitations to sit on
committees.
Valuable education
Literature and conferences can provide valuable
education as well. “Read journals that go
beyond the clinical to understand what is happening
legislatively in the country, what drives our
decision making,” Anderson said.
Executive jobs aren’t easier than clinical
ones, just different. Executives often have eight
to 12 hours of meetings a day, and are essentially
available 24 hours a day, 365 days a year. “I
feel like my job is the old circus entertainer
who is spinning plates in the air,” Kuhn
said. “You spend a lot of time keeping everything
going.”
Cychol said the biggest difference between a
practicing nurse and an executive is the approach
to decision-making. “Hospitals are complex
organizations, stratified according to layers
of jobs, clinical competence, standards of care.
You’re meeting patient and family expectations.
You have to navigate successfully around all the
different personalities.”
“Your job never ends,” Hunt said.
“You have to find balance.”
But if the job is big, so are the rewards. “I
work with patients collectively rather than individually,”
Horvath said. “There is no better place
to be, no better place to change policy at the
local and national level.”
“A lot of nurses see an executive position
as an opportunity to enhance care and benefit
patients,” Groah said. Nurses in executive
positions have much to offer patients, employees,
and the health care system.
“Nurses bring a perspective, a value set,
know-how. Nurses I see in leadership have a strong
can-do spirit.”
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