Trading Places
Strong clinical, communication, and business skills position nurses as leading candidates for executive roles

By Melissa Gaskill
August 10, 2004

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.”

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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