By Debra Wood, RN, contributor

May 25, 2010 - Whether nurses set out to lead a hospital or health care system or their career evolves in that direction, those who find themselves in charge credit education, opportunities and mentors with providing them the chance to reach the top.

Mentors have helped shape the career of Debra (Debbie) Linnes, BSN, MHA, ACHE, and she now mentors upcoming leaders.

“We are nationally seeing a growing trend of individuals with clinical backgrounds in leadership and top executive roles,” said Debbie Linnes, BSN, MHA, ACHE, president and CEO of Southeast Missouri Hospital in Cape Girardeau, Mo. “That background brings us the ability to effectively partner with physicians and understand the complex systems to clinically integrate care.”

Linnes, who worked in several health care leadership positions before joining Southeast Missouri in 2009, reports cultural changes are taking place, requiring leaders to possess the skills to bring people together to reshape health delivery. Many leaders achieve that by combining clinical expertise with a knack for motivating and inspiring others.

Christine Schuster, RN, MBA, expects leading health care organizations will become even more difficult in the years ahead, but she said she is up for the challenge.

“I wanted to be in a position to do more for the patients and saw I needed to get away from the bedside to make the bedside better for staff and to be in a position to affect more change for the patient and the family,” said Christine Schuster, RN, MBA, CEO at Emerson Hospital in Concord, Mass. “At the heart of all of this is I’m a nurse. It wasn’t so much about being a CEO but continuing my role as a patient advocate.”

Schuster began her health care career as a candy striper at age 13. After working as a nurse for two years in an academic medical center, Schuster attended the University of Chicago to earn a master’s degree in business administration. She then began a management consulting practice with Coopers and Lybrand, now part of PricewaterhouseCoopers.

“It allowed me to get in and out of more than 100 hospitals and to see good leadership and not-so-good leadership and to work on turnarounds and strategic plans,” Schuster said.

Subsequently, she accepted a service-line management position and worked her way up the ranks at various hospitals until joining Emerson.

“I’m in a position to make decisions every day that impact how we treat patients in our hospital,” Schuster said. “Some people go through life trying to figure out what they are supposed to do, but I know I am right where I am supposed to be.”

Paths to the top vary, but have similarities

Frank Cracolici, MA, RN, empowers front line managers and recognizes the achievements of people at all levels of the organization.

Frank Cracolici, MA, RN, president and CEO of St. Luke’s Roosevelt in New York, moved from staff nursing to education to chief nursing officer in the late 1970s at a Florida acute-care facility.

“I like the challenge of affecting change by influencing people’s behavior,” Cracolici said. “I foster teamwork, but on a parallel path, it’s critical to influence and develop individuals and help them see the goals of an institution.”

Mentors and bosses often play a role in nurses moving up the ladder. While a clinical nurse specialist, Duke University Hospital leaders offered Kevin Sowers, MSN, RN, FAAN, the opportunity to head up a new unit. He initially declined, wanting to stay at the bedside but, ultimately, he accepted the challenge and has not looked back, now serving as president of the 924-bed hospital.

“Sometimes people see things in us that we don’t see in ourselves,” Sowers said. Mentors have helped him recognize his skills and mature in a leadership role.

Tammie Brailsford, RN, MS, said leaders must never forget that they are responsible for all of the patients and their families.

Tammie Brailsford, RN, MS, executive vice president and chief operating officer of MemorialCare Health System in Fountain Valley, Calif., began her move to the executive suite early in her career, when a director of nursing recognized Brailsford’s leadership potential, offered her a management residency rotation followed by a nurse manager position. She moved up through the ranks at different facilities and outside health care during the ensuing 30 years.

“I never set out to become an executive,” Brailsford said. “I learned from my parents that you work in service to the organization you are in. If you look for work that needs to be done or if you are asked to do something you hadn’t planned, if you do it and work hard at it, it leads to the next opportunity.”

Susan Stout Tamme, RN, BSN, MS, FACHE, moved up within the same organization and is now president.

Susan Stout Tamme, RN, BSN, MS, CACHE, president of Baptist Hospital East in Louisville, Ky., also began her leadership career as a nurse manager after a short time as a staff nurse at Baptist East. She stayed within the same organization for 37 years as it grew from 257 beds to 519 beds. She credits the rapport she has established over with the years with helping the hospital become an employer of choice and provider of quality care.

What it takes to run a hospital or health system

All of the COOs and CEOs report varied days. Tamme calls it a busy 24/7 job.

They devote their time to improving quality, designing new units, monitoring financial status, fundraising, strategic planning, representing the hospital in the community, advocating in their statehouses or in Washington for adequate reimbursement, and working with physicians on joint ventures and other shared goals.

Linne reports her role focuses on the vision and strategic relationships.

“My day is a series of conversations with people that are responsible for different parts of the organization,” Brailsford said. “I assimilate all of the information and figure out what has to be done next.”

Brailsford considers relationship building and communication to be key skills in her position. She also finds it important to be clear about her personal values.

Sowers cautions nurses to understand how their values influence the decisions they make on behalf of an organization and to work to ensure they are always impartial.

“How people judge you is, are you fair and consistent?” Sowers said. “And be willing to celebrate the successes.”

The nurse executives take time to walk through their facilities and talk with staff and patients.

“I am so energized by the work of my staff,” Schuster said. “I have a good team I surround myself with, a supportive board and a good medical staff. By working together we get it done.”

Drawing on their nursing backgrounds

Nurse top executives find their clinical experiences as nurses help them in a variety of ways.

“It’s important for people to draw on all of their past experiences when in a position of leadership,” said Brailsford, who applies the nursing practice of assess, develop a plan, implement and evaluate the results to everything she does. “That thought process is invaluable.”

Schuster leads by putting the patient first, saying it’s something she learned as a nurse and has not wavered from throughout her career.

“I draw on my nursing skills every day,” Tamme added. “I look at every decision from what is best for the patients and their family.”

While Sowers acknowledged that his clinical experience adds value, he said leadership skills are most important for executive level staff.

Advice for nurses looking to move up

Nurses typically cannot step from a clinical role to the executive suite without securing knowledge of business and administration, how insurance markets work, revenue streams, expense control and driving waste from the system. That, typically, requires returning to school for an additional degree.

“I needed to have the business acumen to drive my part of the enterprise,” Sowers said. “I had tremendous mentors.”

Cracolici agrees nurses must learn more about the business side of health care, but he also suggested those aiming for the executive suite hone their interpersonal skills and respect everyone on the front lines.

Brailsford added that leadership requires looking for opportunities to be of service and working harder than anyone else. She considers health care one of the more complex businesses to run.

“It’s not for the faint of heart,” Brailsford said. “It takes hard work, concentration and humility.”

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