You may not naturally think of becoming a nurse executive, which may seem far removed from the bedside and benefiting patients. Yet, you can significantly impact patient care as a nurse executive, such as a chief nursing officer.
“When you’re caring for patients, as a nurse, you’re caring for a set cadre of individuals,” says Elizabeth Speakman, EdD, RN, FNAP, ANEF, FAAN, senior associate dean, professor, and chief academic officer, School of Nursing, University of Delaware. “When you’re in a leadership role in the clinical environment, you may have thousands of patients you are responsible for.”
If that appeals to you, read on. In this article, we’ll examine a few programs available to prepare for the nurse executive role.
Students at the 28-month program “typically come with a master’s degree already and have some experience at a leadership level,” according to Kimberly Nerud, PhD, RN, dean at Post University’s American Sentinel College of Nursing and Health Sciences. Perhaps they have worked as a charge nurse or directed a healthcare unit, and “they’re looking to build on those skills that will help prepare them for those advanced opportunities within a healthcare system.”
At the Frances Payne Bolton School of Nursing at Case Western Reserve University, students who want to pursue a role as a nurse executive can choose from a range of programs, according to Joyce J. Fitzpatrick, PhD, MBA, RN, FAAN, Elizabeth Brooks Ford professor of nursing, Frances Payne Bolton School of Nursing and distinguished university professor, Case Western. Those programs include a doctoral program with an executive focus and a postdoctoral and senior executive program. These programs are housed within Case Western’s Marian K. Shaughnessy Nurse Leadership Academy.
Although students need a doctoral degree to enter the postdoctoral program, for instance, the academy believes that “every nurse is a leader,” notes Dr. Fitzpatrick. “Our philosophy is you’ve already got the leadership skills. You may not know how you have been leading, but you have been leading as a clinical nurse.”
For example, Dr. Fitzpatrick notes, “Nurses are leading care at the bedside for the patient. They’re leading care for the patient’s families. So as they become nurses, they learn to lead in clinical care. We capitalize on the experiences they’ve already had as clinical nurses and help them to understand how they’ve been leading all along.”
The school emphasizes a relationship-based leadership model, according to Dr. Fitzpatrick. That includes components such as communication, executive presence, intentional communication, and helping the leader understand any individual’s influence in a leadership role.
The academy, says Dr. Fitzpatrick, is especially interested in identifying individuals to join the program who come from under-represented groups. The school also seeks to engage minority nurses in mentoring the next generation.
“Stackable Credentials”
According to Dr. Speakman, nurses considering executive leadership positions can benefit by focusing on two actions. First, “they need to know that leadership is not just your title. Leadership can be very informal. How you lead is more important than your position. How you hold yourself pedagogically in life and how you present yourself. I think that’s the first and foremost conversation.”
The second involves earning what Dr. Speakman calls “stackable credentials.” That can include fellowships, earning certificates, and joining leadership programs – gaining new skills. Another word of advice: “Before you decide you want to be the top executive, spend time with the top executive.”
Leading After COVID
In considering a role as a nurse executive, know that COVID took a toll on nurse leaders, making the need to prepare nurses for executive roles even more important. Dr. Nerud hopes that “we can help to rebuild that area of nurse leadership that decided to take a step back or step out or retire early because of all of the demands that came from the pandemic.”
Dr. Nerud stresses the need to have nurse executives view problems from a policy perspective “that we’re helping these leaders go in to help be able to think fast and be able to talk about the policies that need to be made to move quickly because we learned during the pandemic that that was huge. We needed to be able to focus on quick changes and quick policies and quick things that needed to happen.”
During the pandemic, leaders faced significant challenges, notes Dr. Fitzpatrick, as did clinical nurses. “We need to continue recruiting nurses into leadership roles because the challenges are still there,” she says.
Even though the worst of the pandemic is over, we still have to rebuild and revitalize the clinical systems,” says Dr. Fitzpatrick. “We want to be sure that we focus on nurses staying in the workplace, which falls to the leader. We know from the research that if you have good leaders, you have higher nurse satisfaction–that leadership is key to keeping the clinical nurses engaged.”
“There is No Box”
Nurse executives and leaders have opportunities in traditional healthcare systems, industries, and corporations. “We shouldn’t just think of nurse leaders being positioned in the traditional healthcare environments, but engaging them outside of the traditional healthcare environments into executive positions in corporations as well as in community health,” says Dr. Fitzpatrick.
“The potential is unlimited because nurses come with skills that help them to help others. I like to teach my students, we often talk about thinking outside the box, but what we try to communicate to our nurse leaders is there is no box.”
Vanderbilt University School of Nursing created a new leadership development program for nurses new in health care leadership and academic positions who are from groups historically underrepresented in nursing and/or those who support them. The Academy for Diverse Emerging Nurse Leaders will be held in Nashville from November 14-18. Applications for the inaugural class of fellows are now being accepted.
“The need for nursing faculty and nurse leaders from groups historically underrepresented in nursing is well established, but research shows a need for career development resources that address the specific needs and challenges of diverse nurse leaders,” says Pamela Jeffries, PhD., FAAN, ANEF, FSSH, dean of Vanderbilt School of Nursing. “We believe that the knowledge, mentorship, strategy, and skills that new leaders will attain via the Academy for Diverse Emerging Nurse Leaders will empower them to continue to advance and lead.”
VUSN Associate Dean for Diversity, Equity and Inclusion Rolanda Johnson and Vanderbilt University Medical Center Senior Director for Nurse Diversity and Inclusion Mamie Williams will co-direct the academy, designed for nurses who have been in academic or health care leadership roles for less than three years.
“What makes this fellows program different from other professional development opportunities is that it incorporates and builds on the lived experiences of diverse faculty and health care leaders who have navigated a similar leadership path,” says Johnson. “It explores the challenges of being a leader from an underrepresented group as well as the challenges of supporting and expanding diversity in nursing leadership.”
Academy for Diverse Emerging Nurse Leaders
Academy for Diverse Emerging Nurse Leaders
The academy is taught by experienced faculty and health care leaders from diverse backgrounds and is specifically designed to serve the needs of new and emerging nurse leaders and faculty. In addition to the initial five-day, in-person meeting, fellows will also participate in virtual sessions, receive mentorship from an executive coach and institutional mentor and develop a leadership project.
Williams said that the idea for the academy resonated with her as she thought about her own nurse leadership journey of more than 25 years. “This leadership academy, based on specialized education, discussions, and interactions with peers and diverse nurse leaders, affords the emerging leader an opportunity to thoughtfully design their leadership journey,” she says.
She and Johnson said the academy was developed to help new nursing faculty and new nurse leaders build skills, gain knowledge, and build a network of colleagues and mentors to help them advance their careers and mentor other emerging nurse leaders.
I just returned from a leadership seminar in Jamaica, which was held at a luxurious resort. The thoughts of gaining leadership knowledge and skills, while on a beautiful island was exciting. Day three of my trip was devoted to community service. It was a satisfying feeling to be able to give back to others. We had the opportunity to visit a primary (basic school), a middle school, and a hospital.
Upon arriving at the schools they were surrounded by large gates. As we drove through the entrance we saw children in uniform and they were carrying their chairs from one building to the next. Despite the condition of the school, which had no air conditioning, no chalkboard, and no visible books, the children were excited to see us. The look on their faces was priceless when we gave them gifts of pens, pencils, markers, crayons, and books. They were very eager to learn about CPR and we had mini-manikins for them to practice on. Talking with many of the kids, their dreams and aspirations were amazing. Many want to be soldiers, police officers, lawyers, beauty technicians, chefs, and a scientist, just to name a few. Even though these children did not have the luxuries that most schools in the USA have, they were still enthusiastic to learn and very respectful to the teachers.
The hospital was another experience, which was very eye-opening, tear-jerking, and gut-wrenching. Although health care is free, the condition of the hospital and lack of supplies was deplorable. Again, just as at the schools, despite the poor conditions the medical staff were very pleasant, had smiles on their faces, and were very engaged in their work. We visited the pediatric unit where there were 45 patients, which normally holds 32 with only three nurses. They did not have IV poles or monitors, things that we take for granted in our health care facilities. The staff does the best that they can with what they have and they welcomed the medical supplies that we were able to donate. Seeing the other areas of the hospital, such as the laundry and central supply was very shocking; without staff there you would not know that you were at a hospital.
I think that every U.S. citizen should be required to visit a third-world country to see the conditions that people have to live and work under. They would see how blessed we are in the United States, even though we have some poor areas here. Driving down the streets of Jamaica there were multiple unfinished buildings, trash, and junk along the road. We saw a car that had caught on fire and was completely burned and charred, the firefighters were there with a hose, but the water trickled out like it was a home garden hose.
This experience was very educational, informative, and enlightening. It made me think of how thankful I am for what I have. My goal is to stop striving for material things and gain more rewarding experiences. Every U.S. citizen needs to reflect before complaining and be thankful for what they have. Be happy with the little that you have. There are people with nothing that still manage to smile. This also reminds me of a quote from Victory Today:
While you complain about your electric bill,
there’s someone with no home.
While you complain about your job,
there’s someone praying for a dollar.
While you complain about the food in your pantry,
there’s someone praying for crumbs.
While you complain about life,
there’s someone who didn’t wake up today.
Your complaints are simply blessings to others.
One way to stand out as a leader in your organization is to make a positive change in your unit. It may not be easy, but changes can make a drastic impact on patient care and staff satisfaction. If you are thinking about making a move into leadership in the future, bringing about change is a great way to set yourself up for job advancement.
First, you need a problem to fix. Identify an issue that is creating problems for staff or patients alike. It really should not be too hard to find an issue. What are staff or patients complaining about? What practice doesn’t make sense because it is overly complicated and inefficient? Brainstorm some solutions to consider.
Next, share some well thought out ideas with your manager or member of your leadership team. Create a SBAR (situation, background, action, recommendation) to give them that will outline the problem and what you’re going to do about it. If you have an idea that your manager supports, you could get dedicated paid time to work on the issue.
Once you garner support from your manager or another leader, you must take a deep dive into the problem so you can determine potential solutions. You’d be surprised that many fixes or solutions are cost-effective meaning they require little to no money to implement a change. After developing a potential solution, you will want to clearly articulate the potential impact this change would have. In other words, you have to understand why this change is important. This will help you gain buy-in from staff when implementing that change.
Lastly, you want to do a pilot test or test the change. This is the do or die time for the proposed solution. You will create data and implement that change to see if your solution solved the problem or not. Were patients more satisfied with their care? Did a process take less time? Did fewer errors occur? If the data didn’t change, you will have to go back to the drawing board and determine a more effective solution. If you made a drastic impact, then you should make the change permanent.
When you go through the process and make a permanent change, add this to your resume and CV! These are great experiences to reference in job interviews. The difference you make for your team and workplace will set yourself apart and can also benefit your day to day work as well as your future opportunities.
Leadership—it’s the Holy Grail that’s stressed in business and health care administration. But how can you get there? And how do you know if nursing leadership is even right for you?
“Not everyone has the skills, desire, or disposition to be an administrative leader,” says Laura S. Scott, PCC, CPC, ELI-MP, CPDFA, president and founder of 180 Coaching, an executive coaching and leadership training provider based in Tampa, Florida. “I recommend that my clients go to a trusted supervisor and ask, ‘Where do you see me going as a professional and leader?’ and then just listen. You might be surprised at what you hear. If you have a role in mind, ask that trusted supervisor if they think you would be a good fit for that role and ask, ‘Why or why not?’”
Use caution when thinking about getting into leadership. “Don’t rush into what isn’t easily seen as an opportunity,” says Alisha Cornell, DNP, MSN, RN, a clinical consultant with Relias, a health care talent and performance solutions company. To decide whether a leadership role is right for them and what they want get out of it, Cornell says that
self-exploration is necessary. “How did the nurses identify that they even wanted to be nurses? My recommendations are to stick to the original design. Whatever got you to nursing school and whatever helped to push you out of there, that’s your personalized equation.”
If you’re not sure if you want to be a leader, Romeatrius Nicole Moss, DNP, RN, APHN-BC, founder and CEO of Black Nurses Rock, says, “First, it is determined by the specialty you enjoy, followed by what you can contribute. Leadership starts now, as a staff nurse.” She suggests you ask yourself these questions:
Do people often come to you for help, advice?
Do you offer suggestions at meetings?
Are you the go-to person for issues on the unit before elevation to leadership?
Are you available, outgoing, approachable?
“If you are the unit leader, charge nurse, etc., these positions are set up to move you to the [higher] levels when opportunities arise,” explains Moss. “So be ready.”
If you know that you aspire to a leadership position, then move ahead. If you don’t or you try a leadership role and don’t like it, that’s okay. “If you don’t like nursing leadership, you can always go back to patient care,” says Thomas Uzuegbunem, BSN, RN, an RN administrative supervisor as well as the editor of the nursing leadership blog, NurseMoneyTalk.com. “Some nurses can get enough leadership fulfillment by being on a board. Others find that it’s not enough, and they want to move into nursing leadership as a career.”
Make sure that after self-reflection, you are the one making the decision to move into a leadership position. “Nurses who are seen as good caregivers are often promoted. While patient care is extremely important, being able to care for a patient does not mean that a nurse can care for a team of peers,” explains Bill Prasad, LPC, LCDC, CTC, a licensed professional counselor who has also worked as a hospital director and a leadership coach. “A nurse must understand that moving to a leadership role means you are moving from a focus on health care to a focus on organizational health.”
If that doesn’t fit in your life goals, there’s no shame in not pursuing leadership or moving into management. Yanick D. Joseph, RN, MPA, MSN, EdD, an assistant professor of nursing at Montclair State University in New Jersey sums it up: “Not everyone is destined to lead or to be an administrator,” she says.
Skills and Characteristics Needed for Nursing Leadership
“Leaders are born, but there are no born leaders,” says Prasad. “Becoming an effective leader takes training and education. Without this, you don’t know what you don’t know.”
Communication, flexibility, and organizational skills are the most important skills that Moss believes nurses wanting to move to leadership need to have. “Leaders should have the skills that allow them to be calm in stressful situations such as in crisis, emergencies, schedule management, and more,” she says. Nurses also need the “ability to work with different personalities and change leadership styles based on the staff member. Nurses should understand this even while working with their teams: you cannot use the same leadership style on everyone. Some people do better with taskers and checklists, while others need a little supervision to flourish.”
Moss says that leaders must be relatable and personable. “Allow your staff to see you get your hands dirty. Be the expert on the unit/department and show the team your skills and that you can handle the unit if need be. Start IVs, jump in on a code, participate while letting your team lead.”
One other characteristic Moss believes is imperative for nurses who want to lead is to be calm when challenged or with disagreements. “It is important to understand differences of opinion and to negotiate the best options. It’s even more important when dealing with difficult staff, family, etc. to not get emotional and to always be open-minded.” She admits that this was tough for her when she began to lead. “I had to understand the different personalities, politics, and overall strategic plan, and how they all come into play with decision making. Once you get this, your life will become less stressful,” she explains.
Scott agrees that good communication skills are crucial. “Effective communication and opening the channels for two-way feedback is very important. Also important is knowing what keeps these staff and providers on board and engaged so that you can give them what they need to stay motivated and fulfilled,” says Scott.
When communicating with others, Cornell says to keep this in mind: “Nurses are well-versed in the scientific methods of providing care from an academic perspective, but relating to ourselves, learning to listen for the conversation instead of solving a problem, and not reacting spontaneously are all critical skills of a strong leader.”
Nurses also need to be patient and have courage. “These characteristics are important because the normal job responsibilities of the nurse require quick thinking and paying attention to details. However, being a great leader requires the brain to slow down and digest the information in order to resolve a problem or at least know where to look to resolve it,” says Cornell.
Nurse leaders, Uzuegbunem says, must have an ability to accept diversity and understand technology. “Nurse leaders must be able to embrace diversity and adapt to those cultural differences of the nurses they lead as well as the patients the nurses take care of,” says Uzuegbunem. “Technology is having more of an influence in health care. From electronic medical records to the equipment nurses use. [Leaders] need to be able to adapt to these technological changes.”
Educational Necessities
While our sources have different opinions on how much education leaders need, one thing is certain: if you want to hold a leadership position, you must keep learning all the time.
“Nurses need to obtain additional education, certifications, and always continue to have a thirst for knowledge,” says Cornell. “A nurse leader should have, at minimum, a master’s degree in a focused area of nursing.” While she says other advanced degrees are helpful, one focused specifically on nursing “drives the objectives of nurse leadership and the shared experiences of nurse leaders. At the advanced leadership level—which includes directors and CNOs, they should have a doctorate. The terminal degree is a collaborative journey of nursing experience and leadership needed to facilitate a structured systems approach to patient care and organization of nursing teams.”
“A nurse aspiring a position in leadership should attain the highest level above what the unit or department requires,” suggests Moss. “Managing nurses who have higher credentials could lead to resentment or turnover as the staff nurse doesn’t see progression at the top. A unit should be led by the expert, in my opinion, the go-to person. This person should obtain the needed certification, education, and training to support this.”
Scott reminds nurses to check to see if the facility you work for provides funding for earning advanced education. “Many hospital groups will offer tuition reimbursement to qualified candidates, so you don’t have to go into deep debt to get this education,” she says.
Uzuegbunem believes that there’s no set educational path to leadership. “Depending on who you talk to, you’ll get different answers. Some will say that nurses should have at least a BSN before being able to get into leadership. I don’t. I also don’t think a certification is needed. All that’s required is a desire to lead others and a willingness to serve those you lead,” he argues.
Money, Money, Money
Besides the other skills, characteristics, and education that prospective leaders need, there’s another that many don’t consider—financial knowledge. Jane C. Kaye, MBA, president of HealthCare Finance Advisors, states that nurses in supervisory positions in all types of health care facilities need to have some financial skills. “The financial health of health care organizations depends on how well nurse leaders manage staff and supply costs. For example, salaries are the single largest expense line in any health care facility, and nurses represent the largest share of salaries. Similarly, nurses lead large departments such as surgical services, where supply costs are very high. If salary and supply costs are not managed, the sheer size of these spending areas can jeopardize the financial health of the health care entity,” explains Kaye.
According to Kaye, the types of financial skills nurse leaders need include: management of full-time equivalent staff, management of supplies, expense variance analysis techniques, knowledge of budgets, an understanding of operating statistics, and an understanding charge capture techniques so that all services performed are included on the patients’ bills.
For nurses who don’t have good math and finance skills, Kaye suggests that they find a trusted colleague in finance to help them understand financial concepts. “They should never be afraid to ask questions,” she says.
Attending webinars, seminars, and workshops on finance may also help.
Prep Work
A good way to prepare for a nursing leadership role, says Scott, is by taking on leadership roles outside of work. For those who want to become more confident speakers and grow in leadership presence, she recommends looking into Toastmasters, a national organization with chapters across the U.S. that help members learn to give great speeches.
Cornell says that networking is a must but can begin way before nurses are even considering leadership roles. “Knowing colleagues in the industry is always a plus, and it helps to learn what other nurses are doing. Volunteering for committees and sitting on boards are all great experiences, and nurse leaders should participate in these activities,” says Cornell. She cautions that doing this should be fine. If it’s not what the nurse is aligned with liking or doing then s/he will lose interest fast.
“Becoming part of committees and boards allows you to gain the experience and confidence you need to speak out on your opinions, work with different personalities, and see your strengths and weaknesses,” says Moss. “It can really show you what type of leader you naturally are.”
To prepare for taking a leadership role, Joseph suggests the following: reading professional journals, attending seminars, networking, joining LinkedIn, researching the role you want, reaching out to professional organizations for best practices, speaking to a mentor or someone who has made the transition, being proactive and enthusiastic about learning the intricacies of the new role, and being visible.
No matter what, being true to yourself is most important. “Being a leader is challenging, arduous, demanding, trying, and hard,” says Joseph. “But the joy of doing what you are born to do and have a passion to accomplish is indescribable.”
