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Nurse CEOs Lead the Way in Familiar Territory

Friday August 1, 2003
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What's it like running a hospital when you're a nurse, too? Although there may be obstacles to moving into the executive suite, CEOs from Tennessee and Alabama tell Nursing Spectrum about the challenges and the satisfaction of leading hospitals and how their nursing careers paved the way.
Moving Up
Leading a healthcare institution with 4,800 employees, 1,000 faculty members, and revenues exceeding a billion dollars was not in the career sights of Mary Nash, RN, PhD, CHE, FAAN, executive director, University of Alabama (UAB) Hospital, Birmingham. A nurse with almost 30 years of experience, Nash says she always wanted to be a chief nurse at a large academic center. But when she was given a dual role of CNO and COO at UAB, she also knew she wanted the responsibilities of running the whole hospital as CEO, a position she assumed a little more than a year ago.
Roxane Spitzer, RN, PhD, MBA, FAAN, CEO of the Metropolitan Nashville Hospital Authority, Nashville, TN, worked hard to become a CEO because she wanted to be able to set a vision and direction for an organization. "My PhD is in strategic management, which is my strength," Spitzer says. "I have been a COO and a CNO, but I felt that I could only do strategy as a CEO."
Spitzer's thesis adviser was Peter Drucker, the internationally known management expert, who still serves as her mentor. "He has always given me valuable advice, but one of the most important things he told me was that the responsibility of the CEO is to ensure that an organization survives and prospers on behalf of its employees so that they can feel that you're a good steward for their jobs."
Focus on the Product
It may not be necessary to be a nurse in the hospital's CEO position, but Spitzer, who has 35 years of nursing experience, says nurses really understand what the business is about and that nurse-CEOs stay focused on the product, which, of course, is the patient.
Nash says having a clinical background is important when it comes to CEO issues, such as designing a new building (UAB is completing a $300 million expansion on time and on budget), balancing a budget, and working with physicians about resident coverage. "The interesting thing about academic medical centers is that the doctors, nurses, and staff really like the fact that the head of the hospital is a nurse."
Nash adds that although nurses appreciate the fact she is a nurse, she does not advocate for them more than other departments. "I have to balance that very carefully; I can't look like I'm doing something for the nurses when I have thousands of other employees to worry about. But I always say that if we take care of the patient, everything else takes care of itself."
Although Spitzer thinks the nursing staff regards her with a certain level of camaraderie and identification, she says she has to treat everyone as part of a team required to deliver care. "Nursing probably does not see me as an ally while I'm running two city hospitals and the city clinic," Spitzer says. "I believe that hospitals exist to deliver nursing care, but they can't possibly be good at it without the other members of the team."
Education Isn't All You Need
If you think you want to be a CEO and that an MBA is your ticket to the top office, think again, according to Spitzer. "Your ability, commitment, and experience with good outcomes will get you far more than a business degree," she explains. "And, your reach should always exceed your grasp."
Nash, although occasionally discouraged by others from using her nurse credentials, never wants to hide the fact that she is a nurse. "We have to be savvy, and we have to learn certain angles, but we should never hide it. It's a proud thing that we're nurses."
Against the Odds
Being both a nurse and a woman worked against Spitzer until she was able to get her CEO position four years ago. Spitzer, who is on loan from Vanderbilt University to the city of Nashville, says: "I believe that the concern is that a nurse would be so focused on the patient that the financial piece would fall behind. Some people see nurses as territorial and believe that they practice in a vacuum."
Nash says some think women have to do twice as much to prove themselves. She also says many boards don't take women seriously even though she has a good relationship with her own board of trustees at UAB. What does concern her, however, is that she has been told she acts too much like a nurse.
"How does one act too much like a nurse? I don't even know what that means, so I just ignore it and continue to be results-oriented. Whether you're black, white, man, woman, nurse or not, we have to show outcomes. Critics will eventually see that CEOs can be nurses and still be accountable, influential leaders."