Broader Training Makes for Good Leadership
Monday March 27, 2006
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As nurses rise through the ranks of health care, they are usually confronted with the demands of leadership on an ever-larger scale. Nurses have always been comfortable in the traditional roles of unit manager or charge nurse. This level of management allows for a "hands-on" approach to leadership. Most charge nurses are adept at a range of negotiations - from getting the staff to work overtime to working with a physician to transfer a patient - and are prepared to take over the direct care of patients in a crunch. However, when the number of staff members is measured in the hundreds rather than dozens, opportunities for this kind of involvement evaporate. At this level, different attitudes and skills are required.
Training nurses to take their seats at the management table makes sense. In the Veterans Administration (VA) hospital system, training for management has been in place for a long time. There are opportunities at many levels to identify and promote new managers. Mary Ann Musumeci, RN, MBA, started in the VA system in 1973, as a staff nurse in the Brooklyn, New York hospital. She is now the medical center director of the James J. Peters VA Medical Center, Bronx, New York.
Training for the top
The VA has had several training opportunities through the years for those interested in entering the ranks of upper management. Musumeci participated in one such program, since disbanded, but others have been instituted with the same goal. She now participates in the VA system Executive Career Field (ECF) program, a highly competitive program open to those who are interested in pursuing an executive career in the VA. As part of this program, she mentors candidates throughout the country and acts as a preceptor to those in her own facility. In the same spirit, Musumeci has promoted nurses to a variety of leadership positions in her hospital and helps them learn the skills they need to succeed.
"When I hire someone for upper management, I look for good interpersonal and excellent communication skills and an ability to think outside the box," says Musumeci. "These qualities are more important than anything."
Musumeci has hired nurses into some of the most senior positions in the hospital, including compliance officer, quality management officer, patient safety officer, utilization manager, and assistant to the chief of staff, who manages the computer system and the Ambulatory Care Center for the medical center.
The nursing process writ large
Nurses are the most important professionals in the hospital, says Musumecci. "These are the people who are here 24 hours a day, seven days a week," she says. "They are responsible for the quality of the care we deliver. It is in their hands."
The strength of nurses in management is the training they receive at the beginning of their careers, says Musumeci. "They learn through the years how to do an assessment and how to formulate a plan based on that assessment," she says. "As nurses, we do very well 'thinking on our feet' and solving problems."
If nurses have any shortcomings when it comes to management training, she says, it is in the difficulty they have expanding their viewpoint to encompass the larger picture. The skills needed to run a medical center can be learned, but the qualities of communication and interpersonal skills to motivate others are harder to teach.
They must use a broader vision and be able to see things globally, Musumeci says. Sometimes it takes a while to learn to transfer the nursing process (assessment, planning and action) to the arena of senior management.
Getting out of cubbyholes
Musumeci has organized her office so that senior people are able to learn several aspects of medical center operations. When decisions are made, they must be made in the context of the larger picture. She prefers a team approach and involves the entire senior management group in strategic planning and problem solving.
"It's challenging for the nurse to think out of the box, to know about all the services available, and to get out of her own little realm," says Musumeci. She finds that working with an interdisciplinary team to make changes in patient care can be very rewarding.
Lynda Olender, RN, MSN, NP, B-C, is the nurse executive officer of the medical center and has also been in the VA system for many years. She agrees that one of the biggest challenges to nurses entering senior management is seeing the big picture.
"I know I had tunnel vision when I first took on a larger role," she says. "I had to learn to step back and to get a broader perspective." She notes that once nurses learn to think globally, the way they problem-solve is very effective.
The VA is not unique in its approach to promotion from within the organization, but there are certainly many opportunities in the system for growth, says Musumeci. There are 150 hospitals and more than 300 clinics throughout the country, she says. When it comes to advancement, "The sky's the limit for someone who works hard and knows how to set and achieve goals."
There are many steps towards advancement in the VA system, says Musumeci. There are hospital-based, one-year regional programs available for those who want to develop themselves into leaders before applying for the highly competitive national program. These paths to leadership are available to all disciplines, and Musumecci often encourages nurses to avail themselves of the opportunities.
"This is a patient-centered organization," says Olender. "The challenge for nurses is to learn to see the bigger picture, to see not only nursing issues, but to see the interdisciplinary issues that affect patient care. There is a lot of coaching involved in helping other disciplines understand how everyone interacts. For me, the challenge was to change the model of nursing to something broader."
Having a seat at the leadership table requires a new level of integration between nursing and other professionals. Being able to see the big picture and finding new ways for nurses to use their core skill of assessment, planning, and implementing, gives nursing new and effective ways to improve the care of patients.
Marylisa Kinsley, RN, BSN, is a contributing writer for Nursing Spectrum. To comment on this article, e-mail jspillane@nursingspectrum.com.
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