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6 CNO-to-CEO Strategies

 |  By Alexandra Wilson Pecci  
   June 18, 2013

Why don't more nurse leaders go after hospital CEO jobs? Too many nurses underestimate their potential and believe that landing a chief nursing officer position means that they've reached the pinnacle of their career.

Connie Curran, EdD, RN, FAAN, hears a common refrain among chief nursing officers who are frustrated with their hospital's top leadership: "How many CEOs do I have to teach to do their jobs?"

Curran has ready reply: Why don't you apply to be a CEO?

Most often, though, nurses don't go for it. In a profession where more than 90% of the workforce is female, nurses are still seriously underrepresented in CEO positions.

Why is this? Although there are certainly external factors that hold women back from pursuing executive-level positions—sexism is still alive and kicking, folks—there are also internal factors that hold them back. Curran says female nurses who move up the ranks into hospital leadership positions most often end up in chief nursing roles—and then stop there.

"I think that a lot of people really underestimate their potential, and if we don't see somebody else doing it we think it can't be done," Curran says.  

Her challenge to chief nurses? Dream of being the CEO.

Curran is CEO of Best on Board; a faculty member of the American College of Healthcare Executives; a member of the boards of directors for Hospira Inc., DeVry Inc., and DePaul University; and former chairman of the board of Silver Cross Hospital. 

Nurses—most of whom are women—don't dream big enough, Curran says. "She should stop and think about where she is in her career and is that as far as she wants to go?" she says. "Has she reached the pinnacle of her dreams?"  

Becoming CEO someday isn't an aspiration for many nurses, not simply because they're contented in their current role, but because it never occurs to them that they could be the CEO.

"I do think lots of times we set our bar, or our goal, or our dream too low," Curran says. Plus, many nurses are dedicated to patient care and don't want to move out of that realm. But she counters that nurses who move into chief executive roles can exercise great power and influence over improving patient care.

In fact, the desire to be a CEO "really comes from the very thing that makes you want to be a nurse," she says: Wanting to help people. She says nurse managers should ask themselves, "'Why wouldn't I want to run the hospital or be on the hospital board?' It's kind of an extension of your core mission."  

Curran says successful nurse executives possess the fundamentals skills a CEO needs. They know how to set priorities and delegate responsibility. They also understand the importance of building good networks and positive relationships, as well as always learning new things and broadening their skills by doing everything from reading articles to attending webinars and workshops. They have a firm grasp on finances, something many women are convinced they're ill-equipped for, despite routinely and competently managing their household finances. But that's a column for another day.

Risk-taking is also important.

Of those who have ventured forth, Curran says, "They all kind of stuck their nose out there and tried something that they had never tried before and never thought of trying." And maybe more importantly, they don't let fear of failure keep them from trying new—and maybe scary and intimidating—things. If you've never made a fool of yourself, now's the time to do it, she says.

"This is about taking a risk with your own abilities, taking a chance," she says. Don't be afraid of mistakes—they're inevitable—and don't linger over them. For example, if you use wrong terminology in a meeting, get over it and move on.  

Nurses should speak up when they're underrepresented on hospital boards, Curran says. She points out that the ratio of nurses to physicians on hospital boards is incredibly skewed when compared to the ratio of physicians to nurses who work in hospitals. Only a very, very small percentage of hospital board members are nurses, yet the majority of the workforce consists of nurses.

"I really believe nurses need to be on board for the sake of the patients as well as the sake of the other caregivers, but I don't see if happening," Curran says. "Who knows how the place runs on Christmas Eve? Nurses." Why wouldn't you want nurses who literally run the place on the board, she asks?

Although hospital executives and board members should work to inject a new and critical perspective into the good-old-boy network and make a conscious effort to get more nurses on their boards, Curran says nurses should take the initiative here and advocate for themselves, too.  

She tells chief nurses to get in front of CEOs and tell them they need a nurse on the board. Many times they'll get an "oh yeah" kind of response from the current board members. As in, "oh yeah, I never thought of that."  

Here are six strategies for nurses who aspire to the corner office:

1. Step out of your comfort zone: Get on a committee that you may not be entirely comfortable with. For example, if you're intimidated by numbers, join the finance committee.

2. Develop relationships: Have a broad view and understanding of your entire organization, not just your little slice of it. Cultivate relationships with people who work in the lab and housekeeping, as well as with physicians and other nurses.

3. Find a mentor: When you encounter someone you admire and who does something really well, make an effort to learn from that person.

4. Get a coach: If you want to be a better tennis player, you wouldn't hesitate to get a coach; why should developing leadership skills be any different? "It's worth the investment to get a coach to help you," says Curran.

5. Understand the numbers: It's not enough to be a good clinician; you have to understand the financial aspect of healthcare, too. Curran believes deans of nursing schools should require finance classes for students. If you didn't take one while you were in school, though, it's not too late to take one now.

6. Value your work: If you're working unforgiving hours, day in and day out, maybe surrounded by people who appear not to appreciate you, it's easy to forget the just how important your work really is. "When someone diminishes the significance of what you do over and over again you start to lose appreciation for it," Curran says. "You lose the awe about how miraculous it is."

Alexandra Wilson Pecci is an editor for HealthLeaders.

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