Nurses aren't trained to be managers. They're trained to be clinicians. So how can your hospital ensure that it is providing the additional training and leadership development needed to create the next generation of chief nursing officers? The first step is identifying which nurses have the personality traits to be effective managers—and just because a nurse is a great clinician doesn't mean she'll be a great leader.
Recently, I spoke with M. T. Meadows, director of professional practice at the American Organization of Nurse Executives in Chicago, about the different skill sets that nurse executives need in smaller community hospitals versus larger health systems. She said that nurses in rural or critical-access hospitals have numerous responsibilities; for example, they may be in charge of the nursing units plus housekeeping and pharmacy. "They need to be able to identify with the groups of people that they are leading. They may have a nursing and a non-nursing department, and the needs of those departments are going to be different, so they have to wear more hats and work on their objectivity in dealing with multiple departments," she says.
I have heard that hospitals should be looking for nurses who don't intimidate easily, are confident and compassionate, exhibit objective and independent thinking, have the ability to see the big picture, and embrace change as an opportunity for growth. But identifying potential leaders is just the first step. Next is establishing an in-house training program—which may be difficult for mid-sized or smaller hospitals because they often lack the infrastructure and resources required to establish such programs. One training tool that is fairly easy to implement whether you're a small or large hospital, however, is a mentoring program. Mentors can help groom new nurse executives by helping nurses identify what their learning needs are and directing them to that information. They can also help nurses transition into a new role by acting as a sounding board for new nurse leaders' questions or problems.
While it is beneficial for the mentor to have knowledge of the nurse executive's role, is it absolutely necessary to have only nurse managers mentoring other nurse managers? I wonder if smaller hospitals should establish a mentoring program in which non-nursing executives are partnered with new nurse leaders—especially since nurses in these facilities assume multiple responsibilities. Why not have the chief financial officer or chief operating officer mentor the new nurse executive? The CFO or COO could help get the nurse leader up to speed on the financial elements of the job—an area frequently requiring additional training—or the operational elements of the organization.
In addition, this type of mentoring program could give smaller organizations the opportunity to pick truly great mentors—people who have good communication skills and understand how adults learn—rather than choosing mentors based solely on their job. The bottom line is that the organization needs to foster an environment that supports learning. Staff members need to feel comfortable sitting down with a colleague and saying, “Tell me what I need to know about this spreadsheet.”
If you have a unique approach to mentoring or training new nurse executives, I would love to hear about it. Please drop me a line at cvaughan@healthleadersmedia.com.
Carrie Vaughan is editor of HealthLeaders Media Community and Rural Hospital Weekly. She can be reached at cvaughan@healthleadersmedia.com.
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Cooperation is absolutely essential to quality healthcare in rural areas, according to a national expert. The word "collaboration" might have negative connotations for some people and groups, but it is "central to what we're trying to do in rural American, rural health," especially because in rural areas, competition and free-market forces are sometimes entirely absent, Forrest Calico, MD, told a gathering of agencies that came to Plymouth State University in New Hampshire for a forum.
About 15 third-year medical students from Touro University College of Osteopathic Medicine in Vallejo, CA, will spend one year in North Coast clinics providing care to rural communities. The rural clinical rotations in Humboldt and Del Norte counties are new for the university, and give students opportunities to work at rural clinics as opposed to large, often hierarchical hospitals, say Touro University representatives.
It's a "Tale of Two Cities" story for individual health insurance plans: the best of times and the worst of times.
Individual health insurance plans are on the rise as more employers end health benefits and Americans turn to individual policies as a way to avoid being uninsured. According to American's Health Insurance Plans, approximately 18 million Americans are covered by individual health insurance compared to the more than 230 million who are enrolled in group plans through their employers or government programs. The rising use of individual plans is causing some states to review their laws governing health insurers and the plans' actual policies.
Take California, for instance. A woman won a $9 million judgment against Health Net for canceling her coverage while she underwent chemotherapy. With that making news from coast to coast, the Golden State's Department of Managed Health Care took notice. After a review of the situation and negotiating with two insurers, the state announced that Kaiser Permanente and Health Net would reinstate nearly 1,200 individual policies that were cancelled since 2004. California is seeking similar deals with Anthem Blue Cross, Blue Shield, and PacifiCare.
The news from California is making others take note.
Healthcare advocacy group Families USA recently released a 50-state survey of the individual insurance market called Failing Grades: State Consumer Protections in the Individual Health Insurance Market. In response to the survey findings that showed "many abuses" and "few state-level consumer protections," Ron Pollack, executive director of Families USA, called the individual market "the wild, wild west" of healthcare.
Some of the findings did not put laws that govern individual insurance in the best light:
Only five states prohibit insurance companies from "cherry-picking" the healthiest consumers and excluding "everyone else from coverage"
In 21 states and the District of Columbia, insurers can exclude coverage for pre-existing conditions, such as cancer and heart ailments, for more than one year
In 44 states and the District of Columbia, insurers can revoke an individual's health insurance without advance review by the state
In 45 states and the District of Columbia, insurers do not have to spend at least 75% of their revenues on healthcare
In 20 states and the District of Columbia, insurers can set and raise premiums without oversigh
It's easy for health plans to dismiss the Families USA survey as the latest criticism of the individual market. Rather than simply ignoring the report, health plans should review individual policies to make sure they are providing the best consumer protections. One only needs to look at California and the more than a dozen health insurance-related bills in the legislature to see that if there is enough bad publicity the states will rise up and make decisions that could harm health plans.
AHIP released a report in December 2007 called Guaranteeing Access to Coverage for All Americans in which it offered a new strategy that included limiting the use of pre-existing condition exclusions, restricting rescission actions, and establishing a third-party review process for pre-existing conditions and rescission decisions.
As more businesses end health coverage because of costs, the individual health insurance market will continue to rise. With that greater interest will come more opportunities for government intervention.
The question is: Are health plans going to get ahead of this issue and review their rescission and coverage policies, or wait until the state comes knocking on their doors?
Les Masterson is senior editor of Health Plan Insider. He can be reached at lmasterson@healthleadersmedia.com .
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Although the overall financial health of Pennsylvania hospitals continues to improve, many small, rural hospitals are struggling. Overall, 42 hospitals, or 25% of the state's hospitals, lost money, according to a report by the Pennsylvania Health Care Cost Containment Council. "This is troubling because most of these smallest hospitals are a vital resource for rural Pennsylvania communities," the report said.
While there's a community health center and some doctors in town, for them, residents of Chincoteague Island, VA, either have to drive an hour to the north or south for hospital care. This story highlights a problem that many small or rural communities face when hospital care is sometimes hours away.