3 nurse CEOs on combating assumptions, getting ahead of skill gaps

CEOs of hospitals and health systems with a background in bedside nursing appear to be few and far between, making the advice from nurses at the helm of hospitals even more valuable to aspiring nurse CEOs. 

The true proportion of nurse CEOs in healthcare is unclear due to a lack of data, though the digging it takes to find nurses who hold the position suggests that, perhaps, there aren't enough to fully address all of the complexities surrounding nurse shortages. The American Organization for Nursing Leadership told Becker's it is hard to track because not every nurse CEO continues to use their RN credential.

Becker's spoke with three hospital and health system nurse CEOs about their path to the top leadership position. They also shared their advice for nurses who hope to get to the C-suite and discussed assumptions about what skills are needed at the helm.

Ditch the one track to C-suite mindset

Leaders have said healthcare needs to do away with the assumption that strong nurse leaders have one track: chief nursing officer. 

One way aspiring nurse CEOs can combat this single path mindset — and any other assumptions about what skills are needed as a hospital or system CEO — is ensuring the institution they're at or considering joining has a broader way of thinking surrounding the value nurse leaders bring to the table, according to Johnese Spisso, RN, who has served as president of Los Angeles-based UCLA Health, CEO of the UCLA Hospital System and associate vice chancellor of UCLA Health Sciences since 2016. 

That means an organization that sees the nurse leader "as a valuable part of executive leadership to not only shape nursing, but shape patient care services in the organization," she said.  

"As you're thinking of your career, it's important not only to look at what you can bring, but are you bringing that to an organization that will allow you to grow in that way?"

Ms. Spisso said that is something a nurse can look out for during the interview process as far as where the institution places nursing and their views about nursing leadership.

"It has to be a match. And that's where I think sometimes in the past nurse leaders have gotten frustrated because otherwise it's hard for them to get out of that box if it's not the organizational culture," she added. 

Imposter syndrome — doubting one's abilities and feeling like a fraud — is also a challenge. A recent survey of 750 women who are "one or two career steps away from the C-suite" found three-quarters of female executives have experienced imposter syndrome. 

Nancy Howell Agee, MSN, BSN, CEO of Roanoke, Va.-based Carilion Clinic, said, "It starts with the nursing leader seeing herself as CEO." Prior to serving as CEO, Ms. Agee was the system's executive vice president and chief operating officer. "Women often — and the majority of nurses are still women — have a distorted view of what they're capable of, which limits opportunities for career advancement. To that, I say 'lean in.'" 

Lean into strengths, address knowledge gaps 

As a whole, the healthcare industry could do a better job of recognizing the value and unique perspectives nurse leaders can bring to the helm of an organization, nurse executives told Becker's

"As nurses, we utilize critical thinking, evidence-based practice, and the Nursing Process to care for our patients," said Holly McCormack, DNP, RN, CEO of Cottage Hospital in Woodsville, N.H. "These skills, coupled with a transparent, authentic leadership style, are a solid foundation for a healthcare executive." 

After serving as director of the medical-surgical unit at the 35-bed critical access hospital, Dr. McCormack advanced to director of inpatient services. In 2016, she became CNO and was named CEO in 2021. 

Ms. Spisso, with UCLA Health, began her career as a critical-care nurse in the medical, surgical and transplant intensive care unit at Pittsburgh-based UPMC Presbyterian. She then spent more than a decade at UC Davis Medical Center in Sacramento. She also held roles at UW Medicine in Seattle including chief nursing officer, COO and chief health system officer and vice president of medical affairs for the University of Washington.

She told Becker's that she's found her nursing background to be advantageous throughout her career. 

"Because of the way nursing really works is the team approach and being the leader of the team, the nurse also understands the roles and value that every member of the team brings and the importance of that," she said. "So, I always felt that having that experience and having that lens of a team approach to care definitely prepared me for understanding what our most important model of business was in healthcare, but also how you can continue to motivate and inspire a team to deliver on results and outcomes for patients and families."

While recognizing the strengths that stem from their nursing background, each CEO also emphasized the need to get ahead of knowledge gaps and develop business and financial management skills. 

"One of the biggest challenges that nurses face as they advance in their careers is a knowledge gap in the realm of finance," Dr. McCormack said, adding that she continuously seeks out opportunities to learn about healthcare finance and reimbursement, including at trainings, meetings and conferences, despite usually being "the only nurse in the room." 

Ms. Spisso recommended nurses who want to get into the C-suite get involved in project development and new programs to strengthen familiarity with the business side of patient care. 

"I always like to see individuals in the organization who volunteer to be on committees, to be on projects," said Ms. Spisso. "Not only to share their knowledge, but I've gained valuable insights through my career by that participation and that learning opportunity, the ability also, to work with other leaders in the organization who were amazing mentors."

She also recommended that nurses who are particularly early in their career and want to get into the C-suite double down on doing the best they can in their current role.

"I find now that so many people put so much pressure on themselves to say, 'Within every two years, I have to have a promotion, I have to have a title change,'" she said. "I think focusing on whatever role you're in, doing the best that you can in that role [is important]. And people will notice you and they will seek you out to do additional duties, to be thought of when promotional opportunities come up. So, not to get caught up in the time sense, but really focus on the quality of what you're learning and how that will really add to your long-term career potential."

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