Confessions of a Hospital Administrator

There is a reason nurses are the most respected profession in America. A former hospital CEO offers advice on how to help take care of patients by serving nurses. This advice includes: 1- Get Out of Your Office: 2- If You Want to Solve a Problem in a Hospital, Ask the Nurses; 3 - Protect Your Nurses; 4 - Remember, What Happens in a Hospital is Not About You. Nurses Announcements Archive Article

Gallup announced the results of its annual "Honesty & Ethics in Profession" recently. I was so pleased to see nurses ranked number one in the survey because they certainly deserve the honor. With the exception of grade school teachers, who ranked third, nurses are the embodiment of what it means to have a calling of dedication, grace and love.

I worked in hospitals most of my career with much success (and a few times when I was not successful, but that's a story for another day). I started as a manager for what is called an "ancillary service", or nonclinical service. These include such areas as housekeeping, food services, engineering, IT and accounting. My specialty was public relations and marketing. I finished my career in hospitals 28 years later as a CEO responsible for an approximately $80 million in net revenue and payroll for up to 700 employees, mostly nurses. I even won a few awards, including being named nationally, with my executive team, as "Top Leadership Team in Healthcare for Mid-Sized Hospitals" by HealthLeaders magazine in 2009. I was compensated well, on average about four times that of the average nurse's salary. Something I learned, as my career progressed, however, was that even with recognition and high compensation there were days I was barely worthy to serve nurses. The truth is I neither had the brains nor the courage to be a nurse. But I finally did figure out how I could serve as a useful hospital administrator to nurses as they went about the sacred task of laying hands on patients every day. Serving nurses is also a good way for an administrator to run a successful hospital. Every metric on which hospitals are evaluated - from quality outcomes to safety to patient satisfaction to staffing efficiency to medical staff confidence - is dependent upon having a staff of nurses who feel valued on the job. It's also the right way to be in charge of a hospital. Here are four things a hospital CEO can do serve nurses and manage a hospital well.

Get Out of Your Office

If a CEO ever wants to be anything more than the latest suit in the front office, go to where the work of the hospital is done - at the bedside. I learned this important leadership tip from one of my two mentors. It wasn't always easy and there were many a day when I didn't think I had time given the work and people lined up in my office. But without exception, once I made it to the floors to where nurses (as well as physicians and other therapists) worked I understood it was the most important part of my day. Invariably I would find inspiration that made me work happier when I did get back to my office. And when nurses see an administrator every day, they begin to open up. The administrator hears whet they need to hear, not what staff thinks the administrator wants to hear.

For example, one day while making rounds I noticed the nurses seemed aggravated. When I asked why I discovered that they were running up the stairwell to another floor to get ice for patients. The machine on their floor had been broken on and off for weeks. Do you know how much ice nurses use? When I got back to my office I called the Director of Engineering and he told me they kept fixing the machine, but it was old and needed to be replaced. When I asked why the machine was not replaced with a new one, the Director said he tried, but the Chief Financial Officer told him that a new machine was not on the capital list. Now, this hospital was doing well and had discretionary capital money. And the CFO, in his mind, was doing his job by controlling expenses while the Director of engineering was focused on the matter of the equipment's readiness and not the effect its downtime was having on staff and patients. But if I had not been up on the floor every day I would have never noticed that something was amiss with the nurses. Needless to say, a new ice machine was ordered and installed within a week. Not only was the action of the Engineering Director and CFO insensitive and a bit clueless about the work of nurses (which I addressed), but the frequent trip to the next floor to get ice was terrible for productivity and patient satisfaction.

Getting out of the office also includes coming in a few times a month to make the rounds to visit nurses on the third shift as well as on weekends and holidays.

If You Want to Solve a Problem in A Hospital, Ask the Nurses

Nurses are really smart - they have to be to get through nursing school. If an administrator comes up with a bad process to address a problem without asking nurses what they think, it won't work. Because nurses are the queens and kings of work around and they do not suffer fools gladly. When we were having persistent problem with falls and the magnetic door signs my Chief Nursing Officer and I had decided would fix the problem didn't, we finally put together a committee of nurses to figure things out. It didn't take long. There solution included; nonslip socks; beds with built-in alarms for high risk patients (and a built-in scale, which also reduced back injuries among nurses); more frequent bathroom visits for patients at high risk ; and family and patient education. And guess what? Our fall rate decreased to a fraction of the national average.

Protect Your Nurses

There is a lot of power and money in healthcare. When these two things get mixed in with human nature, the politics can be rude and nasty. In hospitals, nurses are often on the frontline of this dysfunction. I am a collaborative leader, but I have had to stand up to doctors who thought they could bully - and even sexually harass - nurses. This included forcing three physicians to resign from the medical staff or have their privileges involuntarily revoked. I have added armed guards in hospitals to protect third shift nurses from intruders and mentally ill, combative patients. I have had to argue against corporate drones that wanted to reduce nursing staffing ratios per patient to levels lower than safe national averages. And while patient feedback is usually valid, there are times I've had to listen politely while an unreasonable family or patient member made unfair accusations against nurses of the most outrageous nature, often in an attempt to get their hospital bill waived.

It wasn't always easy or popular for me to take these positions. The medical staff doesn't like it when an administrator takes a stand against their colleagues. Patients and family members write letters to editors and post their venom on social media. Even my own senior managers have pushed back when I insisted they set a good example. But that is the job of an inspirational leader: to live the Mission, Vision and Values of an organization all the time, not just when it is easy. And it is worth noting; an inspirational, servant leader still holds others accountable. The difference is staff has a say in the metrics, which fosters ownership.

Remember - What Happens in a Hospital is Not About You

I heard Al Stubblefield, the founder of the most successful servant leadership hospital system in the world, Baptist HealthCare System in Pensacola, FL, talk about his transformation from a command and control leader to an inspirational leader. "We used to come to work early and spend all day and eat two meals in the executive suites and then go home. And we thought that was good day." There is a real temptation to think the endless meetings that administrators sit in are the business of the hospital. I once had a CFO joke to me: "John, I feel like we're an advertising agency that does healthcare", so I was not immune to this mindset. And certainly what a good leader contributes to a hospital is important. But that's exactly what it is - a contribution, not the end all. I have seen first hand that even when hospital administrators are embroiled in what ever political fight of the week may be, patients still get taken care of day in and day out by the nurses on the floor. They are quite capable of doing so with a total lack on nonclinical leadership.

And finally, remember this; there is a reason administrators (business executive) ranked far down the list at 22 percent approval compared to nurses number one ranking at 82 percent: hospitals are a nurses' domain, not the CEO's. The fact is that we are all going to be a patient some day. Nurses will be the ones who comfort our fear, ease our pain and make us want to go on, not the CEO. But a hospital CEO can help care for patients by making hospitals a good place for nurses to work.


This should be compulsory reading for all management. The principles have applicability to any field or industry. Thank you for such no nonsense advice that validates the work of frontline employees.

Specializes in Neuro ICU and Med Surg.

I wish more administrators thought this way. We had a CEO that retired, replaced with someone new and she just isn't the same. We knew Mr.S would come and talk to everyone. I have never met her. All employee forums are day shift time only. I wish someone would tell her that we midnight shifters would like an opportunity to voice our opinions. We would also appreciate it if she did walking rounds as well.

I am looking for a Private Duty nurse in Florida. Do you know where I can start?

Specializes in Administrator inspired by nurses.

nrsang97 - Has anyone on the other shifts sent her a polite message making this request? If she's new, it would be a favor to inform her.

I also wish for the management to ask nurses their opinion before making decision about our work and our environment we work in. I can see mistakes being made that are not correctable during our unit reconstruction/renovation just because they never asked us. We could of help a lot.

Specializes in med surg.

this article is so true. I wish there were more CEO's who felt this way

Specializes in Neuro ICU and Med Surg.
nrsang97 - Has anyone on the other shifts sent her a polite message making this request? If she's new, it would be a favor to inform her.

Honestly I have no idea. I wonder if anyone did.

Thank you for a great article. My recent experiences as a family member and friend of patients in two hospitals run by the same organization tell me, as a retired nurse, that your message has a long way to go to get to all CEOs.

How can the environment be changed so that compensation for CEOs, CFOs, and others with similar titles is more in line with the workers. Yes, nurses are the backbone of any hospital. They need excellent service workers: Environmental, Nutrition, etc. With current executive salaries so far from the pay of nurses and ancillary workers there will continue to be the "us and them" attitude rather than a team working together.

I really feel like we need to clean house of all those CEOs whose compensation is greater than 5 times the beginning RN pay. I am willing to think of other criteria for compensation. I do not believe any bonuses should go to CEOs until every employee gets the same percent bonus. A job well done deserves a bonus, if possible. The job is a team effort therefore the rewards need to be shared.

Specializes in Public Health, L&D, NICU.

I know that no hospital is perfect, but I bet the morale at your facility was pretty high. Some things I've seen as a nurse these last 16 years:

1. A nurse was assaulted by a surgeon in the OR during a case. The nurse was fired (after being shuffled to a couple of different departments) and the surgeon is still there today.

2. Within a week of being told by administrators that we were under a hiring freeze, no vacancies would be filled, and there would be no cost of living raises, our local magazine did a lavish spread on the CEO's multi-million dollar beach house. What a way to let us know how much we mattered.

3. Unit secretaries were done away with. Nurses in my L&D were expected to do phone triage for L&D patients (which requires at least some minimum documentation). When calls weren't being answered because we were caring for patients, administration purchased mobile phones for us and we were told that calls must be answered. I literally answered phone calls with one hand while my other hand was inside another human being. Humiliating and unprofessional, but it saved a few bucks.

4. Housekeeping was ended on night shift, and L&D nurses were told that they could mop the rooms and clean the beds while doing the patient's recovery. q 15 minute vital signs interspersed with mopping--wow, that looks professional.

5. During orientation at a new hospital, we were flatly told by the CNO that we were not to ever give our opinions or suggestions to the doctors because they were smarter than us and didn't want to hear it.

I worked 5 years at my last hospital, and never exchanged a single word with our hospital administrator, nor did I ever see him on our unit. I miss doing direct patient care, but I got sick and tired of having so much responsibility with so little authority, autonomy, and recognition. I pray every day that I can continue working at my current job at a smallish non-profit, and that I never ever have to work in a hospital again. I read on the internet just last night that the prestigious Vanderbilt Hospital is having nurses fulfill housekeeping duties to reduce costs. I'm sure that their nursing responsibilities have not been reduced to accommodate the new responsibilities. A hospital would come to a screeching halt if no nurses showed up for the day, but rarely do administrators recognize their value or potential. Instead they are seen as a cost, a liability, a necessary evil, or a headache. I'm glad to know that you are out there, but I fear that you are thoroughly unique.

Interesting read.

I do not understand the disconnect, and the "Us vs. Them" mindset that seems to creep in and destroy a good thing. I will say it can be bi-directional, and each "side" can be equally guilty in fanning the flames of mutual discontent.

I've been a nurse for almost 22 years, and I've seen a lot.

The saddest experience to me, was when my beloved hospital decided to expand by essentially building an entirely new facility. To the best of my knowledge, not one nurse (unless one counts the CNO) was invited to participate in the planning and design. It seemed clear we were not welcome in this new, inner sanctum of the council.

It sent a loud and clear message: "Your experience and opinions are not welcome." Beyond that, though, was a sense (right or wrongly attributed) that we as nurses were being "told" exactly where we stood in management's eyes--that of non-thinking automatons who are a necessary evil, and a nuisance to the real business of the business.

What we got was a decentralized, mess of a floor plan that seemed intentionally devised to divide and conquer the staff. It was a bleak experience.

And maybe the most egregious? They campaigned the staff to donate from their paychecks to the cause of building the new facility. Many staff did, because at that point we were all still "family." So we thought. Then, when the piggy bank went bust after building the facility, many of those same people who donated were laid off, asked to take early retirement, and or their departments closed.

The CEO, however, blew into retirement with a golden parachute.

When I first went to work for that hospital, and would hear the rare nurse moan about things, I would tell them they didn't know how good they had it. It was one of the most positive environments I'd ever worked in in my entire career.

I cannot say the same now.

Specializes in Administrator inspired by nurses.

I sadly have see similar disruptive behavior tolerated by physicians. However, I can honestly say I, as a CEO, never ignored disruptive behavior by anyone, including doctors. I know of a nurse who won a six figure settlement from a doctor for similar behavior in the early 90's and I have seen other bring hostile workplace environment suits against hospitals for ignoring disruptive behavior. In my opinion, it is stepping over dollars to pick up dimes to have nurses perform work that can be done by lower skilled employees. I understand it happens every once in a while, but creating a staffing model to do so is short sighted. The situation you describe as begging for a major medical mistake.

Specializes in Administrator inspired by nurses.

sadly have see similar disruptive behavior tolerated by physicians. However, I can honestly say I, as a CEO, never ignored disruptive behavior by anyone, including doctors. I know of a nurse who won a six figure settlement from a doctor for similar behavior in the early 90's and I have seen other bring hostile workplace environment suits against hospitals for ignoring disruptive behavior. In my opinion, it is stepping over dollars to pick up dimes to have nurses perform work that can be done by lower skilled employees. I understand it happens every once in a while, but creating a staffing model to do so is short sighted. The situation you describe as begging for a major medical mistake.