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.


Specializes in Administrator inspired by nurses.
Specializes in Administrator inspired by nurses.

Thank you. You can reach me at [email protected]

Sadly, this is not the typical mindset of most CEOs, or any C-level hospital administrators INCLUDING Chief Nurse Executives. The "not-for-profit" hospital I work for has a CEO that approves massive cuts over his nursing staff's benefits, salary, and PTO, all the while requesting that the board provide him additional compensation to his over 4.5 million dollar per year salary. He LOVES saying "health care is business." I hope I get the chance to take care of him when he's on his deathbed someday. I'd love for him to experience the low level of caring that his "business" decisions foster.

Specializes in criticalcare, nursing administration.

guttercat, so sorry to hear of your experience. Staff input is a critical patient AND nurse safety aspect when building and occupying a new facility.I was responsible for the building , education and staffing of 4 units in a new Critical Care Tower. Each Unit developed a team ( nurses, CNA, unit clerks, MDs etc) to explore their workflows, equipment needs, and staffing pattern. They and i met together frequently during the build, and updated/ obtained input from other staff as needed. Thanks to our collaboration the opening went well. Our efforts were commendedby the ANCC as a best practice in opening new facility. most importantly, safety for all was enhanced.

Specializes in med-surg, post-partum, ER, psychiatric.

I am temporariily on a sabbatical from nursing. I am a forensic psychiatric RN and worked at a state hospital. The reason I am on sabbatical. The stress of the job. Why the stress of the job? Yes, patients are part of it, but MOSTLY due to administration/nursing management. We staff/charge RNs who are the core RNs of our units are expected to run the units smoothly and keep the units (staff and patients) safe, ensure that the hospital policy and procedures are abided by and enforced, report violations, etc. OK, that makes sense; however, the major issue we RNs have is that the psychiatric technicians know that we RNs do not have any "power" and all we can do is report issues; however, when you have unit nursing management, when things are reported, do NOTHING (of which is most of the time), we RNs have no backing, support, etc., and the staff know it. Prior to me being reassigned from one unit to another (and the reason was to help "fix" issues of this particular unit due to my background in leadership, etc.), a couple of months prior, 3 RNs were adminsitratively removed from that unit due to the psych techs, and essentially no support (as it was found out) from the unit nursing director). I did as was asked and reported issues (via emails, etc.) about what was going on with the staff. Bottom line: No support from the UND at all. Staff retaliated (like they did with the other 3 RNs). As I told our hospital risk management, who was also aware of "issues" on this particular unit, that what should have been done the first time was the staff should have been removed, since they are the initial problem(s), and then the unit nursing director who does not support the unit nurses at all. the other 3 RNs (two night shift and one other day shift RN) do nothing to ensure that staff follow policies and procedures in that they are too afraid to do so, etc. The unit nursing director has admitted that has handled things poorly, but yet nothing changed (and from friends I still remain in contact with, said things remain the same, etc., and staff continue with their antics and the nurses do not get the support needed). It starts at the top with the hospital superintendent and the hospital nursing director who do nothing to resolve issues overall. There is so much empty talk about supporting us, but when it comes down to it, it doesn't happen at all. More RNs would leave if they were not so invested in their retirement at the hospital and lose it, but they are sick and tired of nursing adminsitration and lack of support, yet more and more demands placed on our shoulders as a result. i have several years of leadership/management experience (non-nursing) as a result of the military, etc., and what I have seen in nursing leadership (lack thereof) amazes me. I refuse to compromise my ethics, standards, ethics, honour, etc., just to keep my job/position, etc.. So for now, I am on a sabbatical, focusing on my additional/continued education (non-nursing related) for what I want to do in the future, etc. (that could possibly include nursing). I am fed up with the status quo! I am also fed up (especially at this hospital) how some people management to get into key leadership positions. Head scratching time! OK, end of rant!

Specializes in criticalcare, nursing administration.

This discussion is turing into a sad situation. There is heartache on both sides. My job in administration often placed me between a rock and a hard spot , and trying to please both. The ultimate loser was me. That said, look for SOLUTIONS not problems...START by ASKING HOW and WHYexample: I was a manager on a CCU where staffing was determined by an acuity system. The system seriously. undercaptured the workload of cardiac nurses, and my unit staffing was always recommended low. My staff and I became EXPERTS on the crietria for the staffing tool. We then documented 95% of recommended vs. needed staffing AND the classification errors that caused the difference. Turned out the staffing tool was in error, and my nurses got fully supported staffing back. ASKING WHYA surgical ICU I covered as a nursing director consistenly lst hugh $$, after making money for years. I asked why.... When are charges posted, what is covered in a charge, when did the loss begin. Tured out to be that the interface between the electronic chart and the hospital charge siystem had never been tested. when computer charging went live, once an ICU patient got transfered to other floors. he charge was wiped from the bill .... No one asked why for OVER 2 years. Finally SHAREAs nurses we are only as strong as our communication. If you know of a solution to a problem SHARE it, and follow it up. The whole best practices movement is BASED on sharing and utilizing the successes of others. We can initiate solutions to our problems

Specializes in criticalcare, nursing administration.

EXCUSE my typos above... formatting here is difficult

Specializes in Administrator inspired by nurses.

Wow - two years to discover charges were being lost in transfer. Too bad administration did not listen to you sooner. As I noted, if a problem needs to be fixed, ask the nurses. Greats story THX for posting.

Specializes in Oncology.

I say BRAVO and agree with other nurses on here as well that we definitely need more CEOs with your heart and mind set! We used to have a wonderful CEO until he retired and was replaced by a more "modern" thinking one who's only concern seems the bottom line with NO REGARD WHATSOEVER about the nurse's opinions. We are NEVER included in any decisions the administration ever makes any more (which we are mostly the ones that usually carry out said decisions or new policies!). It has made me so glad that I will only work for approximately 6 more years (at age 60)and then after that I want to just forget I was ever even a nurse. I think the Gulf of Mexico could use me more!

Specializes in Oncology.

Wow MonkeyBug, your commentary "hits the nail on the head" EXACTLY!

Specializes in med-surg, post-partum, ER, psychiatric.

That is awesome it worked out for you. Been there, done that; however, the attitude of this particular nursing administration is that they don't want solutions or new ideas. They are perfectly content with the status quo et al. It is a complicated situation that is also layered with nepotism and favourtism et al. I am one who likes to present solutions not create further problems; however, unfortuntaley, it doesn't work well with this hospital. What needs to be done is an entire change (from the top on down) overall.

Specializes in Emergency Department, Rehabilitation.

Too bad 99.9% of hospital CEOs will never follow this advice. They're more concerned about the bottom line and getting their million-dollar bonuses (as opposed to the nurses measly 2%) than they are about quality patient care.