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.


WOW.Finally after nearly half a century as a nurse a CEO who makes sense and well appreciated I am sure by all of those hard working nurses throughout the world,who in my opinion,deserve the reputation of being voted almost annually the most respected of all professions.Your comments should be published and a copy given to every hospital CEO and CNO in the country.Your comment about"one day being the patient" has rung true in my experience several years ago .When working in the largest and much heralded hospital in Dallas,the hospital administrator was one of my 15 patients I was caring for on an intensely busy cardiac floor.In all the hustle and bustle of a normal,understaffed night shift,the gentleman had a life threatening cardiac arrhythmia requiring immediate IV meds that saved his life.Later the other nurse remarked jokingly"that was a good time to ask for a pay raise".Please note that each of us had 15 cardiac patients each a regularly occurring event that that hospital deemed'okay' to the detriment of staff and patient health alike.Fortunately comments like yours will go a long way toward treating nurses health as well as patients.Thank you again for your encouraging words

Specializes in kids.

Great read Thx! While not in a hospital but many years in LTC, a recent administration has been so difficult.

Census based staffing, with no consideration for acuity.

Knee jerk reaction via email blasts to situations instead of discussing what ACTUALLY happened.

Always talking about money concerns but planting a multitude of annual plants outside THREE Times a yearwhen perennial planting would be prettier (IMHO).

I could go on and on

I am so grateful that I work for a company whose CEO and COO regularly meet with nurses, nurse managers, and techs. They really do listen and we feel it at the clinic level. Satellite Healthcare. "Not for Profit" Dialysis Company.