Finding More of Tomorrow’s Health System Executives on Today’s Frontline Teams

By CJ Floros, COO and Co-Founder, Laudio

It’s no secret that nurses make great leaders. Often battlefield promoted¹ from frontline clinicians to pseudo unit CEOs in short periods of time, nurse managers, and frontline leaders in general, are tasked with leading large teams early in their careers, frequently with minimal formal leadership training. Despite this lack of formal management training, frontline leaders by and large excel in these roles, managing fast paced and complex clinical and operational environments where they often have large spans of control. They are also regularly tasked with managing unit performance from both an operational and clinical perspective, with outcomes like patient throughput, readmittance rates, labor unit productivity, and budget surplus’ in their purview as frontline leaders. 

A recent report² co-published by the American Organization for Nurse Leaders (AONL) noted that the average nurse manager has a span of control greater than 40 employees, while the top 20% of nurse managers had spans of control of over 80 employees. Nursing units are churning out operational pros, who are well-versed in leading large teams, managing ever-changing and diverse outcomes, and achieving more with less. 

Yet there is a discrepancy when it comes to nursing backgrounds in the most senior leadership roles versus other backgrounds. A recent focus group interview³ of C-suite health system leaders in Florida with nursing backgrounds found that their experience is still a rarity, with most health system executives outside of the CNO and CNE roles coming from finance, business, and administrative backgrounds. Recruiters agree as well, acknowledging that most systems are seeking CEOs and COOs with business backgrounds when filling executive positions, rather than to clinicians who have spent years leading bedside care teams. Given the diversity in job types and roles in the health care workforce, executive leaders with different backgrounds are crucial to finding innovative and broadly applicable ways to move health systems forward. 

The case for expanding nurse leaders’ presence in the C-suite is compounded by the fact that nurses (and adjacent roles like LPNs, CNAs, etc.) make up most of the workforce in nearly every major health care system. Nurse leaders are often tasked with leading teams of 80+ reports as their first managerial assignment, which arms them with the experience of leading large teams while managing complex outcomes early on in their careers. This builds as they advance higher in the org structure, to eventually leading thousands of team members across multiple locations in a role as a Chief Nurse Executive. This operational experience represents the pinnacle of complexity and strategic leadership in health care, providing a well-rounded, essential perspective on innovation needed around both employee and patient experience, alongside rich experience driving impactful change on the frontline. 

Nurse leaders’ unique viewpoint as bedside clinicians is also critical to maintaining perspective in the C-suite when making broadly applicable decisions. A recent article⁴ from AONL quoted WellStar Health CEO Candice Saunders on the topic: “To me, there are only advantages to having a clinical background. The skills and experience I gained as a bedside nurse have helped me keep my priorities as I lead a large health system.” 

Similarly, UCLA Health President and CEO, Johnese Spisso, weighed in on the advantages her nursing background has lent her in her role as CEO: “It has allowed me to advocate for the things that our patients need. I think it helps me understand the importance of being creative and innovative in delivering the highest quality of care to our patients. Being a clinician allows you to quickly sort out details to make good decisions.” 

This clinical and patient-centric perspective is needed now more than ever among the C-suite, as competing financial and workforce challenges make allocating resources ever more challenging. Keeping the patient at the heart of decision-making is needed, and no one understands this better than nurses and bedside caregivers. 

The operations-focused mindset is a key asset for health system leadership teams today. Optimizing hospital operations is more important than ever, with razor thin margins, substantial workforce challenges, and tough union negotiations all key focus areas for most health systems. Elevating team members with operations know-how is a powerful lever that health systems can pull to manage these issues. Frontline leaders across all areas of health care typically possess this skill set, making it more crucial than ever to ensure frontline leaders – in nursing and outside of nursing – have an opportunity to advance to senior leadership roles to drive operational excellence for the system as a whole. Diverse operational experience, whether it’s EVS managers, patient transport supervisors, or food services directors, benefits leadership strategy, and operations-focused health system leaders bring a unique perspective that can drive positive change throughout the system.

Health systems are navigating some of the most significant operational challenges they’ve ever faced. Executive leaders across the country are contending with how to solve pressing issues across the quadruple aim of health care while remaining operationally sound. Bringing more operational leaders from the frontline to the top levels of leadership is an under-utilized solution to solving many of these challenges. Frontline leaders with complex operational experiences are well-positioned to take on broader responsibilities and can complement an executive cadre with other diverse backgrounds in finding creative and effective strategies to move their health systems forward.   

References 

Darling, T. The "incredible vanishing COVID managers.” Laudio.com. November 10, 2023. Accessed October 24, 2024. https://laudio.com/insights/the-incredible-vanishing-covid-managers

AONL and Laudio release new report measuring the impact of nurse managers on health system performance. AONL. Accessed October 24, 2024. https://www.aonl.org/press-releases/AONL-and-Laudio-New-Report

Brassfield M. From bedside to C-suite. Florida Trend. Accessed October 24, 2024. https://www.floridatrend.com/article/39716/from-bedside-to-c-suite

From the top: Voices of nurse CEOs. AONL. Accessed October 24, 2024. https://www.aonl.org/news/voice/top-voices-nurse-ceos