Introduction: The Class You Missed at Nursing School

My background is not healthcare. In fact, the bulk of my professional career has resided in power plant operations and quality engineering in different industries, environments, and business segments. I learned a wealth in these spaces about how to influence change, whether it stemmed from data and analysis or from developing skills needed to guide people toward change. While in grad school, I dove deep into a set of criteria used to identify quality management systems across the United States (the Malcolm Baldrige National Quality Award Criteria). I found myself evaluating case studies in healthcare and learning how healthcare lags other industries in its use of improvement disciplines. From my experience outside of healthcare, I had become a practitioner of these disciplines, such as Lean and Six Sigma, which I’ll explain later in this book.

Seeing the need to instill these disciplines into healthcare and desiring to influence healthy change, I sought a career change. In healthcare, I could add real value. The trouble was I knew nothing of healthcare.

I pursued some positions in healthcare, but none seemed to be the right fit until a friend and mentor Greg Blanks brought me under his wing to fill in as the corporate management engineer for a large division of hospitals with a focus on Emergency Services. I was gracious and humbled by the opportunity. However, I quickly felt like a fish out of water. This was a new world to me. It was a different culture, attitude, and perception of change management. Further, like most industries, healthcare has its own distinct language. I remember "googling" all these new terms like "rad onc", “endo”, “peri-op”, triage, just to name a few.

To be perfectly humble and honest, if I had to give one group credit for teaching me about healthcare, it is undeniably nurses! To learn healthcare, I jumped into the hip pocket of nurses who, even in their busy schedule, cared enough to let me shadow them. I could talk all day about this group of remarkable men and women, of whom I have developed lifelong relationships with. These colleagues are intelligent, passionate, empathetic, hardworking...I could go on and on. I could spend days thanking nurses who have poured themselves into me, and I hope this book displays my level of gratitude for those investments. Nurses are truly unique, and I will always have a soft place in my heart for the empathy, discipline and tenacity that comes with that two-letter acronym at the end of their names…RN.

Which brings me to this book. Through the years, beginning with those studies in grad school, I have noticed that the nursing population is at a distinct disadvantage when it comes to the business side of their field. Because healthcare, for better or worse, is a business like any other. Nurses, meanwhile, have the misfortune of an education that does not teach them about the business in which they reside. Their development is rightfully centered on patient care. However, it is woefully lacking in management.

You see, a good bedside nurse may do a few tours in different departments or gravitate to a cohort of nursing he or she enjoys. Eventually, however, many will move to become a clinical manager or charge nurse and, later, a director role. After a great deal of hard work and sacrifice, they may complete grad school and move into a still higher leadership role, such as an AVP or small hospital CNO. And throughout the continuum of their journey from Nursing School to Executive, there is an unanswered need.

The nursing leaders I deal with typically have great ideas, drive, and work ethic, but they may lack the ability to connect the dots and make these ideas come to fruition, through no fault of their own. These nurse leaders are, by all practical definitions, CEOs who have never had the opportunity to learn the business of being a Chief Executive.

Nursing Directors are responsible for overseeing millions of dollars in charges and revenues and managing millions of dollars of inventory. They have upstream and downstream internal customers as well as patients and their families. Nursing Directors are responsible for customer satisfaction and for keeping their employees engaged in their roles and duties to retain them. They hold in their hands the scheduling and staffing of many employees. They have stakeholders and reporting structures up and down the organizational chart. We could go on and on about all the responsibilities of being a nursing leader. My argument is that with all these responsibilities, when did we teach them to be a CEO?

I am not writing this book to bring any attention to myself. I simply want to shine a light on these great folks taking care of our loved ones and on the lack of material available to them about not simply being a nursing leader - but also a business leader. My hope is that this work will bring value to nurses as a reference manual of sorts and to stir thought earlier in the nurse’s professional career. I want to introduce you nurses to concepts and strategies that will help you thrive as both clinical and business leader.

I take my hat off to you patient warriors and advocates whose voice is often not heard or understood by the C-Suite of executives. A disconnect does exist. Nurse Leader, thank you for your continued diligence in doing what feels like the right thing. I hope in the chapters to follow that you can find a nugget of strategy, planning or execution to employ in your department for the benefit of your division, hospital, and corporate office but most importantly…your patients!