Q Our hospital president has only one thing on his mind: the bottom line. As a CNO, how do I make him realize that this mentality will destroy the organization rather than grow it?
Ah, the debate between “no mission, no margin” versus “no margin, no mission” continues! The CEO, and all of us, must have a financially viable organization that sustains itself. As nurse leaders, we must constantly balance between frugality and patient safety, knowing not to cross the line when safety is truly compromised. It takes creative thinking, transformational leadership, and solid grounding to develop models of care and practice environments that achieve both the financial and clinical goals of the organization.
I'm a firm believer that investing in the bedside workforce is essential. This can be done with an eye toward the bottom line. Funding can be found through grants, revenue-producing programs, collaborations, and using available budget monies wisely. Many times there are improvements that can be achieved through available resources without spending any more money.
In the age of value-based purchasing, quality and service affect revenue. This is a sea change in reimbursement models for hospitals. In fiscal year 2013, up to 1% of Medicare reimbursement is at risk, which is the extent of the margin in many hospitals. Therefore, the bottom line is clearly connected to your work as CNO. The organization must have a balanced dashboard of financial and other metrics to remain strong. Public availability of your hospital's standing within numerous indicators is easily obtainable, which can't be ignored.
Share your accomplishments and ideas on improving these metrics with your hospital president, as well as evidence-based management strategies that are aligned with organizational goals and contribute to the bottom line. Work together with other stakeholders among your quality, medical, finance, and human resource colleagues who also play an important role in organizational approach and culture. Remember, you can't do this alone!
Q Should a nurse leader move on after a couple of years or is it okay to stay in the same position for many years?
There's no right answer to this question—it all depends on you, your job enjoyment, and your career goals. Sometimes it also depends on timing and availability of interesting opportunities. If you love your job, your boss, and your staff, there's no compelling reason to leave unless you have aspirations to do something completely different. An exception may be if your organization is transitioning and job security is an issue. Often, nurse leaders “move on” to “move up” when there are no promotional opportunities, but reading between the lines of your question, I don't believe that's your situation.
Sometimes working in the same job in the same organization for a long time can narrow your view in terms of creativity, approaches, and strategy. This can be mitigated by active professional involvement outside of the organization either by attending conferences, such as Nursing Management Congress, or by joining associations, such as your regional nurse leader group. In addition, and perhaps more important, you should also get involved in department- and hospital-wide projects, so that even though you're in the same position, you're expanding the scope and breadth of your skills.
If I were interviewing a candidate who was in the same position for many years, I would look to see what that person has accomplished: energy exuded, motivations, challenges handled, and passion for nursing leadership. All of these qualities can be positively demonstrated by candidates who've been in the same position for a long time or by those who've moved around in their careers.
David Williams writes in “10 Reasons to Stay at a Job for 10 or More Years” that there's good reason to be part of the long-term success of an organization, stating “perhaps it's time to turn your career into a devoted and prosperous marriage, instead of a series of dates.”1 There's nothing wrong with being “married” to your position as long as you're happy and productive.