In April 2023, VCU Health in Richmond announced an inaugural chief nursing officer position. The 13-hospital McLaren Health Care system in Michigan did the same June 1, as did the WVU Health System in June 2022.
Closer to home, ECU Health announced in November 2022 that Trish Baise would assume the role as the system’s first chief nurse executive.
What these newly established positions seem to show is a recognition by major health care systems of the importance of having business-savvy nurses in leadership positions to help bridge the realities of hospital administration with the life and death demands at the bedside.
A new dual program offered by the East Carolina University College of Nursing, in partnership with the ECU College of Business, aims to empower nurses with the tools to advance up the ranks in executive leadership and health system administration. Graduates of the program will receive a Master of Science in Nursing and a Masters of Business Administration (MSN-MBA).
Bimbola Akintade, dean of the College of Nursing and an MBA graduate, understands the benefit of having nurses empowered to lead in health care administration.
“As we navigate unprecedented nursing shortages, nurse leaders with health care economics and health care finance acumen are important to advocate for the profession and to partner with health care administrators to properly assess the nursing needs of health systems, and to make fiscally responsible decisions regarding staffing and other financial investments,” Akintade said.
“Bringing their clinical backgrounds and leadership knowledge to the table, they will improve communication of financial decisions that impact nursing practice and direct patient care between administrators and bedside nurses. In addition, this knowledge will help graduates of the dual MSN-MBA program contribute meaningfully to the nursing workforce development solutions that will positively impact the health and well-being of residents of our region and beyond.”
The program
Students in the online program will graduate with a Masters of Nursing Science in health system leadership and a Masters of Business Administration, a potent combination of qualifications that will help graduates tackle long-term challenges in health care administration. Twelve semester hours will count toward both degree programs.
The first semester of the program will have students focus on business, the second semester will veer back into nursing coursework, and the remaining year and a half of students’ time will be blended.
Thompson Forbes, ECU assistant professor of nursing and one of the program’s directors, said the goal of having students complete the two degrees in tandem is to give them knowledge and skills they can use to bridge the cultural gap between frontline nurses and hospital administration, not making nurses into accountants.
Communication, Forbes said, may be one of the biggest problems facing health care systems — the legion of credentialed health care professionals in scrubs and lab coats don’t often speak the same language as the administrators and analysts in suit coats and dresses.
“We need to have leaders who can understand health system organizational theory, nursing theory and nursing evidence-based practice, and then pair that with an understanding of finance, accounting and marketing. They will be better prepared to translate decisions that are made in the clinical environment to business environment and vice versa, so the systems can be more efficient,” Forbes said.
Linda Quick, assistant dean of ECU’s Thomas D. Arthur Graduate School of Business, is new to the partnership’s leadership, but her experience in business administration gives her a good sense of the balance between health care and business the program’s students will need to be effective after graduation.
“As businesspeople, we don’t want to make clinical decisions,” Quick said. “But at the end of the day I only have so many dollars. So where do I want to spend that money, how can I best use my investment?”
Quick said the fallout from the COVID-19 pandemic shined a spotlight on the stresses health systems already faced in managing nursing resources. Hospitals were forced to invest heavily in travel nurses, who command significantly more money than staff nurses. This imbalance stresses the hospital’s wallet and can foster mistrust between nursing staff members and the administrators of the health systems who are trying to keep the doors open.
“You have to think about your customer, and in the hospital your patient is, in essence, your customer. The nurses are the ones who have that frontline time and know the customers best. Their perspective is going to be important for leadership,” Quick said.
The dual MSN-MBA program isn’t the first in the nation, but the pool of schools that offer a similar paring is small. Quick thinks that having this program as an option for potential students is a win for the region.
“This might plant the seed for someone who down the line is either going into hospital administration or looking at having their own practice,” Quick said.
Potential students
Brian Floyd, president and chief operating officer of ECU Health Medical Center, the system that services much of eastern North Carolina, believes that anyone can succeed in health care system leadership, but nurses have a particular propensity to be effective leaders. They know how hospitals work from the ground up and experience how the parts of a hospital come together as a whole. Also, the trust that nurses inherently build with patients and coworkers is rooted in practical awareness of how leaders come to their decisions.
“Nurses tend to be empathetic, and this also helps gain trust and confidence as a leader,” Floyd said. “Nurses typically do not present a power gradient with physicians and are more likely to act in a supportive and collaborative relationship.”
Forbes hopes to entice potential students with an opportunity to learn how to fill the dual role of nurse leader and business administrator. Forbes and his team conducted an informal poll with potential students and of about 40 who were asked, 37 said they would be very interested in the coursework. One student was already motivated enough to work out the logistics of applying to both colleges — nursing and business — to carve out his own course of study that the dual degree program will resolve for future applicants.
“It’s a heavy course load — two courses a semester, every semester including both summer sessions. But you can finish it up in 2 1/2 years,” Forbes said.
While demanding, Quick said the completely online nature of the MBA portion of the partnership should offer prospective students the flexibility needed to balance work and home life. Faculty from both colleges have a framework in place to help students manage coursework, but the flexibility in the individual programs should meet students’ individual needs.
“We offer our MBA courses in the summer and in eight-week blocks during the regular semester. Students really have a lot of options from the MBA coursework side to figure out what fits in best with their schedule,” Quick added.
Support for health care systems
Forbes said nursing will always be the largest line item on any health care system’s budget because nurses are the most patient-centric, and patient-intensive, members of the workforce in hospital and most healthcare settings.
“Instead of just striking numbers from a budget, there needs to be someone who can interpret and say, ‘We can handle this much efficiency gain on the business side, but that savings is going to result in a reduced level of quality of care at the bedside,’” Forbes said.
When conversations between the health care workforce and administration on how to balance patient care with keeping the lights on don’t happen, Forbes said distrust naturally festers. Advanced practice nurses with business administration education can foster “an environment of understanding amongst everybody.”
Floyd agrees with Forbes’ assessment that nurses who understand business can help build consensus and confidence in an administration’s business decisions.
Having familiarity with frontline operations is critical in determining what is important in helping shape the strategy of organizations. At the same time, influence to lead others to adopt the strategy is enhanced when the workforce appreciates that the leader has experience in direct patient care and is empathetic to their work, Floyd said.
Modern health delivery systems aren’t humanitarian organizations, but rather must compete as other complex business operations do, he said. As a registered nurse, Floyd understands the importance of having nursing staff who can speak the language of business.
“The skills obtained in MBA programs include data interpretation, financial and operational management, and leadership and organizational management, and the curriculum has been refined over years of volatility. The modern healthcare leader can benefit from decades of learning from business industries and apply those practices in the healthcare environment as it continues to evolve,” Floyd said.