From the bedside to the boardroom: 6 tips from CNOs on the journey to leadership

This story was originally published in August 2013.

Most chief nursing officers begin their careers at the bedside and carry those skills with them to the boardrooms of major health care institutions. Sitting at the table with their peers in business, finance and technology, CNOs serve as the voice of nursing and advocates for clinical systems that deliver care to patients.

“You represent the clinical arena in the boardroom. It’s your job to articulate that experience to other leaders who don’t have that background,” said Susan Breslin, chief nursing officer and vice president of patient care services at DeKalb Medical.

Most nurses don’t go into the field to become chief nursing officers.

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“I’m not even sure I knew what a CNO was when I began nursing school. When I learned about it, it seemed unattainable. After all, there is only one in each hospital,” Tawanda Austin, CNO and vice president of patient services at Southern Regional Medical Center, told The AJC in 2013. “Yet, here I am barely two months into my first CNO position and I’m ecstatic.”

After years of working in critical care and directing emergency department operations for Emory Healthcare, Marilyn Margolis reluctantly took the job as interim CNO at Emory Johns Creek Hospital, where she fell in love with the “down-home feel and phenomenal medical care at this community hospital.” She’s now interim CEO.

None of these nurses became a C-level executive overnight. Promotions came after years of experience and learning, but it started by saying “yes” to positions of greater responsibility.

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With more nurses than ever needed for leadership roles, they offer this advice to new charge nurses, supervisors and managers.

1. Never forget your roots.

Chief titles and boardroom decisions aside, these leaders still identify themselves as nurses.

“A nurse defines who I am,” said Breslin, DNP, RN, NE-BC. “My experience caring for patients and their families made me a better manager and better equipped to make difficult decisions.”

“If you lose the ability to understand the needs of the bedside nurse, you’ve got a problem,” said Austin, MSN, RN, NE-BC.

Breslin still relies on her empathy, assessment skills and nursing knowledge, but when she moved into administration her focus shifted.

“I went from caring for patients to enabling nurses to deliver care in a quality way. I felt like I could make a greater impact in that way,” she said.

Critical-thinking skills, problem-solving and the confidence to act autonomously are nursing skills needed for management. If you want to lead, first learn your craft, said Margolis, MN, RN, NEA-BC. “In managing, you’ll need also to develop a vision for the future. You’ll have to become a systems thinker.

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2. Move outside your comfort zone and seize opportunities.

After six years of nursing, Austin said “yes” when her supervisor told her she was leaving and suggested that the nurse apply for her role.

“I was completing my master’s degree, but there were nurses on our unit with many more years of experience,” Austin said. “For her to see something in me surprised me, but I did eventually interview for surgical service leader and I asked all the nurses I looked up to for their support.”

After years of working in critical care, Margolis was approached to apply for the position of director of the emergency department at Emory University Hospital.

“I didn’t know anything about emergency departments, but I decided to learn, and with the help of a great medical director, we were able to develop initiatives that improved care and patient satisfaction,” she said.

In 2007, Margolis’ peers and direct reports nominated her for the national Visionary Leadership Award given by Nursing Management magazine, and she received the honor. When nurses express an interest in moving up the ladder, Breslin advises them to serve on projects and committees.

“You’ll show people what you can do, and you’ll learn a lot of skills serving on committees,” she said.

3. Never stop learning.

A master’s degree in nursing administration helped hone Breslin’s budgeting, analyzation, presentation and human resource skills, but she also took advantage of leadership and development programs offered by her employers. She completed a weekend nurse executive certificate program at Villanova University. A leadership program through Ascension Health in St. Louis showed Breslin new ways to respect and value co-workers.

“You need to have a good moral compass, to do what’s right and expect that from others to lead well,” she said.

Breslin just earned a DNP degree from the University of South Alabama. “I’m finished with school, finally, but you’re never finished with your education.”

After earning a master’s degree in nursing administration, Margolis completed a certificate in executive management for health care delivery from Harvard Business School.

“In 2005 I was fortunate to be chosen for the Woodruff Leadership Academy and to have John Fox (CEO of Emory Healthcare) as my mentor,” she said. “To be constantly learning is the key to success in any job.”

Austin earned a nurse practitioner’s degree with a goal of becoming the best hospital nurse that she could. As an administrator, she never passes up leadership conferences or Webinars, but she has gotten some of her best lessons from watching other leaders in the trenches.

“I watched how they developed people and built teams and used it to create my own style. If you want to lead, find a mentor, watch and ask questions,” Austin said.

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4. Expect challenges and change.

“Health care is in flux and it’s challenging to set priorities in a long laundry list of things that need to be accomplished,” Austin said. “You have to be strategic because you can’t do it all.”

Regulatory oversight and financial challenges make health care a tough field to navigate, Breslin said. “Managing to keep the oversight and financial issues in line with delivering high-quality, safe care is a balancing act that goes on all the time.”

Changes in reimbursement and insurance coverage have every hospital “tightening its belt and using all resources to the nth degree,” Margolis said.

A nursing shortage and implementing improved but more complex care models pose additional challenges.

“Change is a constant in health care management, and you have to learn to adapt to it quickly,” Margolis said.

5. Stay visible and accessible.

Soft skills and emotional intelligence are essential for nursing leaders. Listening, communicating clearly, respecting different viewpoints, soliciting feedback and building trust all can make a difference in what CNOs can accomplish.

To observe bedside care first hand, these three chief nurses visit floors regularly and go on rounds with nurses and patients. Margolis holds unit forums to educate staff and answer questions.

It takes “a collaborative spirit” to improve processes, Austin said. “People won’t follow you if you can’t listen and respect them. You have to know what’s going on and you aren’t going to learn that shut up in your office. I believe in honoring people where they are and partnering with others to get things done.”

6. Be open to feedback.

“You need to hear feedback and learn how to use it constructively,” Margolis said. “My biggest growth spurts as a leader have come when things haven’t gone well. You go back and look at every point along the way. You ask yourself what you might have done differently that would have changed the outcome.”