HEALTH CARE
At local hospitals, nurses' time has come
November 15, 2009
Leslie Scrivener
FEATURE WRITER
The only thing that surprises Doris Grinspun about the number of Toronto hospital CEOs who started their careers as nurses is that they weren't running them 30 years ago.
"It used to be an old boys' club," says Grinspun, executive director of the Registered Nurses' Association of Ontario.
Typically, hospital executives have been health administrators, often men, trained in business and management. Before that, doctors ran hospitals, and decades earlier, nuns.
Now the nurses' time has come.
Major Toronto hospitals including Women's College, the Hospital for Sick Children, St. Joseph's Health Centre and North York General are run by women whose first jobs were bedside nurses.
Trillium, York Central and Markham Stouffville are also led by nurses who became CEOs. Earlier this year, Kingston General Hospital announced that Leslee Thompson, a Queen's University-trained nurse, was named president and CEO.
"This should make a huge difference for the public," says Grinspun. More so in the time of hospital cutbacks, she adds. "They have a very good idea what will affect patient care."
Nurses have the benefit of knowing the micro view – looking after individual patients – and the macro view of how a hospital works, she says. How did these women do it? Most wanted to see their work have a wider impact on the hospital; all took advanced degrees. Some thought they could be better managers than their bosses.
Some, like the Hospital for Sick Children's Mary Jo Haddad, worked their way up within one organization while Trillium's Janet Davidson worked in hospitals in Vancouver, Edmonton and also in high levels of government. Some are deeply grateful to mentors who guided them through bumpy episodes of their careers. Some have maintained their nurse's registration; others have let it lapse.
Carolyn Baker, president and CEO of St. Joseph's Health Centre, said she has heard women say in a disparaging tone, "`I'm just a nurse.' That distresses me," she says.
"It creates a framework that nurses aren't as important or critical to the overall health-care system as other professions. I think some of it is a female issue."
It's also not surprising that nurses have advanced to top leadership roles since they make up the largest employee group in hospitals, up to 40 per cent. At the same time, more nurses are pursuing graduate degrees, many in hospital administration.
"As more and more nurses take an interest in management and take advantage of educational programs, we'll see more and more CEOs who were nurses," says Tom Closson, president and CEO of the Ontario Hospital Association.
He also notes that the trend toward CEOs with clinical experience in hospitals also includes doctors returning to top administrative positions.
Closson, trained as a systems engineer, was the prototype of the hospital executive who advanced through the finance stream in health care. He was CEO of both Sunnybrook Health Sciences Centre and University Health Network. He didn't find a lack of clinical experience a disadvantage, he says.
Grinspun sees the shift toward nurses and others with clinical backgrounds advancing to senior levels as part of a power shift. But still, she points out, there are 155 hospital corporations in Ontario – and those led by nurses are few in proportion. "It's progress, but still shy of what it should be."
There are other frontiers to be crossed in health-care management, including promoting nurses of differing ethnic backgrounds, she says.
"These are status differentials."
MARY JO HADDAD
"I have lots of capacity," says Mary Jo Haddad,
president and CEO of the Hospital for Sick Children. "I want to make a
difference, I always have."
After earning a diploma in nursing,
she worked in the neonatal intensive care unit of the Children's
Hospital of Michigan for eight years. Still in her 20s and while
working on her Bachelor of Nursing, she opened a private pediatric
practice in Windsor.
"I felt I was making a difference every day," she says.
And
she kept learning, advancing in experience and academic credentials.
She joined Sick Kids in 1984 in an entry-level management job –
assistant manager in neonatal intensive care – and aside from one year
at Halton Health Care Services, has spent her career there. In 1998 she
earned a graduate degree in health administration from U. of T.
Nurses who have been encouraged to step into leadership roles need lots of support, she says. Honest mentors are invaluable.
"Women
I've worked with tell me, 'I really want to do this with my career.' I
ask them, 'What do you think you have to offer?' You need to really
understand yourself. This self-reflection of why you want to make that
change is important to your own success and satisfaction."
CAROLYN BAKER
"Something I learned in school was to focus on people
in the context of their families and the communities they live in,"
says Carolyn Baker, president and CEO of St. Joseph's Health Centre.
She tells the story of a 33-year-old patient in her care who died after
a brief, terrible illness. "His wife left me a note, written on a piece
of paper ripped from his chart. She said `Thank you for your respect.
It made all the difference in the world.'" Baker kept the note in her
wallet for years. When her wallet was stolen, "Nothing was more
irreplaceable than that letter."
She loved patient care, she
says, but recognized that it was her bosses who could affect the lives
of more people. After three years of nursing she moved into management
– a step she describes as a failure. The job lasted 18 months and she
returned to patient care. Then she found mentors who helped her along
the way. "I wanted to be in a position where I could have a bigger
impact."
Dorothy Wylie, who held senior positions at several
Toronto hospitals and taught at the University of Toronto, was a
treasured mentor. "She was a powerful leader and deeply committed to
supporting nurses and instrumental in helping get me scholarships and
to graduate."
JANET DAVIDSON
"I saw some issues and realized it was not enough to complain about
them. I had to put my money where my mouth was," says Janet Davidson,
president and CEO of Trillium Health Centre in Mississauga. "I also had
career aspirations."
She graduated as a nurse from Toronto East
General and took her BSc in nursing at the University of Windsor. Less
interested in advancing within nursing, she went to graduate school,
earning a master's in health services and administration from the
University of Alberta.
She later worked as chief operating
officer for several Alberta health-care organizations, was a provincial
assistant deputy minister of health and returned to Toronto East
General as CEO. She is also an officer of the Order of Canada. "The
nurse, I've learned over the years, is better at handling complexity
and crises," she says.
"People who represent the largest
practising group in health care are now in positions of influence in
senior management in health care," she says. "That's good and that's a
power shift. There's more balancing now."
JO-ANN MARR
Jo-anne Marr, an advanced practice nurse specializing in patients
with spinal injuries, didn't plan to move into management. But she
liked working on projects with colleagues from other disciplines and
seeing the wider effect across the hospital.
The complexity of a
patient's care can overwhelm nurses, says Marr, acting president and
CEO of York Central Hospital. "You may feel you need more help and it's
not forthcoming, especially if it's the middle of a night. You learn
how to prioritize, what you can do and what is safe."
Recently,
she learned about a problem transporting patients in the hospital. "So,
I hooked myself up with a team for part of a shift and together we
moved patients. I like to do that. It gives me a real appreciation
about the challenges they face and I can understand what they are
talking about."
Marr, who has an MSc in nursing and an MBA from
the Rotman School of Management, is still a nurse. "That is my core
profession. I don't think I could imagine myself giving up that
registration."
BONNIE ADAMSON
Though Bonnie Adamson has been a CEO for 12 years, the last seven at
North York General Hospital, she has kept her nursing registration.
"It's a loyalty to the profession," she says.
"I started out as a bedside nurse. I loved nursing. I loved patient care and I loved hospitals."
She was intrigued by hospital organization.
"I
could see clearly the influence leaders can make in a hospital and the
relationship between leadership and outcomes in patient care."
Adamson, who had a BSc in nursing from the University of Toronto, went
back to school and earned an MSc in nursing specializing in
administration from the University of Western Ontario. "These degrees
are very important – but to me it's not the type of degree but the
critical thinking you learn in a graduate program."
She moved up the ranks as evening and night supervisor, vice-president of nursing and vice-president of patient services.
"My
clinical background has been very important, and I treasure that, but
you have to also know how to mobilize people and create partnerships
and have political acumen."
MARILYN EMERY
"I was a young upstart and thought I could do things better
than my manager," says Marilyn Emery, who early in her career worked
for Saint Elizabeth Visiting Nurses in Parkdale and also at St.
Michael's Hospital. "I became a manager at Toronto General Hospital at
a very young age, about 24 or 25, and quickly learned it wasn't as easy
as it seemed."
Nursing taught her problem solving, says Emery,
president and CEO of Women's College Hospital. One of her early
management jobs was staffing nurses in intensive care units. One night,
they were short 14 nurses. "I had to figure something out. I had to
know what was going on across the entire hospital – what nurse could be
moved to handle intensive care patients, how many were in the recovery
room."
She was named CEO of Markham Stouffville Hospital in 1989.
"There were lots of eyebrows raised ... as much for being a woman as
being a nurse." And in 1997, she became CEO of St. Joseph's Health
Centre.
"Those of us with a clinical background, you can't pull the wool over our eyes," she says.
Toronto Star