Changing times require new management skills
Business, leadership skills being stressed
During a recent consulting trip to a Vermont hospital, Sharon Finniganasked nursing managers and staff what their top concern was. Job security, they answered.Her reply was to the point: "If what you’re looking to do is save your job, you’ve already lost it," says Finnigan, RN, BSN, vice president of Affiliated Dynamics, a health care consulting company in Atlanta. "The job isn’t what it once was. It’s totally different."
ICU leaders agree: Not too long ago, clinical knowledge reigned supreme in the ICU. The bedside nurse who mastered clinical skills likely would move up the ranks to head nurse or a nursing manager, largely to impart those clinical skills to the staff.
But the advent of managed care and its demands for a more businesslike approach to health care is placing a premium on other aspects of managing ICUs: business acumen and leadership, experts tell Critical Care Management And it’s a transition that is troubling many ICU managers.
"There’s a certain point at which you have
to stop thinking like a nurse," says Gladys Campbell RN, MSN,
president of the American Association of Critical-Care Nurses and director
of critical and acute care patient services at the National Institutes
of Health Clinical Center in Bethesda, MD. "I say that cautiously. Nurses
have a particular way of approaching things, and I think you have to be
able to switch your head set and think like a business player, to talk
and respond in ways that you can be heard and understood and which gives
you credibility when talking with CEOs and CFOs."
That credibility can be enhanced with the right initials, like MBA, MSN, CCRN, and FAAN. But there is no true blueprint for success; each manager must design his or her own course.
Some ICU nurses can read a book on budgeting and have it down pat, Finnigan says. Others can simply review a couple of previous budgets and know what to do. But others will benefit more from a formal curriculum, she adds.
"Each person has to figure out what works best for them and what they need," she says.
Advanced degrees and credentials can be important, but the real emphasis should be on rounding out your skills, says Leslie Albrecht MS, RN, CCRN, program manager for critical care at Elmhurst (IN) Memorial Hospital.
"In recent years the wave has been to get an MBA, but that’s not necessarily right," she says. "The goal should be to pursue the education that will make you the most well-rounded, and that’s not always an MBA."
Albrecht has a master’s degree in science with a concentration in nursing,
but she says what may have benefitted her the most were non-
nursing classes she took on health system issues that expanded her
insights. And while she has the CCRN certification, she also went through
a managed care certification program at a local college that provided her
with useful areas of study, such as accounting. "And I did find out why
accountants are accountants and I’m not," she adds with a laugh.
The MBA, she says, is primarily useful for managers who want to move into the executive ranks.
"If that’s your goal, a nurse with an MBA would probably win out over the nurse with the clinical concentration," Albrecht says. "The MBA still carries a lot of weight with the vice president for finance and that type of person."
In selecting areas to round out your education, Albrecht suggests you research legal issues that affect staff, such as the implications of the federal Family Leave Act, equal employment laws, and even workers’ compensation regulations. If you work in a unionized hospital environment, brush up on labor contract regulations, she says.
Wanted: strong leaders
While business skills and some legal knowledge are important, all of the authorities contacted by Critical Care Managementemphasize another element: leadership abilities."Leadership skills are at least as important as business skills," says Finnigan. "When I think of the ICU manager, I think of someone who already puts a great emphasis on the technical aspects of her work. And business classes can get technical. The danger is placing too much emphasis on the technical aspects of the [manager’s] role to the exclusion of leadership."
Managers can acquire the fundamentals of leadership by reading professional literature and by taking executive training courses, she says, but perhaps the best way is to find your own model of an excellent leader.
"Once you have a vision of what a strong leader looks like, you can develop that vision in a very concrete way," Finnigan says. "This is more important that knowing about capitation and budgeting. You need to position yourself in an organization that has people who are clearly leaders. Those organizations are rare, but they are there."
After you’ve achieved that vision, pass it on to your staff, she adds.
"The customer of the manager is the staff," Finnigan says. "However the manager relates to the staff, that’s how the staff will relate to patients and family members. Real leaders model human empathy to their customers. What matters to them is the warm touch, the appropriate eye contact, gentleness, and being comforted."
Before all managers start abandoning their clinical backgrounds for purely management functions, Albrecht urges caution. Aggressive cost cutting and shortened lengths of stay eventually will result in most health systems’ prices being about the same, she notes. The focus then will turn to quality, and the hospitals that provide the best care — meaning the ones that have the most skilled clinicians — will be the ones that thrive, she says.
In California, she adds, studies have shown that while lengths of stay have been cut dramatically, readmissions are rising.
"It doesn’t do any good to get the patient out of the hospital quickly and to have great looking lengths of stay if the patient is coming back in a month or so," she says. "You haven’t really done anything." n
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