Whether forced by economics or incited by ambition, nurse executives are increasingly taking on the responsibilities of chief operating officer at many hospitals around the United States, a new study found.
That's both good and bad for nurse executives, said Kathleen M. Ballein, an executive at the Oak Brook, Ill., offices of Witt/Kieffer Ford Hadelman Lloyd, a recruitment firm that sponsored the study with the American Organization of Nurse Executives.
On one hand, opportunities for nurse executives to lead and manage have grown. On the other hand, the chance of further advancement has dimmed.
"We're seeing the COO role almost become extinct," Ballein said. "In most areas where they're having to do any sort of downsizing, the COO seems to be an expendable job."
That means the nursing executive is managing more and more departments besides nursing. "It's easy for them to say, `Well, the nurse executive can be more of an operations person.'
"The unfortunate piece is, they're eliminating the COO job and dispersing those departments to other people," Ballein said. "For those who aspire to move beyond nursing vice president, that position doesn't exist in a lot of organizations anymore."
Ballein surveyed 286 nurse executives in December 1994. It was the third such study done by Witt/Kieffer. Previous surveys were conducted in 1986, 1988 and 1990.
The intent in starting the surveys was to figure out what nurse executives were actually called upon to do.
"Our clients were asking us to find a more sophisticated director of nursing," Ballein said. "No one had documented how that role had changed."
Typically, the senior nurse executive manages a budget of $48 million, out of a total hospital budget of $145 million. The average base salary is $91,800, vs. $77,670 in 1990 and $65,543 in 1988. Ninety-one percent are female. About 55% are eligible for incentive awards.
Two-thirds of the nurse executives carry the title vice president, while 11% are directors. Chief nursing officers are 8%.
About 35% of respondents expect to be in the same position five years from now, but 40% think they will have a different position in healthcare management. Of those who expect a new position, almost all hope to become chief executive officer or chief operating officer.
"It's terrific that the nurse executives are gaining the skills to move to this level," Ballein said. Chief executive officers see the value of a clinical person who can be developed into a chief operating officer.
The rub, according to Ballein, is that those jobs are disappearing for the very nurse executives who aspire to them.
The average age of nurse executives has risen steadily over the past six years, from 45 years in 1988 to 45.7 in 1990 to 47.8 in 1994. "I think that shows that the nurse executive's role is expanding," Ballein said.
These wider responsibilities have led nurses to pursue more education in business and management skills. More than 90% have attended management training programs.
"The good ones are staying in their jobs. Their tenure is longer," she said. "The average tenure in the job is 5.4 years. It was 4.7 in 1990."
Today, 60% of nurse executives report directly to the CEO. Four years ago, only 52% did.
One fact that emerged from the study is that although the profession is dominated by women, men are paid more: $100,000 on average, vs. $91,000 for women.
Men, Ballein said, have a tendency to gravitate toward university teaching hospitals, which are larger. Their salaries would be accordingly higher.
Findings of the nurse executive survey:
The average base salary nationwide is $91,800, up from $77,670 in 1990.
60% of nurse executives report to the CEO; 32% to the COO.
91% are female, down from 95% in 1990. All respondents are RNs.
96% are white; 2% are black.
40% expect to be in healthcare but in a new position
after five years; almost all expect to become CEO or COO.
Based on a sample of 286 nurse executives in December 1994 by Witt/Kieffer Ford Hadelman Lloyd.