Career advice

Stress puts off nurse directors from going for the top job

A recent report shows nurse directors are reluctant to take on chief executive roles because of the high personal cost

A recent report shows nurse directors are reluctant to take on chief executive roles because of the high personal cost

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The chief executive role might be seen as the pinnacle of achievement for any executive working in a trust, but there is growing evidence that suggests many are reluctant to step up to the role.

It is estimated that one seventh of chief executive roles are vacant or filled by interims, and the average tenure of a chief executive is under three years.

A King’s Fund and NHS Providers report – The Chief Executive’s Tale – includes interviews with 12 departed or retiring chief executives. While they found it a satisfying and enjoyable job where they could make a difference to people’s lives, it was also extremely stressful.

Stressors ranged from dealing with ‘mob-handed’ regulators, the continual pressure of being judged on targets, and lack of support.

King’s Fund chief executive Chris Ham says: ‘The high personal cost to these individuals is hard to exaggerate.’

But, as more than one of the interviewees in the report pointed out, putting clinicians at the top of a healthcare organisation is appealing, so why aren’t talented nursing directors lining up to apply for the top job?

One of the chief executives interviewed – former nurse Steve Shrubb – said: ‘We are often portrayed as greedy fat cats.’

Focus of criticism

Experienced nurse director Caroline Shuldham says chief executive roles are ‘demanding and challenging – and very exposed’. She adds: ‘People are vulnerable and they can become the focus of criticism.’

Dr Shuldham suggests there can be a perception among nurses and others that the director of nursing role is not a stepping stone to the top job.

‘While there are some high-profile nurses in chief executive roles, there is a tendency for other roles, such as chief operating officer or financial director, to be seen as the natural route into chief executive jobs,’ she says. Nursing directors, though, often have a wide portfolio that brings contact with much of the organisation.

Many of the report’s interviewees said the abolition of strategic health authorities had meant people were offered fewer opportunities to gain different experience.

‘It is not just sending people on a leadership course, it is about the whole mentoring and development of careers,’ says Dr Shuldham.

This needs to start early, she suggests, helping nurses to set their sights high and achieve their goals.

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