The right stuff: nurses who become chief executives
Some of the NHS’s most successful chief executives have a nursing background. And no wonder – many of the attributes required are second nature to senior nurses.
Some of the NHS’s most successful chief executives have a nursing background. And no wonder – many of the attributes required are second nature to senior nurses
When Helen Greatorex took up her new job as chief executive of Kent and Medway NHS and Social Care Partnership Trust, one of her first acts was to concentrate on out-of-area placements for mental health patients.
At the time – early June – the trust had 76 patients in beds outside the area, costing £1 million a month. By late July, this had fallen to 43, with a target of no more than 15 by the autumn. The trust’s finances will feel the benefit – but so will patients and their families, who will no longer face long journeys.
It is that sort of patient focus Ms Greatorex believes nurses can bring to the chief executive role. Having been a mental health nurse, she realised that the many out-of-area placements showed the trust needed to sort out its own pathways.
‘It helps you to have a fuller perspective for people who are very unwell,’ she says. ‘What I bring to this job is the recognition that we can change things for the better.’
In mental health nursing, it is often the relationship with nurses and other members of the team that affects outcomes for the patient.
Many other senior nurses agree that nursing develops attributes appointment boards value in candidates for the chief executive’s role. This may explain their success in securing these roles in acute, community and mental health trusts.
Ashford and St Peter’s Hospitals NHS Foundation Trust chief executive Suzanne Rankin emphasises that nurses do not have a monopoly on being patient-focused. She points out that all her executive colleagues – regardless of background – have a similar approach. ‘I am very lucky to work with a range of directors, all of whom put the patient first,’ she says.
Where she feels her nursing experience may help is in how she operates: delivering high quality care is what nurses are trained to do, she says. And the impact of the Mid Staffordshire scandal has been to put quality centre stage for NHS organisations.
The nursing emphasis on collaboration, listening, interpreting and involving is something she uses as a chief executive. She sees her role as enabling other staff to deliver high quality care – which has a lot to do with the culture and environment they work in.
‘The core skills of nursing are absolutely the skills I employ when enabling the team,’ she says.
The process of planning and evaluating care also translates to the bigger picture of an entire organisation providing care. A clinical background can also help when dealing with colleagues, especially when having difficult conversations.
Making the jump
So what helps nurses working at executive level to make the jump to the top job?
Ms Greatorex won a leadership scholarship from the Florence Nightingale Foundation, which she says was transformational. The support offered through these is bespoke, but includes core elements, such as a week-long residential course and mentoring.
Her mentor was Katherine Fenton, former chief nurse at University College London Hospitals NHS Foundation Trust, who she says was constructive and challenging. She also has experience of working in the third sector, and has an MBA which looked outside the NHS.
Other opportunities for nurses looking for chief executive roles include the Leadership Academy’s aspiring chief executive programme. Over two cohorts of the programme, seven participants at executive director level have come from a nursing background.
Lack of financial knowledge is sometimes seen as a barrier for nurses wanting to advance to the top job. But anyone operating as an executive director of nursing is likely to be exposed to trust finances. This is because they will be responsible for much of the workforce, and will be part of the corporate board making financial decisions.
Ms Greatorex says the assumption that nurses will struggle with the financial side of running an NHS trust is patronising. ‘It’s typical people think that nurses can’t do maths!’
Ms Rankin says she was conscious that the intricacies of NHS finance was an area in which she did not have detailed knowledge. But she made sure she found out more.
Most nurse chief executives will have had experience as a director of nursing, either in their own organisation or elsewhere. If there was a tendency to see those roles as ‘soft and fluffy’ instead of preparation for running the show, this has changed.
Ms Rankin suggests that following the Francis enquiry into Mid Staffordshire, a ‘premium’ was put on the value of a good chief nurse. This gave ‘power to their elbows'. 'But', she adds, 'I think the leadership talent is more important than the background.'
Making the move
Some nurses make the move into general management at an earlier stage in their career, perhaps taking on an operational role such as chief operating officer. RCN director of nursing Professor Dame Donna Kinnair suggests this may be more common among nurses leading acute trusts.
She says making the move into general management can make it harder for nurses to remain on the Nursing and Midwifery Council’s register.
Others broaden their experience, perhaps working in a different part of the NHS for some time, or for a central body. Ms Rankin worked for the Royal Navy for most of her career, only leaving in 2008.
However, it is not always the case that talented nurses with management ability aspire to be chief executives. Professor Kinnair is one who felt it was not the route for her. She saw the nursing director job as focused on quality of care, and the chief executive’s role, with its compromises and ‘political’ nature, as diluting that.
‘Your job as a nurse director is to advise the board about what they are doing,’ she says. ‘It’s about being able to say this has an impact on patient care and quality.’
Having a nurse at the top can inspire other nurses. Ms Rankin says that since she became a chief executive many colleagues have said it has given them a real boost. 'They say it's made them think about their own careers.'
She adds: ‘I’m a chief executive who is a nurse, not a nurse who is a chief executive. That’s the transition I had to make.’
Nurses at the top: chief executives with a nursing background
There is no shortage of role models for nurses looking to move into the top job – with many running big acute trusts.
Dame Julie Moore spent 10 years in clinical practice before moving into nursing management. Regularly named one of the top NHS leaders, she currently runs the University Hospitals Birmingham NHS Foundation Trust and Heart of England NHS Foundation Trust.
Pauline Philip, Luton and Dunstable University Hospital NHS Foundation Trust chief executive, is seconded to NHS England as national urgent and emergency care director.
Nurses running acute trusts include:
Claire Panniker (Basildon and Thurrock University Hospitals NHS Foundation Trust)
Jackie Daniel (University Hospitals of Morecambe Bay NHS Foundation Trust)
Matthew Hopkins (Barking, Havering and Redbridge University Hospitals NHS Trust)
Community and mental health services have traditionally been seen as easier areas for nurses to rise to the top - although those who are in the job are swift to point out they are not easy options.
Nurses running community trusts include:
Claire Murdoch of Central and North West London NHS Foundation Trust
Tom Cahill of Hertfordshire Partnership University NHS Foundation Trust
Tracy Taylor of Birmingham Community Healthcare NHS Foundation Trust
Alison Moore is a freelance health writer