Where the heart lies

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There are a variety of reasons as to why certain nurses choose the management route. These decisions can range from a critical need for someone to manage the unit to concepts such as, “I can have more say over what happens here,” “the money is better,” or a more altruistic reason coupled with the above about believing “I can make more of a difference for more patients and families than I can through direct patient care.”

For many nurses, management has been a deliberately chosen career path, while for others, it just seems serendipitous. I started my career with aspirations to be a clinical specialist and began my master's degree in coronary care. Multiple circumstances, both personal and professional, led me into the management arena. By the time I was promoted to assistant director of nursing, I knew this was the best way for me to express creativity and initiative. I have never regretted one day of it. I have had the opportunity to manage in a variety of settings with wonderful, committed people and make some positive impact on the patients, staff, organizations, and the nursing profession.

My recent years as the CEO of a public hospital system, working with two excellent academic institutions, were probably the height of my career. I believe all of the leadership and management experiences I had gained over the years culminated in working with the disenfranchised and various ethnic and racial groups who didn't have a health care system that worked. I believe that I can identify real positive impacts for people and the community where I and others together made a difference in our institutions and in the delivery of patient care.

Recently, however, I had another experience that made me question my choice to leave direct patient care for the very first time. I think this is a natural process as one prepares for a new future after retirement, but I was surprised by my reaction. I had the experience of spending 3 full days and 2 full nights with my sister at Sloan Kettering Hospital. I was awed by the combination of superb technical skills and interpersonal caring that each and every professional nurse brought into the setting. Although leading by walking rounds is a necessity when one reaches a leadership position, it is by no means the same as spending intensive time with the nursing staff and patients. What became very clear is how well organized operations were and how nurses were enabled to do their jobs; they obviously enjoyed their work. Kudos to Liz McCormick, the chief nursing officer who has worked with her leadership staff to be on the cutting edge while focusing on compassion and excellence in care delivery.

What was most astonishing to me was not just my pride in the nurses and pride at being one of them but that I realized how much I missed by not delivering direct care. Having the personal experience was an intense reminder of what nursing is about and the critical nature of nursing care. I also realized the importance of leaders and managers maintaining their passion for care in order to lead with the right values.

During my many years in leadership roles, I often said that if decisions were made with the patient at the core, they were usually the right ones. I can point to one decision based on financial impact alone that was detrimental to some of the staff, not good for morale, and could have adversely affected patient care. Ultimately, it turned out well for the majority, but I learned a great deal about what is at the core of our business and why we do what we do.

As a result of my recent experience at Sloan Kettering, I made a decision to consider part-time employment as an oncology nurse. My desire to find a way to return to direct clinical practice may well make the circle complete, and that is the beauty of nursing. The bottom line is that where the heart lies, so lies the passion, and those who become nursing managers and leaders have to truly honor both their roots and those nurses who choose clinical practice, making a huge difference for our society.