These Nurses Mean Business

Link to MinorityNurse.com

How many hospitals today have a minority nurse as CEO?

By Lisa Hochgraf

While it’s hard to say exactly what that number might be, Elaine Brown is on track to increase it. Indeed, Brown thinks the master’s degree in nursing and business administration she’ll earn this December will make it possible for her to join the ranks of nurses-turned-health care CEOs one day. And she’d welcome the opportunity.

Moving to Management

Don Bergland found that earning an MSN-MBA made for a quick trip to management.

During his MSN-MBA studies at Vanderbilt University in Nashville, Tenn. Bergland worked weekends as a staff nurse for Maury Regional Hospital, Columbia, Tenn., which has the contract to provide medical services to auto maker Saturn Corp., in Spring Hill, Tenn.

Upon graduation, Bergland was hired as assistant director of occupational medicine for Maury/Saturn and was promoted to director six months later when his manager left. Bergland now manages 50 health care professionals who provide initial care and follow up for any and all work-related injuries and emergent or urgent conditions at three Saturn plants. His team maintains 24-hour operations six days a week, and three clinics, one at each location.

Not surprisingly, Bergland says the MSN-MBA classes that most relate to his current work are leadership, organizational design and development, and labor relations.

While getting the degree was expensive (to the tune of $80,000), Bergland says it was an excellent way to get into management fast—and that his increased compensation will eventually recover what was spent on tuition.

“I would really recommend it for nurses who want to get into leadership, especially upper-level leadership,” says Bergland, whose MSN and MBA concentrations were nursing administration and human resources and organizational management, respectively. “I think the two degrees together do give a person credibility. It really stands out.”

“I will go as far as I’m allowed to go,” says Brown, a native of Jamaica and a student in the MSN-MBA program at North Park College in Chicago. “I will be quite comfortable going as far as CEO.”

As Brown’s situation suggests, minority nurses may find that getting an MSN-MBA helps them launch a career as a health care executive. With courses in finance, labor relations and management—as well as nursing—students in these programs learn critical business concepts and how they apply to health care organizations and patient care.

Interestingly, the MSN-MBA track is chosen by a relatively small number of nurses. This may be because it’s difficult to take a leave of absence to study, or to work full time while taking courses. Still, Brown and others see the value of the degree not only for nurses interested in administration, but for the patients and organizations these graduates will serve.

As an MSN-MBA program graduate working in health care, “you’re determined to meet a patient’s needs, but you’re determined to do it in a way that’s [economically] viable,” Brown says.

Founding Vision

Three factors appear to have driven the creation of several MSN-MBA programs in the late 1980s. First, perspectives on health care were changing at the end of the decade, with health care reform becoming a major political agenda by the early ’90s. Health care would now be run as a business as well as a service. Second, nurses with MBAs and MSNs were seen as particularly well qualified to be leaders in the new business-oriented world of health care. Finally, savvy educators knew that encouraging nurses to get an MSN and an MBA meant that a dual degree—easier to achieve than getting both degrees separately—needed to be created.

The Vanderbilt University School of Nursing, in Nashville, Tenn., created its MSN-MBA dual degree curriculum with support from The Commonwealth Fund, a large philanthropic organization in New York, in 1989.

Sample Curriculum Plan:
Vanderbilt University MSN-MBA Program

Fall Semester, Year 1
Nur 382 Health Systems Management
Mgt 311 Managerial Accounting
Mgt 322 Micro Economics
Mgt 342 Leading Teams and Organizations
Mgt 361 Marketing Management
Mgt 373 Operations Management
Mgt 382 Managerial Statistics

Spring Semester, Year 1
Nur 375 Research Methods
Nur 381 Informatics
Nur 386 Management Practicum
Mgt 321 Macro Economics
Mgt 341 Organizational Management
Mgt 350 Managerial Problem Solving and Communication
Mgt 355 Strategic Management

Summer Semester, Year 1
Nur 308 Models and Theory
Nur 376 Scientific Inquiry
Nur 387 Management Practicum II
Nur 389 Population Based Case Management

Fall Semester, Year 2
Nur 383 CQI and Outcomes
Management concentration requirements and electives

Spring Semester, Year 2
Nur 380 Epidemiology
Management concentration requirements and electives

At that time, the MSN-MBA was seen as “a combination that was going to be needed for the reform,” says Patricia Peerman, assistant dean for admissions. The health care environment “needed clinicians that could consider the clinical outcomes and the financial piece.”

So Vanderbilt’s School of Nursing worked out a joint MSN-MBA curriculum with the university’s Owen Graduate School of Management. Because it avoids overlap in the MSN and MBA requirements, Vanderbilt’s program can be completed in five full-time semesters. At the same time, the resulting MSN-MBA credential wields some clout.

“The intent of this [The Commonwealth Fund’s support of the MSN-MBA curriculum development] was to increase the number of people who went through this type of program,” says Linda Norman, Vanderbilt’s associate dean of academics.

The University of the Incarnate Word, a Catholic university in San Antonio, also started an MSN-MBA program in the late 1980s. “At that time, you could see that health care was becoming a business type of enterprise,” says Sara Kolb, chair for the department of graduate nursing.

Even before the MSN-MBA was developed at UIW, the dean of the nursing school required MSN students to take some business-related courses, Kolb says. The grumbling would stop when students realized how a course like macroeconomics really applied to their work in nursing. “They’d start to say, ‘You know, this is really helpful,’” Kolb says.

Now, graduates of UIW’s MSN-MBA program, which includes the full coursework of both degrees, “are on common ground with people with [traditional] business degrees,” Kolb says. “It strengthens their ability to be part of the whole team.”

Perfect Only for Some

Brown started working on her MSN-MBA at North Park College as preparation for her first nursing management job. As additional encouragement, her employer at the time offered 100% reimbursement for getting an MBA if she also earned an MSN. When she started studying for her MSN-MBA in January 1997, she realized that she’d stumbled onto exactly the right career path. “When I started the program, it was a whole new world,” says Brown, whose background is in obstetrics and pediatrics.

“It put a whole new light on nursing. I never knew something new could be so exciting and change your whole career.”

Moving Up

An MSN-MBA could be a ticket to higher-paying administrative jobs. Compare the following mean salaries:

Hospital CEO	$244,279
Hospital CFO	$125,802
Director, Nurses	$93,823
Anesthesiology nurse	$73,756
Head nurse	$47,270
Staff nurse	$41,704
Licensed practical nurse	$26,707

Source: Hospital & Healthcare Compensation Service, 1997. http://www.health-care-jobs.com.

Brown ended up paying some tuition herself after she left her job to devote more time to studying. But she expects the degree to pay off financially over time because of the potential increase in her salary, especially if, as she hopes, she reaches the upper levels of hospital management.

Kolb says several graduates of UIW’s MSN-MBA program serve as nurses in the military. One graduate has put her nursing and administrative skills to work to create the “Ask-a-Nurse” program, an e-mail service that helps nurses consult with each other on their cases. Another UIW graduate credits the degree with significantly advancing her career, noting that people outside of nursing recognize the credibility of the MBA.

Despite these success stories, few nurses have chosen to pursue dual MSN-MBA degrees since Vanderbilt and UIW started offering them. Vanderbilt’s Peerman reports having zero to three students enrolled in the program at any given time, while Kolb says UIW has graduated only 10 students from its program in 10 years.

“What we’re finding is that it is a lot to ask of nurse executives to take almost two years out of their lives to do this,” Norman says, noting that the nurses who choose the program are often in their 20s or 30s, with a few years of clinical experience.

“If they’re further advanced in their careers, they have to take a leave to do it.”

Leadership Opportunity

Still, for early-career minority nurses wanting to make the leap into management and administration straight away, an MSN-MBA could be a good option.

“I think that it opens up a lot of opportunity with the higher-level administration positions,” Norman says. “It’s really the kind of degree that’s going to help them get to those top levels faster.

The combination gives them the clout with patient services and to work with the health care systems design,” as well.

Despite the low enrollments, Peerman maintains her enthusiasm for nurses—especially minority nurses—considering a joint master’s degree in nursing and business.

“This is not a career path that many nurses go down, but it is a combination of two wonderful degrees” that allow nurses to step up their leadership in many types of health-care organizations, she says. Having increasing numbers of “minority nurses in positions of leadership like this would really make me excited about the future of nursing.”

Lisa Hochgraf makes words work for people through Top-Notch Text, a national writing and editing service. She can be reached at lisa@topnotchtext.com.