The head of a major health network recently called as he prepared to launch a recruitment initiative for a new system chief nursing officer (SCNO). He asked me to level with him: "Should we look for a PhD or an MBA?"
In this case, for his system's needs, I said "MBA." This doesn't mean that both PhDs and MBAs (as well as DNPs, MSNs, masters in healthcare administration, and others) were not considered for the role. Ultimately, as the search was conducted, the pool of viable candidates included nurse executives with varied and intriguing backgrounds and qualifications.
Yet the "MBA or PhD" question is one that hiring managers and search committees are asking regularly as they undertake SCNO searches. And it is a question that young and midcareer nurses should ask themselves as they return to school to burnish their credentials in order to transition into nursing administration and senior leadership.
The Nursing Business
Put simply, business and finance are critical aspects of the SCNO role today. From a recruiting perspective, nurse executives with MBAs, especially those with a degree concentration in nursing or healthcare, are in great demand-the reason being that the CNO role at the system level is much more strategic and enterprise oriented than previously.
As noted by the influential 2010 report by the Institute of Medicine,1 the nursing profession as a whole needs to shed the perception of being "functional doers" and instead become "thoughtful strategists whose actions are based on education, evidence, and experience." Nurse executives must set the tone for this transition, and the MBA degree sets the tone for the "education" component.
Witness some of the qualifications cited in a recently written position specification for a SCNO role at a large health network in the Midwest:
* Spearhead the creation of a horizontally and vertically aligned nursing organization that serves the entire continuum of care;
* Report directly to the system chief executive officer (CEO) and have a meaningful voice in operational and strategic issues critical to the organization;
* In collaboration with the CEO and executive leadership team, develop short- and long-term nursing strategic plans for the health system and affiliated services; and
* Exercise vision, initiative, and influence in driving measurable improvements in quality, patient satisfaction, and cost of care.
Another position description describes required candidate qualifications as follows: "A master's degree in nursing, healthcare administration, business, or related field is also required. An MSN with an emphasis in healthcare administration or business is preferred. Candidates with a PhD or DNP are encouraged to apply."
This is very telling, I think. MBA-prepared nurse executives do not have a monopoly on strategic, results-driven businesslike thinking. However, strategy and execution are the primary curricular emphases of business school courses, providing graduates a framework for managing, leading, and effecting change at an enterprise or system level. Some business schools are, of course, better than others and some are gearing themselves toward developing leaders and nursing executives for today's healthcare marketplace. The quality of the MBA degree program, as with a PhD program, is certainly of importance.
What is often needed in today's SCNO is a business executive with specialization in nursing, as opposed to a nurse who has learned the ropes of business and administration through years of on-the-job training. Leadership academies and certification programs in healthcare finance are worthwhile for CNOs looking to gain business savvy, but are not a substitute for an MBA. These points might not be well accepted by traditionalists, but they reflect a reality of today's reform environment from my experience.
Bedside and Boardroom
We may see more MBAs getting recruited into SCNO positions if only because more nurse executives are pursuing these degrees. Any degree is meaningless unless the individual is able to apply the learnings in a practical setting. The MBA works only if the executive is a credible nurse who can walk the corridors; commune with clinicians, staff, and patients; and apply business principles to operational realities. Nurse leaders with PhDs have had to do the same, prove to their charges that despite their academic achievements they are still caregivers at heart. This is especially true as the nursing profession in general becomes more educated, more professionally diverse, and more responsible for primary and other care in a post-Affordable Care Act environment.2
SCNOs must be comfortable and influential among both clinical and executive peers, at the bedside and in the boardroom, as the saying goes. Success for the SCNO is about marrying current theory with best practice. In more and more large health systems today, it so happens that both theory and practice are heavily influenced by the business imperatives of today's unique era in healthcare.
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