Photo: Mark Wemple
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Health Care
From Bedside to C-Suite
Nurse leaders around the state are leveraging their clinical backgrounds to run hospitals and tackle some of the health care industry's biggest challenges.
Audrey Gregory knows how to treat an alligator bite. Stephanie Conners learned fast that being a nurse takes guts. Martha McGill held two pediatric nursing jobs at the same time. And Lisa Nummi knows all the ways a hospital is different at night than it is during the day.
All of them started their careers as nurses. Today, they’re CEOs and COOs, leading hospitals and health care systems with thousands of medical professionals, billion-dollar budgets and big decisions to make.
Modern-day health care is more complicated than ever, and most hospital CEOs start out as number crunchers, not nurses. They study business or finance or health care administration in school; then they get office jobs and work their way up the ranks. But a small percentage of health care executives get their start in nursing, taking care of one patient at a time.
Florida has 321 hospitals. Out of those, we talked to seven health care leaders scattered around the state and asked them how their beginnings as nurses inform how they operate in their current roles.
We found commonalities: They’re driven people, as well as big believers in higher education and advanced degrees. All emphasize the importance of teamwork and their ultimate goal of top-notch patient care. Most spent time in the early parts of their nursing careers working in emergency departments or as trauma nurses, which can be fast-paced and demanding and stressful. And they all believe their nursing careers give them a valuable perspective as they navigate their new challenges.
“When you’re a trauma nurse, you learn early how to prioritize. You look at airway, breathing, circulation, then the rest of the body,” says Audrey Gregory, executive vice president and CEO of the AdventHealth East Florida Division, which employs more than 11,000 people across three counties. “That governs how I prioritize now. Does it need to be done today, or can it wait until tomorrow?”
“I use the nursing process a lot. I add an intervention, and then I go back in and assess: Did the intervention work?”
While more nurses are becoming CEOs and COOs now than 10 years ago, it’s still rare, according to recruiters of health care executives. There’s reason to believe their numbers might increase in the future, though.
To recruit new employees in a competitive market, hospitals are having to meet their expectations regarding professional development and future career opportunities. “Nurses are getting access to more professional development resources that may lead them on a path into management and administration of hospitals,” says Mary Mayhew, president and CEO of the Florida Hospital Association.
And good talent is in demand in hospital C-suites, because hospitals today are facing daunting financial challenges triggered by a staffing crisis. It started during the COVID-19 pandemic when hospitals were forced to raise wages dramatically to compete with high-paying temporary staffing agencies. “Their labor costs went up 45% in two years,” Mayhew says.
Although staff shortages are stabilizing, labor costs remain high. Meanwhile, reimbursement rates from Medicare, Medicaid and private insurers haven’t kept up with increases in the cost of care. And there’s plenty else to keep health care CEOs up at night — everything from increased supply costs to the threat of a cyberattack to patient satisfaction scores to staff burnout.
While there are no quick fixes, Florida’s nurse CEOs are working on moving the needle. One example: At BayCare, Conners is implementing AI-driven voice technology to help ease the stress and burden of documentation. A 2022 report by the U.S. Surgeon General shows nurses spend up to 41% of their time documenting in electronic health records, and click fatigue contributes to health worker burnout. With BayCare’s new “Medical Brain” application, nurses will be able to dictate information into a mobile device, “so when the nurse is caring for the patient, their focus is on the patient and not on the computer,” Conners says.
Having nurses as hospital leaders could lead to increased efficiency and effectiveness, says Rayna Letourneau, executive director of the Florida Center for Nursing at the University of South Florida. “Nurses make up the largest portion of the health profession, and nurses spend more time with patients than any other health care provider,” she says. “Nurses offer unique perspectives regarding health and wellness.”
Diane Smulling Smith is a principal at WittKieffer, a global recruiting firm. She started out as a nurse, and now she recruits health care executives. She’s seeing more hospitals combine the jobs of chief nursing officer and chief operating officer. And she’s seeing more nurses getting their MBAs to augment their financial skills.
“Prior, becoming the chief nurse exec was the pinnacle of a nurse’s career,” she says. “Before, this role didn’t always have a seat at the table.”
- Change Agent
Stephanie Conners had wanted to be a nurse ever since she was in middle school and found herself acting as a caregiver for her great-grandmother and great-aunt. But she grew up in inner-city Philadelphia to young parents who couldn’t afford to send her to college. When she finally earned a nursing degree and landed her first job, she says, “I thought I hit the pinnacle of my career. I needed nothing else.”
Today, Conners is president and CEO of BayCare Health System, West Central Florida’s largest not-forprofit health care system. With 16 hospitals in four counties, nearly $5 billion in annual revenue and about 32,000 employees, it’s one of the Tampa Bay region’s largest private organizations.
Before joining BayCare, Conners helped lead health care systems in Pennsylvania and New Jersey, where she earned a reputation as a leader and a change agent. Earlier in her career, she became chief nursing officer at the age of 29 at Hahnemann University Hospital in Philadelphia. “I was told I was the youngest chief nursing officer in the country leading a large academic medical center.”
She earned her MBA while working full-time and pregnant with her third daughter. “Going back to school seemed daunting and it was super hard financially. But I was a nurse leader, and a mentor said to me, ‘This is where you stop if you don’t get your master’s degree.’”
But before all that, she worked as a trauma nurse. Caring for patients with critical, life-threatening injuries, she says, taught her courage.
“Courage is important when you’re dealing with the sickest of the sick and their lives are in your hands ... You have to have a lot of confidence that you’re going to do right by those patients, and it’s not easy. So I give those bedside nurses an incredible amount of credit,” she says. “I think from a young age, the pressures I dealt with as a child, to being a bedside nurse to being a trauma nurse, taught me how to deal with the most complex situations in the calmest way possible.”
Hospital Challenges
A fall 2023 survey of 241 community hospital CEOs identified the following top issues affecting hospitals:
- Workforce challenges (including personnel shortages)
- Financial challenges
- Behavioral health/addiction issues (including a lack of funding and facilities and insufficient reimbursements for care)
- Access to care
- Government mandates
- Patient safety and quality
- Patient satisfaction
- Technology
- Physician-hospital relations
- Population health management
- Reorganizations (mergers, acquisitions, restructuring, partnerships)
*Source: American College of Healthcare Executives
