LN 1

A PHENOMENOLOGICAL STUDY OF THE CAREER TRANSITION OF NURSES
INTO HOSPITAL CHIEF EXECUTIVE OFFICER ROLES
by
CHRISTINE GREENIDGE
A Dissertation Proposal Presented in Partial Fulfillment
of the Requirements for the Degree
DOCTOR OF HEALTH ADMINISTRATION
UNIVERSITY OF PHOENIX
April 2007
UMI Number: 3270978
Copyright 2007 by
Greenidge, Christine
All rights reserved.
UMI Microform 3270978

Copyright 2007 by ProQuest Information and Learning Company.
All rights reserved. This microform edition is protected against
unauthorized copying under Title 17, United States Code.
ProQuest Information and Learning Company

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A PHENOMENOLOGICAL STUDY OF THE CAREER TRANSITION OF NURSES INTO
HOSPITAL CHIEF EXECUTIVE OFFICER ROLES
by
Christine Greenidge
April 2007
Approved:
Karen Bammel, Ph.D. Mentor
Suzanne Richins, DHA, Committee Member
Patricia A. Quigley, Ph.D., Committee Member
Accepted and Signed:

Karen Bammel
Accepted and Signed:

Date
Patricia A. Quigley
Dawn Iwamoto, Ed.D.

Dean, School of Advanced Studies
University of Phoenix
ABSTRACT
Nurses are making strides in the boardroom of hospitals in the role of chief executive
officer (CEO). As nurses became more prevalent in CEO positions, stressful transition
processes may dictate the need for the nurses to acquire various skills to be able to lead
diversified workers outside the familiar nursing domain and to manage total operations
effectively. The purpose of this qualitative phenomenological study was to capture the
lived experiences of 19 nurse CEOs in Connecticut, Maine, New Jersey, and New York
related to possible influential factors that may have contributed to the phenomenon of
how nurses transitioned to hospital CEO positions. Moustakas (1994) modified van
Kaam methodology assisted in the analysis of data collection in the study. The research
findings identified several influential factors that evolved from themes associated with
easing the transition of nurses into hospital CEO positions. The factors were the ability to
listen and communicate effectively, involvement in a mentoring relationship, acquisition
of finance and business education, and support by the institution in roles prior to
becoming the CEO were the most common themes that influenced ascension to a hospital
CEO position.
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DEDICATION
I dedicate this dissertation in loving memory of my grandmother Isaline Ismay
Weekes, whose presence in my formative years nurtured me and provided an important
foundation for the rest of my life.

iv
ACKNOWLEDGMENTS
I would like to acknowledge my God and savior whose presence in my life was a
source of strength and faith as I journeyed towards my goal of achieving a doctorate
degree. I want to thank my husband Ashton for his continuous love and relentless
support. Ashton, your patience, inspiration, and understanding are invaluable. I want to
thank my mother Merline Kinard whose words of encouragement and prayers motivated
me throughout my doctoral journey. I would like to thank my University of Phoenix
cohort and teammate Judith Kaplan for her support and encouragement. Judith, your
expression of kindness shall always remain with me. I want to thank my work colleague
and friend Alex Bux who listened and contributed to my creativity. I thank you all for
being there for me. I also thank Dr. Tekemia Dorsey for assisting me in the analysis of
the data from the study. I want to thank my mentor Dr. Karen Bammel who was an
enlightening source of inspiration, motivation, and honesty in providing detailed
feedback on my progress through my doctoral journey. Karen, your guidance inspired my
level of dedication and performance through my journey. I want to thank Dr. Suzanne
Richins for being on my committee and for her encouragement and expressions of
excitement for my chosen topic. I want to thank Dr. Patricia Quigley for being on my
committee and for her honesty in advising me to consider different perspectives in my
study.
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TABLE OF CONTENTS
LIST OF TABLES.............................................................................................................. x
LIST OF FIGURES ........................................................................................................... xi
CHAPTER 1: INTRODUCTION ....................................................................................... 1
Background ......................................................................................................................... 5
Nurse Executives .................................................................................................... 6
Leadership Skills..................................................................................................... 7
Statement of the Problem.................................................................................................... 9
Purpose of the Study ......................................................................................................... 11
Participants............................................................................................................ 12
Eligibility .............................................................................................................. 12
Geographic Location............................................................................................. 13
Significance of the Study .................................................................................................. 13
Significance of the Study to Health Care Leadership....................................................... 14
Nature of the Study ........................................................................................................... 16
Research Questions........................................................................................................... 18
Theoretical Framework..................................................................................................... 19
Transformational Leadership ................................................................................ 19
Stratified Systems Theory..................................................................................... 21
Grounded Theory .................................................................................................. 21
Definition of Terms........................................................................................................... 22
Assumptions...................................................................................................................... 24
Scope, Limitations, and Delimitations.............................................................................. 25

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Summary ........................................................................................................................... 27
CHAPTER 2: REVIEW OF THE LITERATURE ........................................................... 29
Documentation.................................................................................................................. 29
Scope of Literature............................................................................................................ 30
Title Searches, Articles, Research Documents, and Journals ........................................... 31
Introduction to the Literature Areas.................................................................................. 33
Historical Perspectives...................................................................................................... 35
Research Questions........................................................................................................... 37
Literature Review.............................................................................................................. 38
Transition .............................................................................................................. 38
Mentorships........................................................................................................... 40
Clinical and Educational Backgrounds................................................................. 42
Leadership Style.................................................................................................... 45
Emotional Intelligence .......................................................................................... 46
Upward Influence.................................................................................................. 49
Mentorship ............................................................................................................ 51
Stratified Systems Theory................................................................................................. 52
Grounded Theory .............................................................................................................. 53
Conclusion ........................................................................................................................ 54
Summary ........................................................................................................................... 55
CHAPTER 3: RESEARCH METHODOLOGY .............................................................. 57
Research Design................................................................................................................ 57
Phenomenological Approach ................................................................................ 58

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Qualitative Design ................................................................................................ 59
Appropriateness of Design................................................................................................ 60
Population ......................................................................................................................... 62
Informed Consent.............................................................................................................. 63
Sampling Frame ................................................................................................................ 64
Confidentiality .................................................................................................................. 65
Instrumentation ................................................................................................................. 66
Data Collection ................................................................................................................. 68
Semistructured Interview Questions ................................................................................. 69
Data Analysis .................................................................................................................... 70
Validity and Reliability..................................................................................................... 72
Validity ................................................................................................................. 73
Reliability.............................................................................................................. 74
Summary ........................................................................................................................... 74
CHAPTER 4: RESULTS.................................................................................................. 76
Review of Data Collection Process................................................................................... 78
Demographics ................................................................................................................... 81
Findings............................................................................................................................. 83
Research Questions, Purpose and Findings ...................................................................... 83
Interview Question 1............................................................................................. 83
Findings from Interview Question 1 ..................................................................... 83

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Results from Question 6........................................................................................ 94
Overview of Advantages Positive and Negative for Clinical Background........... 95
Findings from Question 7 ..................................................................................... 96
Findings from Question 8 ..................................................................................... 98
Interview Question 9........................................................................................... 101
Findings from Question 9 ................................................................................... 101
Interview Question 10......................................................................................... 103
Findings from Question 10 ................................................................................. 103
Reliability and Validity of Research Instrument ............................................................ 104
Summary ......................................................................................................................... 105
CHAPTER 5: CONCLUSIONS AND RECOMMENDATIONS.................................. 106
Significance of the Study to Leadership ......................................................................... 109
Core Themes and Composite Description ...................................................................... 109

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Cross-Theme Analysis and Research Question 3: What Meaning Is Construed
from These Experiences?.................................................................................... 112
Chapter Overview and Summary.................................................................................... 119
Findings from Study and Linkage to Conceptual Framework.121
Leadership Theory...121
Stratified Systems Theory122
Grounded Theory.123
Recommendations........................................................................................................... 124
Health Care Leadership....................................................................................... 124
Registered Nurses ............................................................................................... 126
Recommendations for Further Study .............................................................................. 126
Final Summary and Conclusion ..127
References129
Appendix A: Invitation to Participate in a Research Study ............................................ 147
Appendix B: An Introduction Letter to Participants....................................................... 148
Appendix C: Consent to Act as a Research Participant.................................................. 149
Appendix D: Semistructured Interview Questions ......................................................... 150
Appendix E: Transcribed Responses to Interview Questions......................................... 151
Appendix F: Tables of Findings from Responses to 10 Interview Questions ................ 196

x
LIST OF TABLES
Table 1 Literature Categories Searched........................................................................... 32
Table 2 Distribution of Sample by Gender, State, Ethnicity, and Bed Size of Hospital ... 82
Table 3 Gender of Mentors ............................................................................................... 99
Table 4 Cross-Theme Analysis and Research Question 2: What Are the Experiences That
Lead to Executive Leadership Attainment Interpreted by Nurse CEOs? ..................... 1112

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LIST OF FIGURES
Figure 1. Roadmap of literature review. .......................................................................... 33
Figure 2. Responses to Interview Question 7................................................................... 97
Figure 3. Gender of mentor and position level held....................................................... 100
Figure 4. Cross-theme analysis and Research Question 1: What factors practiced by nurse
CEOs facilitate executive leadership attainment?..............Error! Bookmark not defined.
Figure 5. Cross-theme analysis and Research Question 4: What Types of Prior
Leadership Skills Contributed to Nurse CEOs Ability to Ascend to CEO Positions in
Hospitals?...................................................................................................................... 1199
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CHAPTER 1: INTRODUCTION
The health care chief executive officer (CEO) is most often associated with being
responsible for the strategic direction of hospitals and health systems (Waldman, Smith,
Hood, & Papplebaum, 2006). Chief executive officers in hospitals are predominantly
male (American College of Healthcare Executives [ACHE], 2001, 2004), but women are
beginning to ascend to these positions, especially women who transition from nursing
careers (ACHE, 2002, Gathers, 2003). At the beginning of 2004, there were 1,112
females in hospital CEO positions, which represented 19.3% of the CEO positions in
U.S. hospitals (ACHE, 2004). By the beginning of 2006, females holding hospital CEO
positions increased to 21.5% (Snowbeck, 2006) and although the number of female
hospital CEOs is considerably lower than the rate of male hospital CEOs, it represents
progressive growth of females, in particular nurses, acquiring hospital CEO positions.
The ascension of nurses, both male and female, to hospital CEO positions
provides the opportunity to examine the CEOs leadership skills and to identify how
more hospitals could nurture nurses into the CEO executive role. In addition, nurse
CEOS may offer hospitals more diversity in choosing CEOs, along with new perspectives
on leadership styles stemming from their nursing career. The exploration and
examination of the phenomenon of nurses in hospital CEO positions provides insight into
how hospitals and other health care organizations may benefit from their unique
leadership perspectives.
Health care organizations require executive leaders to be equipped with leadership
characteristics that will enhance sustainability and influence a growing, demanding health
care global market (Papidimos & Marcos, 2004; Prybil, 2003; Spinelli, 2006). Leaders
2
are needed that can transform health care organizations during turbulent times and keep
strategy as an important focus to achieve organizational goals. Despite the need for
competent health care leaders, the health care professions are known for their inability to
mentor individuals (Bohne, 2003; P. Martin, 2005; Witt/Kieffer, 2001), which impacts
the development of strategies that enhance leadership skills of emerging leaders.
Furthermore, health care organizations are experiencing volatility in recruiting and
retaining talented leaders (Hartman & Crow, 2002), which influences the effectiveness of
governance and overall achievement of goals. However, the health care industry is
acknowledging the difficulty of recruiting leaders and is developing strategies to
circumvent the void of talented leaders by investing in new efforts to prepare future
health care leaders (Edmonstone & Western, 2002; Garman & Johnson, 2006).
In order to increase the talent pool of potential health care leaders, an assortment
of strategies such as the identification of health care leadership competencies may be
necessary to recruit and train future leaders (Garman & Johnson, 2006). Competencies
may include strategic focus on developing leaders by focusing on mandatory leadership
development, personal mentoring, and personal acquisition of power and influence tactics
(Edmonstone & Western, 2002). Collectively, these strategies may help to equip future
leaders with influential tactics that will assist them in successfully leading organizations
(Edmonstone & Western).
Successful executive health care leaders must possess a myriad of personable
traits and characteristics that enable achievement of goals and objectives (Garman, Tyler,
Darnall, & Lerner, 2004; Grazier, 2005). Effective leaders contribute to dynamic change
in organizations through their transcendent vision that creates a positive working

3
environment and through their ability to manage people by improving communication
and learning (Bujak, 2005; Kerfoot, 2004). Throughout history, leadership in
organizations has been associated with males, but females are slowly making strides in
leading organizations. Health care leadership has not embraced the notion of looking
beyond gender for diverse leadership and executive health care leadership continues to be
male dominated (Barney, 2002; Burress & Zucca, 2004). Males continue to be associated
with organizational leadership attributes, especially in the health care profession (Dennis
& Kunkel, 2004; Fisher, 2005; Kunkel, Dennis, & Waters, 2003; Ragins, Townsend, &
Mattis, 1998).
Successful leadership characteristics are important for female health care leaders
because of a historical trend of significant challenges for females emerging into executive
health care leadership positions (ACHE, 2002; Dempsey-Polan, 1988; Gathers, 2003;
Reubens & Halperin, 1996). For instance, successful advancement in leadership positions
is associated with masculine terms. Females in health care leadership positions have
unique perspectives on leadership and career advancement (Hopkins, ONeil, &
Bilimoria, 2006). Therefore, it is important to examine enabling factors that may
empower females, particularly nurses, to lead health care organizations in order to reverse
the trend of gender-based health care leadership. An examination of enabling factors in
nurse CEO leadership may be pivotal to the attainment of strategic objectives that are
often the responsibility of those held accountable for the success of organizations
(Bennis, 1994; Bodinson, 2005).
The American College of Healthcare Executives identifies trends in various areas
of health care, including executive leadership, and tracks and trends the profiles of CEOs
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in hospitals. Typically, Caucasian men with business backgrounds rather than clinical
backgrounds have populated leadership positions at the executive level in health care
organizations, although the trend is changing as more women are acquiring similar
positions (ACHE, 2002; Burda, 2003). The changing trend highlights the progress female
nurses are making in executive health care positions (Hemmila, 2005; Leading women,
2005; Shea, 2005) and has provided opportunities for nurses to consider hospital CEO
positions. The research addressed the trend of nurses ascending into CEO roles in
hospitals and examined themes from lived experiences that influenced nurses that
transitioned into CEO roles.
Chapter 1 introduces the background of the study and the relevant factors
associated with the rise of female nurses into hospital CEO positions. Included in the
chapter is the demographic information that supported the study along with the nature
and significance of the problem that prompted the qualitative phenomenological inquiry.
Research has not indicated factors associated with nurses ascension to CEO roles, which
prompted inquiry into the phenomenon and provided the foundation that helped to shape
the study that examined the lived experiences of female nurses in the role of CEO in
hospitals.
Chapter 1 provides an explanation of the studys significance to healthcare
leadership in hospitals; in particular, how hospital leadership may have to incorporate
strategies to accommodate the growing number of nurses in CEO positions. Chapter 1
also includes an explanation of themes that may reveal possible factors that ease the
transition of female nurses to these executive hospital roles that men have dominated
historically and traditionally.

5
Background
Health care leadership continues to be male dominated (ACHE, 2002; Barney,
2002; Burda, 2003). The literature identifies various factors such as segregation and the
preference for White males in leadership positions in health care organizations to explain
the lack of women leading health care organizations (Curran, 2003; Gathers, 2003;
Hopkins, 1997; Weil, Haddock, & Barowsky, 1996; Weil & Mattis, 2001, 2003). Male
dominance within organizations has contributed to creating an environment that impedes
womens ascension into executive roles (Hardy & Clegg, 2001). Hardy and Clegg wrote,
Certain male identities constituted in socially and economically privileged
contexts routinely will be more strategically contingent for originating decision-
making, and for access to and success in hierarchically arranged careers (Heath,
1981). But, organizations do not produce actions that are masculinist, so much as
masculinism produces organizations that take masculinist action. Often they do
this without anyone even being explicitly aware of it. In such a case, the decisions
that characterize organizational action will be a result, not a cause, of ideology.
Organizations may be the arenas in which gender politics play out, and, as such,
suitable places for treatment through anti-discriminatory policies. But, such
solutions may address only the symptoms and not the causes of deep-seated
gender politics. Attacking their organizational expression may suppress these
symptoms but it is unlikely to cure the body politic, behind which there is a
history of living, being, and (dis)-empowering in a gendered world that is tacit,
taken for granted and constitutive of the very sense of that everyday life-world.
(p. 633)
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According to Hardy and Clegg (2001), males have influenced decision making in
organizations and may have created environments where males are more successful than
female leaders. Male dominance in organizational leadership evolved from the traditional
leadership literature of the great man theory, when males took charge and directed
organizations (Parker, 2004). Male dominance continued to prevail, which led to the
theory of the glass ceiling, a term describing the difficulties women have in gaining
leadership roles (Boatwright & Forrest, 2000; Stelter, 2002). In health care organizations,
the theory of the glass ceiling is prevalent, with males holding higher senior level
positions than females (Weil & Mattis, 2003). The dominance of males in executive
health care positions is evidence of the glass-ceiling phenomenon that exists in
organizations lacking female executive leadership (Dreher, 2003; Robinson-Walker,
1999).
Despite the presence of a glass ceiling in executive health care positions, females
are beginning to make strides in migrating to senior executive roles (Weil & Mattis,
2003). Although these gains represent a recent trend, common knowledge and
perceptions indicate female executives have not attained top-ranked executive positions
at the same rate as men (Burress & Zucca, 2004; Curran, 2003; Evans, 2005).
Subsequently, health care leadership should consider the talents of more female nurses,
such as their potential to lead organizations at the executive level (Curran, 2003).
Nurse Executives
A macroscopic global review of nursing management throughout the world
revealed women held approximately 30% of managerial nursing positions despite women
constituting more than 85% of the nursing workforce (Kim, Woith, Otten, & McElmurry,
7
2006). Trends noted by ACHE indicated that more females, in particular those who are
registered nurses (RNs), were making inroads in becoming health care CEO roles in the
United States (Gaskill, 2004; Phillips, 2005). At the beginning of 2006, females held
21.5% of hospital CEO positions (Snowbeck, 2006), indicating progressive growth in
female nurses acquisition of the CEO position. Although nurses and women in general
are penetrating hospital executive positions, women remain underrepresented in hospital
CEO positions (Phillips). For those nurses able to transition into executive positions,
essential skills such as financial management, graduate education, and political acumen
are important assets that may lead to successful leadership (Rothenberg, 2001). The
aforementioned skills represent acquisition of knowledge in key areas such as business
and finance that are often associated with executive titles.
Leadership Skills
Other skills such as effective leadership, upward influence, emotional
intelligence, and mentorship are important factors that ease the transition of nurses from
traditional nursing leadership positions to CEO health care positions. These skills are
common characteristics of nurse leaders and require exploration to identify their
statistical relationships to the successful transition of nurses into CEO positions.
Identification of these skills will help health care leadership develop multifaceted
strategies of developing emerging nurse executive leaders and to incorporate
developmental skills into a proactive executive leader succession-planning program.
Relevant background factors can be crucial in identifying how successful nurses
are able to transition to CEO positions in health care organizations. An ACHE (2001)
study noted that in 2000, 56% of women in executive health care positions had clinical
8
backgrounds, compared to 30% of men. The importance of a clinical background may
give nurses a competitive advantage in obtaining CEO positions in the health care
environment. However, if a clinical background is a determining factor enabling nurse
executives to make impressions in corporate boardrooms, and which eases the transition
to these leadership positions, then exploring the phenomenon and other influencing
factors may be necessary to increase nurses access to corporate executive positions and
their potential contributions to corporate success.
The study examined a population of nurses who held hospital CEO positions in
the states of Connecticut, Maine, New Jersey, and New York. An examination of the
lived experiences of nurses in hospital CEO positions may benefit society and health care
by providing information on how females who are nurses begin to shatter the glass
ceiling that exists in health care leadership. Strategies for increasing the numbers of
female nurses in executive roles may benefit health care organizations (single and merged
corporations), which have cyclical difficulties in recruiting and retaining effective high-
level health care executives (Wilson, Stranahan, & Mitrick, 2000).
Health care organizations leadership may also gain insight into the preparatory
needs of nurses who may wish to attain a CEO position in their organization. Society may
also benefit from understanding what organizations need to consider in developing
recruitment and retention strategies to increase the number of women CEOs. The
improvement of recruitment and retention strategies may also alleviate turnover rates of
women in health care CEO roles, who have higher turnover rates than male CEOs in
health care (Wilson et al., 2000). As more nurses ascend to the executive hierarchy of
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health care leadership, organizations may need to incorporate formal mentoring programs
as a succession strategy to nurture emerging nurse CEOs.
A qualitative phenomenological methodology study that explored and examined
the perceptions of nurse CEOs provides knowledge of the influential factors that ease the
transition into high-level executive roles. Themes associated with nurses ascending to
CEO roles and that identify factors related to a successful transition may be valuable to
organizations seeking to appoint nurses to these positions. The identification of
successful factors from female nurses perceptions may help organizations understand the
importance of why nurses may need to acquire certain leadership and business skills to
promote success in leading hospitals at the executive level.
Statement of the Problem
The volatility of the health care environment has contributed to hospital
leaderships need to recruit CEOs that enhance viability and sustainability (Spinelli,
2006). In addition, hospitals are facing enormous challenges in recruiting and retaining
talented, multi-skilled CEOs due to factors such as CEO turnover, stress, burnout,
financial viability, and the changing health care environment (Barney, 2002; Sieveking &
Wood, 1992; Wilson et al., 2000). A possible solution to the recruitment and retention
challenges hospitals face is for the hospital administration to consider nurses with
leadership abilities as viable CEO executive leaders. The hospital environment may be
conducive to nurse leadership because acquisition of the CEO position in a hospital
considers competency in leadership and business; two skills nurses have achieved
(Kaplan, 2006a). Nurses also represent the highest number of employees in hospitals and
may have less difficulty acclimating to the CEO role in the hospital environment.
10
Critics have chastised health care leadership for not considering the leadership
talents of nurses (Curran, 2003; Moore, 2003) in identifying nurses as prime candidates
for CEO positions. Although women have penetrated the upper levels of hospital
leadership, breaking the glass ceiling in hospital CEO leadership is difficult and
examining lived experiences of nurses in these roles provides insight into how nurse
CEOs can be more successful. The research addressed how, as nurses ascend to CEO
roles in hospitals, key enabling factors may have aided the transition into the role of
CEO.
The problem the study focused on was as female nurses became more prevalent in
top-level executive CEO positions in hospitals, stressful transition processes may dictate
the need for female nurses to acquire a variety of skills to enable them to lead an
assortment of workers outside their familiar nursing domain and to manage total
operations effectively. Possible solutions to the problem may benefit future nurse CEOs
if influential factors are identified that ease nurses transition into hospital executive
roles. The purpose of this qualitative phenomenological study was to examine through
critical analysis the lived experiences of female nurses that eased their transition into
hospital CEO positions. An in-depth examination of factors such as having a mentor and
certain experiences or support systems that seemed to ease the transition of nurses into
the CEO role provided insight into how nurses have acquired the role. Female nurses
located within the states of Connecticut, Maine, New Jersey, and New York provided
information from their lived experiences of transitioning into hospital CEO roles.
According to ACHE (2001), nurses filled about 700 CEO and 540 chief operating
officer (COO) positions. In 2005, the number of nurse CEOs had risen to 900 (Executive
11
Briefing, 2005). As nurses become more prevalent in top-level management, they will
need to demonstrate leadership styles that enable them to manage an assortment of
workers outside their familiar nursing staff. Nurses must also equip themselves with
relevant educational knowledge of business and finances to be able to manage total
operations effectively. Nurses also need to demonstrate decision-making skills that reflect
consideration of a wider scope of organizational priorities that maybe unfamiliar territory
from their previous nursing leadership scope. The problem was best suited for a
qualitative phenomenological research methodology that includes a modified van Kaam
methodology to understand the impacts of transitional factors of nurses and how they
influence success in CEO roles in hospitals.
Purpose of the Study
The purpose of the qualitative phenomenological research study was to determine
which influential factors contributed to easing the transition of nurse administrators into
CEO roles in hospitals. Although the term transition may be both broad and general,
understanding the experiences of nurses in hospital CEO leadership positions may
provide organizations with strategies for recruitment and retention into the position. An
exploration of leadership characteristics and the relevancy of enabling factors such as
clinical and educational backgrounds through the lived experiences of nurse CEOs may
provide insight into whether these are influential factors that may ease nurses transition
to hospital CEO roles. The results of the study add to the limited body and scope of
knowledge regarding influential factors that enable nurses to successfully lead and
manage hospitals in the role of CEO. The study also highlights factors perceived by nurse
CEOS as they transitioned to CEO roles in hospitals.

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Characteristics of nurse CEOs backgrounds are inclusive of transformational
leadership styles, previous leadership positions, business and appropriate education
backgrounds, mentoring relationships, upward influence, and emotional intelligence
(Gaskill, 2004; Leach, 2005; Hopkins et al., 2006). These multifaceted characteristics
may offer hospitals and academic institutions empowerment strategies useful to prepare
future nurse CEOs. The lived experiences of nurse CEOs provided insight into how the
aforementioned characteristics were relevant to a successful transition to the position of a
hospital CEO.
Participants
A purposeful sample of 19 nurse CEOs selected from the databank of the
American Hospital Association (AHA) provided the participants from the states of
Connecticut, Maine, New Jersey, and New York for the study. The AHA maintains the
most up-to-date published information on health care CEOs. Information retrieved from
the AHA publication included the name of the hospital CEO and contact information.
Additionally, the samples obtained from the AHA included specific demographic profiles
of hospital CEOs in the four states of Connecticut, Maine, New Jersey, and New York.
Eligibility
Eligibility criteria for the selection of participants included those bearing the title
of CEO for at least 2 years in a hospital setting and a registered nurse (RN). Because
nurses are predominantly female (McMillian, Morgan, & Ament, 2006), an assumption
could be made that a large percentage of nurses in CEO positions would be female.
Irrespective of the acknowledgement of nurses being predominantly female, gender was
not a factor in the selection process, as it does not present a conflict to the contextual
13
factors associated with nurses transitioning into health care CEO positions. Although it is
more likely that those selected to be participants based on these criteria were female, the
study did not exclude males.
Geographic Location
The studys geographical location was originally limited to the region surrounding
New York City that included the states of Connecticut, New Jersey, and New York. The
state of Maine became a fourth geographic location and two participants from the state
participated in the study. Nurse CEOs from hospitals in these four states became
participants for the study by random means in terms of the physical location of the
facility. For instance, the sample of nurse CEOs represented hospitals in rural and urban
settings. The 2005 database of the AHA, which publishes contact information about
hospital CEOs, provided the profiles of CEOs in hospitals in the four states.
Significance of the Study
Historically, hospital leadership positions at the executive level have been male
dominated. Females, in particular nurses, are migrating from traditional nursing
leadership positions to senior leadership positions such as CEO and are challenging the
prevalence of male domination in these positions (Evans, 2005). With the number of
nurses rising to CEO positions in hospitals increasing, distinctive attributes and factors
about their transition into these roles are emerging. An exploration of factors contributing
to the increase of nurses in CEO roles may benefit hospitals in selecting the most
effective individuals to take charge of their operations.

14
Significance of the Study to Health Care Leadership
The health care leadership environment, dominated by males, needs to reflect
more diversity in its CEO roles. Diversity in the CEO role is important because of multi-
cultural patients receiving health care, the changing demographics of health care
communities, and the large number of females who are in health care careers that may be
potential CEOs. The American College of Healthcare Executives (2001) studied the
disparity of females in leadership positions, most notably hospital CEOs, and their
compensation compared to male CEOs. Nurses, who represent the largest number of
employees in hospitals, are entering the boardrooms and are slowly influencing the
traditional profile of the health care executive. As nurses transition into executive
positions, they may challenge hospital environments to become more inclusive in
diversifying executive leadership positions so more of them will be attracted to the CEO
position.
Examining the lived experiences of nurse CEOs may provide hospitals and other
health care entities insight into how certain influential factors enable an easier transition
of nurses to CEO roles. The information obtained from examining lived experiences of
nurse CEOs could encourage organizations to develop appropriate recruitment and
retention strategies for current and future generations of nurse CEOs. Additionally,
programs such as the Robert Wood Johnson Executive Nurse Fellows Program, which
has been a leader in providing business and management skills for nurse executives
(Fralic & Morjikian, 2006), may also benefit by using the results to improve education
for nurse executives. The research sought to identify the importance of relevant factors
that either ease or impede the transition of nurses into CEO roles in hospitals.
15
Health care environments that are hostile and do not embrace female leadership,
in particular female nurses that are CEOs, present many challenges for female executives
to break through the glass ceiling that continues to support the traditional male executive
hierarchy in organizations. Conversely, environments that are conducive to female
leadership help foster improvement in communication, caring, and respect for
differencesthree qualities attributed to women in the work environment (Lunneberg,
1990). Identification of influential factors that ease the transition of nurses into hospital
CEO roles may provide hospitals with strategies to develop talented nurses who can
assist them in visionary and successful leadership.
Hospitals and health care leadership in general may also benefit from the results
of the research in finding solutions to the limited CEO roles for females and subsequently
develop corporate goals that encourage females and nurses to pursue executive roles. The
results from the studys findings may enable hospital leadership to develop mentor
programs that can benefit future generations of nurse CEOs, an opportunity that Tieman
(2002) noted to be a rarity in executive leadership.
Hospitals may realize substantial financial savings from recruiting and retaining
CEOs promoted from within the organization. According to ACHE (2005) data, hospitals
experienced a 16% increase in CEO turnover in 2004, 2% above the 2003 rate. The
turnover rate indicates hospitals may have difficulty recruiting for CEO positions and
thus promoting viable nurse candidates from within the organization may dramatically
reduce costs associated with recruiting outside candidates. A study conducted by ACHE
(2004) noted 62% of hospitals considered CEO succession from within their
organizations. If hospitals continue to consider internal promotion to the the CEO role,
16
nurses may be in a strategic position to capitalize on CEO promotions from within their
hospitals. The hospital CEO turnover rates for the studys geographic locations for the
calendar year 2005 were 11% in Connecticut, 5% in Maine, 16% in New Jersey, and 15%
in New York (ACHE, 2006). Hospitals in these four states may need to employ
recruitment tactics such as looking within their organizations to attract viable CEOs and
developing a succession plan for mentoring future CEOs.
Nature of the Study
The study utilized a qualitative phenomenological methodology to examine the
lived experiences of nurses transition into hospital CEO roles. The research incorporated
the elements of a phenomenological study in that it explored certain characteristics and
phenomena associated with the sample of nurse CEOs (D. R. Cooper & Schindler, 2003).
The study employed a modified van Kaam method suggested by Moustakas (1994).
Moustakas noted, The empirical phenomenological approach involves a return to
experience in order to obtain comprehensive descriptions that provide the basis for a
reflective structural analysis that portrays the essence of the experience (p. 44).
Moustakas (1994) noted that a researcher in phenomenological studies abstains
from making suppositions, focuses on a specific topic freshly and naively, constructs a
question or problem to guide the study, and derives findings that will provide the basis
for further research and reflection (p. 47). Phenomenological designs allow the research
to focus on the objective lived experiences of persons experiencing the phenomenon
(Moustakas). The phenomenological design was appropriate to the study in
understanding how nurses have experienced the phenomenon of influential factors that
ease their transition into hospital CEO roles.

17
The study revealed the relationship of several influential factors to the
phenomenon of ease of transition into CEO roles by nurses. Associations and
relationships among variables are important feature of a descriptive study (D. R. Cooper
& Schindler, 2003). The phenomenological research design allowed the study to
accomplish its goal of examining the relevancy of certain factors in the ascension of
nurses to CEO positions in hospitals.
The phenomenological study enabled the research to incorporate diverse
strategies in employing qualitative means of inquiry into themes and relationships to
discover the meaning of the experience of transitioning into the role of a hospital CEO.
The qualitative structured interview in the phenomenological method retrieved data from
the lived experiences of transitional factors associated with nurses transition to CEO
roles in hospitals. Structured interviews provided information about the personal
experiences of participants and were the source of the primary data.
The importance or relevancy of influential factors that might have contributed to
the ascension of nurses into CEO positions in hospitals was the focus of the research. The
influential factors experienced by the participants provided an understanding about the
career transition of nurses into hospital CEO positions. The study investigated several
background variables rarely identified in previous research studies for correlation, as well
as causal relationships associated with the successful leadership of nurses in CEO
positions. The lived experiences of the participants gave more insight into factors nurse
CEOs identify to be crucial in easing the transition to the CEO executive role
Examination of the factors provided new theory regarding what nurses need to consider
as potential candidates for hospital CEO positions.

18
Research Questions
Common factors that emerged from nurses who are CEOs revealed themes that
indicated an easier transition into the CEO role and were identified as significant in the
participants ascension to the CEO role. Nurse administrators background may be an
important issue in ascension to an executive role. Analysis of the multifaceted
independent contributing variables was an integral part of testing the first research
question. The research questions evolved from the premise that nurses backgrounds are
essential assets in the acquisition of hospital CEO roles. The following specific questions
guided the study:
1. What factors practiced by nurse CEOs facilitate executive leadership
attainment?
2. What are the experiences that lead to executive leadership attainment
interpreted by nurse CEOS?
3. What meaning is construed from these experiences?
4. What types of prior leadership skills contributed to nurse CEOs ability to
ascend to CEO positions in hospitals?
The lived experiences examined for the qualitative phenomenological study
include evidence of a relationship between clinical and educational backgrounds,
emotional intelligence, upward influence, and mentoring relationships as influential
factors that allowed nurses to achieve CEO positions in hospitals. The research questions
and themes considered the possibility of nurses exhibiting distinct transformational
leadership characteristics and identified possible key factors associated with ascension
and transition to hospital CEO positions. The responses to the second, third, and fourth
19
research questions after transcription of the structured interviews of lived experiences
revealed unique practices that may prove successful in transitioning to the CEO role.
Theoretical Framework
The literature notes the ascension of females into CEO positions although it is
devoid of the specifics of nurses emerging into hospital CEO positions. Nonetheless,
several theories exist that provide a framework for the contextual factors governing the
research study. Three notable theories and their conceptual frameworks supported the
underpinnings of the study. Transformational leadership theory gave support to the
relevancy of factors associated with leadership success in organizations (Burns, 1978)
and explained the uniqueness of traits and characteristics associated with the
transformational style of leadership in enabling nurses to ascend to hospital CEO
positions. The second theory, stratified systems theory (SST), gave an empirical
foundation to the importance of organizational structure and environment in the success
of leaders (Hunt & Philips, 1992). The third theory, grounded theory, explained how the
experiences of nurse CEOs might be able to predict the importance of influential factors
in the nurses ascension into CEO hospital roles (Glaser & Strauss, 1967).
Transformational Leadership
The theory of transformational leadership provides an excellent method for
understanding how leadership style influences the transition of nurses into health care
CEO positions. Burns (1978) noted how transformational leaders how they influence
their followers relationship with understanding the needs of the organization. The effect
on followers is a major sphere of influence the transformational leader maintains over
employees and, subsequently, organizational performance. According to Krishnan

20
(2001), transformational leaders tend to involve themselves in a dynamic relationship
with followers who feel elevated by the relationship and become more active themselves,
thereby creating new cadres of leaders.
Transformational leaders inspire their employees and positively influence their
employees performance (Bass, 1985, 1990). Transformational leaders attract and
encourage workers to be innovative and to share their knowledge for enhanced
organizational performance (Bryant, 2003). Matey (1991) identified three behavioral
patterns of transformational leaders that are evident in their leadership style. Each
behavioral pattern has certain attributes that uniquely add dimension to the profile of the
transformational leader. These three behavioral patterns are charisma/inspirational,
individual stimulation, and consideration for the individual (Matey). The characteristics
of these three behavioral patterns engender a style of leadership that includes motivation,
empathy, and empowerment, each of which can be a variable to measure the success of
leaders.
Leadership is a paramount aspect of employee and organizational performance.
Two factors of leadership that affect organizational performance are imagination and
driveelements that motivate a visionary leader (Leavy, 2003). Leavy identified three
main aspects of leadership effectiveness: (a) the context for leadership, (b) the conviction
of the leader, and (c) the flow of credibility over time and tenure (p. 56). The transition of
nurses into CEO positions bears resemblance to Leavys postulation of context for
leadership. Context for leadership is the timing of an opportunity to impact organizational
performance (Leavy). Health care organizations that embrace nurses in their CEO
21
positions are providing timely opportunities for nurses to impact operations and
performance.
Stratified Systems Theory
In Stratified Systems Theory (SST), leaders must perform critical tasks as they
ascend in leadership roles in an organization that allow them to lead their organizations
effectively (Jaques & Clement, 1991). The theory explores the ascension of leaders in an
organization and the qualitative and complex nature of the changes in tasks (Hunt &
Philips, 1992). Stratified systems theory also provides a framework for understanding
how the environment in bureaucratic organizations may affect leadership effectiveness
(Hunt & Philips).
Stratified Systems Theory denotes key behaviors and performance expectations
required from leaders as they ascend into higher leadership roles in an organization (Hunt
& Philips, 1992). An important factor in the principles of SST is the differences in the
decision-making abilities and responsibilities at the higher level of leadership as the
individual ascend in the organization. The ability to make decisions at a higher level is an
important factor to understand when nurses leave their traditional nursing leadership
positions to advance to a higher-level leadership position such as the CEO level. The
research study incorporated the principles of SST to explain the layers of hospital
organizational structure that nurse CEOs encounter in their leadership strategy.
Grounded Theory
Glaser and Strauss (1967) defined grounded theory as the discovery of theory
from data. Grounded theory provides relevant predictions, explanations, interpretations,
and applications (Glaser & Strauss). Grounded theory allows a researcher to derive a
22
theory based on data and is commonly used in qualitative research studies (Neuman,
2003). The identification of influencing factors that enable nurses to transition into
executive roles may provide an explanation of which factors are crucial for success and
for predicting the leadership qualities necessary to ascend to a hospital CEO position.
A grounded theory framework enables researchers to examine predictive
behaviors, interpret results, and apply relevant information to construct a valid theory that
evolves from data analysis (Glaser & Strauss, 1967). Grounded theory is flexible and
accommodates the mixed methodology nature of qualitative and quantitative research
design (Glasser & Strauss).
Definition of Terms
To understand the possible contributory relationships between the ascension of
nurses into CEO positions in hospitals and influential factors that may ease transition, it
is necessary to define the terms involved in the construct of the study. For instance, the
study called for nurses who are CEOs in a hospital environment; the nature of the
environment may or may not be an influential factor that eased nurses transition to CEO
role. Consideration of the hospital environment, such as the organizational structure of a
public versus a private hospital and its geographical location, may indicate easier
transitions for nurses in executive roles. The literature described an environment such as
a hospital as a rich description, a feature of conceptualization that influences
relationships between variables and their meaning in a research study (Rousseau & Fried,
2001). A careful description of the environment and setting of the study is needed to
understand how they may influence the transitional factors nurses may identify from their
lived experiences.
23
Environment is the totality of physical and social factors that are taken directly
into consideration in the decision-making behavior of individuals in the organization
(Duncan, 1972, p. 314). The environment in hospitals is an important consideration in the
leadership success of health care CEOs. The literature indicated that CEOs and managers
in general work in stressful environments (Papidimos & Marcos, 2004; Rudan, 2002).
Changes occurring from multiple sources within health care organizations can have
considerable impact on the performance of leaders (Haveman, Russo, & Meyer, 2001).
Hospital is a long-term care facility, hospital, and multi-hospital network (AHA,
2005). Bed capacity of these institutions was not a criterion for selection of the
organization in which nurse CEOs are leaders. Criterion selection was limited to the
operational definition of health care organizations and the nurse CEOs who lead these
facilities. Environmental conditions vary due to the organizational structure and
classification of the organization, for instance, public versus private or profit versus
nonprofit. Whether such extraneous factors influence the transition of nurses to CEO
positions has not yet been determined based on the lack of evidence from the literature.
Nurse CEO for the purpose of the study is a RN in the four states of Connecticut,
Maine, New Jersey, and New York who holds licensure to practice nursing and who has
been in the position of CEO for at least 2 years.
Setting is the physical description of a hospital or multi-hospital network
regardless of services rendered. The setting in a research study as a contextual factor
influences the spontaneity of participants responses in a direct observation study
(Rousseau & Fried, 2001). The setting of a research study should describe the
environment so that there is a clear understanding of the factors that might influence the
24
studys contextual features (Rowan & Hutson, 1997). The research setting consists of
hospitals and multi-hospital networks that have CEOs that are nurses.
The complexity of the hospital environment challenges a leaders ability to
manage because of the unpredictable forces that may affect effective leadership
(Penprase & Norris, 2005). Therefore, variations in the complexity of health care settings
may either enhance or hamper successful leadership contingent upon the leaders
potential for mastering crucial interpersonal skills (Garman et al., 2004; Martin & Ernst,
2005).
Transition is the movement from traditional nursing patient care leadership to
business and financial leadership positions, such as in the CEO role (Hemmila, 2005).
Assumptions
For the purpose of the study, an assumption was that participants with the title of
CEO share similar leadership and managerial responsibilities within the confines of the
setting and environment of their individual organizations. The American Hospital
Associations description of health care duties and responsibilities assigned to the title of
CEO formed the rationale for the first assumption. Another assumption for the study was
that the extraction of participants from the various databases was accurate and reflected
the definition of an RN CEO. An additional assumption was that the size of the hospital
would not define or limit the general leadership responsibilities bestowed on nurses that
were CEOs in hospital. Although the size of the facility was not a qualifying criterion for
the nurse CEOs participating in the study, a description of the size of their facility is in
chapter 4.
25
A fourth assumption was that participants may have different levels of previous
leadership experience in their traditional nursing roles that may influence the transitional
stages associated with their title of CEO in a hospital setting. Additionally, an assumption
was made that participants may have varying years of experience as a hospital CEO that
may influence responses to the interview questions because selection criteria for
participating in the study is a minimum of 2 years in the title of CEO. A sixth assumption
was made that all participants would feel free to identify inhibiting or enhancing factors
that eased their transition to hospital CEO positions. A seventh assumption about the
study is that themes would emerge from the participants lived experiences that enhanced
their transition from a traditional nursing leadership role to a hospital CEO position.
Finally, it was assumed the participants answered truthfully to questions asked during the
structured interview and provided accurate information recalled from their lived
experiences.
Scope, Limitations, and Delimitations
The scope of the study was limited to the lived experiences of nurses in CEO
positions in hospitals in the states of Connecticut, Maine, New Jersey, and New York.
Commonly referred to the Tri-State area, Connecticut, New Jersey, and New York have a
large variety of hospitals and the AHA database provided an adequate sampling of nurses
in CEO positions. The fourth state of Maine became a location later in the study to
provide adequate sampling of nurses in CEO positions in hospitals. Although other health
care organizations have nurses in CEO positions, the study focused on hospitals because
of the settings and environments that are conducive to the ascension of nurses to CEO
positions. The choice of conducting the study in one type of health care organization,
26
namely hospitals, limited the study because there was no comparison or contrast of the
experiences nurse CEOs may have in other health care settings and environments.
One limitation of the study was there was no comparison of the experiences of
non-nurse CEOs in hospital leadership. Analysis of similarities and difference
experienced by two contrasting groups may provide relevant information about
influential factors associated with the position of CEO whether the leader was a nurse or
non-nurse. Because nurses are emerging into CEO positions, the rationale of selecting
them exclusively as participants is valid for the retrieval of important factors that allow
them to be CEOs.
The study was restricted to the examination of nurse CEO leaders in hospitals in
Connecticut, Maine, New Jersey, and New York. The variables in the study were limited
to upward influence, emotional intelligence, transformational leadership, mentoring
relationships, clinical background, and education background, although other factors
were identified with nurses transition to CEO positions in hospitals. The study excluded
nurse CEOs with less than 2 years experience although their experience may have
contributed to the identification of the studys variables as influential in the nurse CEOs
transition into their new role.
The generalizability of the study was limited due to the small sample size (n = 19)
of the subset of nurse CEOs in Connecticut, Maine, New Jersey, and New York. The
sample size may be unreliable and not representative of the experiences of nurse CEOs in
the remaining 46 states. The size of hospitals that employed nurse CEOs may be an
unreliable predictor of the relevance of lived experiences of nurses transitioning to
hospital CEOs. The experiences of nurses in various hospital sizes may be different due
27
to the intricacies of multi-tiered bureaucratic organizational structures in large hospitals
compared to less tiered, smaller hospitals. Thus, overall generalizability of the study may
be unreliable.
Summary
As nurses ascend into hospital CEO roles, certain factors are clearly emerging as
being influential in the transition to these roles (Gaskill, 2004; Rothenberg, 2001). It is
important to understand how these factors may enable successful leadership and
subsequently enhance operational performance of hospitals because more nurses are
rising to the ranks of CEO hospital leadership (Shea, 2005). Nurses are prime candidates
to ascend into executive hospital roles because of excellent clinical and managerial roles
associated with the nursing profession. Equipped with these assets, nurses are beginning
to make serious claims to top-level hospital leadership positions such as CEO, which men
dominated and controlled by men (Purvis, 2004). Identification of key essential factors
that promote nurses ascension to hospital CEO roles may benefit hospital leadership,
which remains challenged to recruit and retain effective visionary leaders.
The purpose of this qualitative phenomenological study was to examine and
explore the influential factors associated with the ascension of nurses to hospital CEO
roles. Findings in the form of data and themes that clearly identify the relevancy of
influential factors with the increase of nurses in hospital CEO roles may empower and
prepare nurses to seek these hospital executive positions. Chapter 2 presents the literature
review, which includes the summarization of the title search and accentuates the topic
areas researched related to nurses transition to hospital CEO positions. Chapter 2 details
an exploration of topic areas such as mentoring, clinical and educational backgrounds,

28
emotional intelligence, upward influence, and transformational leadership as they relate
to nurses ascension to hospital CEO positions.

29
CHAPTER 2: REVIEW OF THE LITERATURE
Chapter 1 provided an overview of the background and problem about the dearth
of information regarding the factors that may influence how nurses transition to hospital
CEO roles. The qualitative phenomenological study examined the lived experiences of
nurses who are CEOs in hospitals. The review of literature suggested there are multiple
factors that are instrumental to nurses transition to hospital CEO positions. The intent of
chapter 2 is to provide an overview of influential factors that are important to
transitioning into hospital CEO roles. Key words researched for relevancy and
importance to nurses ascension to hospital CEO positions were emotional intelligence,
mentor relationships, upward influence, transformational leadership style, and
educational backgrounds. The results yielded various influential factors that may benefit
how future nurses may need to prepare for executive CEO roles in hospitals.
Documentation
The literature on CEOs discussed the ascension of women to CEO positions in
many industries, including health care (Nelson & Burke, 2000; Roemer, 2002; Wiggins
& Bowman, 2000). The literature review revealed several examples of factors that
influenced the transition of nurses into CEO roles. For instance, clinical background,
upward influence, emotional intelligence, and transformational leadership style are
important factors enabling nurses to achieve CEO roles in hospitals (Carroll, 2005;
Rothenberg, 2001; Shea, 2005; Smith, 2002a). The aforementioned examples from the
literature review described how these factors influenced some nurses who have achieved
hospital CEO positions. Collectively, these influential factors accounted for successful
transition into the hospital CEO role. An examination of the transition of nurses into
30
CEO roles revealed specific influential factors that may enable nurses to achieve the CEO
position in a hospital. The degree of influence of these factors may assist an organization
to develop worthwhile strategies and competencies for facilitating nurses ascension to
top leadership positions in hospitals.
The review of the literature entailed historical aspects of health care
organizational leadership and identified operational, supportive, and internal structures
that provide the foundation for CEO leadership. Enabling factors that included
identification of plausible relationships between leadership style and theory, clinical and
educational backgrounds, organizational skills and culture, and characteristics of nurses
in CEO positions were explored.
Scope of Literature
Although there is literature cataloging the increase of females in CEO positions,
inclusive of health care organizations, various gaps exist in the literature regarding the
ascension process of nurses into CEO positions. An extensive review of the literature
indicated limited studies on the relationships between influential factors and the transition
of nurses to CEO roles in hospitals. The American College of Healthcare Executives
(2001, 2004) has provided demographic information on the increase of nurse CEOs in
health care organizations. As well, there is an abundance of literature regarding how
nurses are currently performing in the executive role (Kerfoot, 2004; Smith, 2002a).
Despite these areas of interest, a lesser amount of information is available that identifies
various factors that influenced those nurses who ascended to the CEO leadership role in
hospitals. The study helped to narrow the gap in the literature that indicated or suggested
there were significant factors enabling nurses to ascend to the CEO role in hospitals.
31
Chapter 2 focused on two main areas: (a) leadership in health care organizations
and (b) enabling factors that influence nurses transition to health care executive
leadership roles. The first area identified the literature related to traditional health care
leadership through a critical analysis of health care organizational structure, operations,
and supportive influences. The second area investigated the role of influential enabling
factors that ease the transition of nurses into CEO positions.
The aim of the literature search was twofold. The first objective was to examine
scholarly studies that pertain to influences that nurses may encounter during their
ascension to the CEO leadership role within a hospital. The second objective was to
investigate the role of the new sciences and workforce development, leadership
competencies, emotional intelligence, and emotional competence in enhancing ascension
to a CEO leadership role in hospitals. The purposes mentioned were the focus of the
literature search.
Title Searches, Articles, Research Documents, and Journals
The study included the collection of research materials through online and
traditional approaches. The literature review consisted of searches of scholarly books,
referenced journal articles, and research documents obtained through the University of
Phoenix University Library Internet search engines EBSCOhost, InfoTrac OneFile,
ProQuest, and Journals@Ovid. Questia, the online library of books and journals, was
another source that provided books and articles for the literature review. Bibliographic
and reference listings were used from appropriate titles for further literature searches
through public libraries interlibrary loan services. Although not all of the literature
32
searched was applicable to the research study, Table 1 illustrates a summary of the
literature categories searched that were applicable to the study.
Table 1
Literature Categories Searched
Scholarly journals Doctoral
Categories searched and articles dissertations Books
Career transition into executive roles 106 8 10
Clinical and educational backgrounds 96 5 10
(including nurse chief executive officers)
Transformational leadership 284 25 27
Emotional intelligence, competence and 232 16 19
leadership
Upward influence 138 4 12
Mentoring relationships 202 18 14
As shown in Figure 1, the review of the literature included an exploration of
historical and current findings on the possible influential factors associated with the
transition of nurses into hospital CEOs. Theoretical frameworks of stratified systems
theory, grounded theory, and transformational leadership theory provided support for the
influential factors identified in the study. The roadmap depicted in Figure 1 illustrates the
three theoretical frameworks of the study. The literature review roadmap also depicts
areas inclusive of a historical perspective and findings on clinical and educational
backgrounds, transformational leadership, emotional intelligence, mentoring
relationships, and the theoretical framework.

33
Introduction and overview
Research Question:
What are the influential factors that ease
the transition of nurses into CEO roles?
Current findings on influential factors:

Historical overview Research question independent variable
Current findings on transition Findings on clinical and

into executive roles educational background
Findings on transformational
Theoretical framework
leadership
Findings on emotional
Stratified systems theory
intelligence
Findings on upward
Grounded theory
influence
Findings on mentoring
Transformational theory
relationships
Figure 1. Roadmap of literature review.
Introduction to the Literature Areas
Peer-reviewed journal articles provided supportive evidence of the relationship
between (a) influencing factors, such as clinical background and educational background,
and (b) the success of nurses in executive roles (McPeck, 2001; Wood, 2004). Gaskill
(2004) found other enabling influential factors such as the relationship between (a) the
34
ability to delegate and prioritize and organizational skills and (b) essential competencies
associated with nurse executive roles. Gaskill identified these characteristics as
elementary components of leadership theory that are prominent in nurses traditional
roles as nurse managers and directors of nursing. Gaskills assertion supported interviews
from nurse CEOs (Curan, 1993; Smith, 2002a) that linked relevant nursing background to
their transition into executive roles.
The supportive literature in leadership practices (Bass & Avolio, 1992; Deming,
1986) and in organizational performance (Kipnis, Schmidt, & Wilkinson, 1980) is
classical sources for empirical studies conducted on these topics. Key terms and variables
in the study are leadership styles, influencing strategies and transformational leadership..
Theoretical frameworks and results from valid findings have supported the variables of
leadership styles, influencing strategies, and transformational leadership (Leach, 2005). A
second theoretical framework, SST, noted that as individuals ascend into leadership roles
in an organization, leaders must perform critical tasks that allow them to lead their
organizations effectively (Jaques & Clement, 1991).
Stratified systems theory explored the ascension of leaders in an organization and
the qualitative and complex nature of the changes in tasks. An important factor is the
difference in the decision-making abilities at the higher level of leadership. The
foundational work of SST evolved from studies dominated by male participants. Male
domination was an important consideration in this study, where women were the
predominant participants.
Competencies associated with effective leadership in health care management are
an important area of consideration in exploring the lived experiences of nurses in CEO

35
roles in hospitals. Wallick and Stager (2002) presented information on workplace
learning and performance tools that enhance a leaders ability to improve organizational
performance. Organizational performance may be an important consideration in
examining whether nurses are successful in hospital CEO positions. Theories found in the
literature covering organizational performance provide support (B. Anderson & Kleiner,
2003; Bello-Adeyemi, 2001). B. Anderson and Kleiner emphasized the relevancy and
importance of critically assessing the measurement of CEO performance. B. Anderson
and Kleiners study provided insight into identifying criteria for the measurement of CEO
performance.
Historical Perspectives
The top echelon in the business world is predominantly male (Wells, 2001) and in
health care; men in CEO roles (25%) outnumber women (11%), as noted by the most
recent demographic figures from ACHE (2001). More women, in particular nurses, are
ascending to senior leadership positions such as CEOs (ACHE). The increase in women
into senior leadership positions challenges the nature and prevalence of the male-
dominated health care executive position. A retrospective analysis was necessary to
understand how nurses evolved to leadership roles in hospitals and to understand why it
has taken so long for them to rise to the CEO levels in hospitals.
Hospital matrons and female superintendents made high-level decisions in
hospital administration over 100 years ago (MacManus, 1929). Prior to the 1950s,
superintendent of nurses led hospitals along with the chief medical officer (Curtain,
2003). Kinzer (1982) noted early health service management was delegated to nuns or
well-weathered nurses. Interestingly, the sex-gender issue was nonexistent in early

36
hospital decision-making roles because all nuns and nurses were women. With an
increase in regulation and third-party payers, the development of specialized courses in
hospital administration eventually gave rise to business- and finance-related CEO
positions (Curtain, 2003). Curtain (2003) posited that the elimination of nursing
leadership positions were a result of the evolvement of the hospital CEO role and because
hospitals became a business model.
Achterberg (1990) noted nurses have always functioned under two layers of male
dominance in hospitals: that of the executive level (CEO) and by practice authority
(physicians). It is from the dual layered male dominance that nurses have been able to
transcend to hospital CEO positions. The phenomenon of nurses ability to make the
transition to CEO roles, a traditional male-dominated role in hospitals, is evident in the
literature review of influential factors that may ease nurses transition to these hospital
executive roles.
Entrance into male-dominated hospital executive roles has not been an easy
accomplishment for women. Dempsey-Polan (1988) posited,
No matter which career path a female executive decides to take in the health
services system, she will, inevitably, encounter some degree of professional
isolation, continuing discrimination, untempered problems of balancing career
and family, and erosion in the number of meaningful executive positions. (p. 95)
Demsey-Polans (1998) assertion may still be attributed to the struggle of women
in hospital executive roles in the competitive environment of the 21st century; however,
according to the trends from ACHE (2001) and the AHA (2005), women are acquiring
executive roles despite actual or potential struggles associated with acquiring these
37
positions. With the increasing upward trend of nurses rising to such roles in health care
organizations, distinctive attributes and factors influencing their transition into these roles
are emerging, thus making it necessary to explore the characteristics of these influential
factors. Through the findings from data analysis, organizations may benefit in selecting
the most effective individuals to take charge of their operations. The acquisition of
various skills is necessary to enable nurses to transition into executive roles (R.
Anderson, 2001; Baggett & Baggett, 2005).
Research Questions
In an experimental study of medically trained health care executives conducted by
Schultz, Pal, and Swan (2004) using computer simulation for decision making, several
factors were noted to impact decision making from quality-of-care and financial
perspectives. Some of the factors were clinical and financial backgrounds (Schultz et al.)
Although the studys participants were physician CEOs, similar factors are possible in
nurse CEOs decision-making abilities that influence the performance of the
organizations they lead. The ascension of nurses to top-level management in health care
organizations elicits inquiry into identifying factors that contribute to successful
transition. These factors, and how they may have eased the transition of nurses to CEO
positions, provided the impetus for several questions:
attainment?
interpreted by nurse CEOs?

38
Literature Review
The review of the literature includes an exploration of factors commonly
associated with influencing the transition into executive leadership roles. The literature
review also included an investigation of historical trends of traditional male dominance of
hospital CEO positions. Subsequently, the barriers that commonly exist for women in
health care CEO positions were identified (Andrica, 1997; Jamieson, 1999; Roemer,
2002) and how nurses are making strides in transitioning to hospital CEO positions was
revealed (Baggett & Baggett, 2005; Gaskill, 2004; Kerfoot, 2004; Smith, 2002a).
Transition
For many nurses who transition into health care CEO roles, a major
transformation occurs as they leave traditional nurse executive managerial roles (Baggett
& Baggett, 2005; Hagenow, 2001). Nurses, however, often possess many transferable
skills that enable them to be successful in these roles (Baggett & Baggett; Gaskill, 2004;
Hemmila, 2005). How nurses transition to executive positions varies. For some, the
transition was mentoring relationships enabled by directly influencing senior executives
(Roemer, 2002). Others may transition to these positions by demonstrating effective
leadership while in traditional nursing managerial roles (Redman, 2006; Smith, 2002a).
Still others may have easier transitions by achieving academic preparation that may
enhance their ability to lead at the senior executive level (Redman).
Transitional factors in the study were identified based upon the lived experiences
of the participants and were examined for themes regarding factors that may enable
39
success in the CEO role. Hence, a qualitative phenomenological study was appropriate to
examine the significance of the experiences of nurses who migrate to hospital CEO
positions. Phenomenological methodology designs illustrate lived human experiences and
enhance evolvement and meaning of themes (Moustakas, 1994). The study utilized a
modified van Kaam method of analysis for examination of themes, as defined by
Moustakas.
Bridges (1991) defined transition as the psychological term people go through to
come to terms with the new situation (p. 30). Transition is an internal means of letting
go of something from the past, while preparing to enter into a neutral zone (Bridges). A
neutral zone is the reality of the old and the new (Bridges, p. 5). The transitional period
is marked by the assessment of past skills and success while carving strategy for future
success (Morris, 2005). Drawing upon the reality of the old and new, as posited by
Bridges, a zone is created when the individual either progress in the new or remain
stagnant from the old. The concept of a neutral zone may be a crucial phenomenon when
applied to how nurses are transitioning into executive health care roles.
In the context of understanding how nurses are transitioning to CEO positions in
hospitals, it is important to identify the influential enabling factors that ease the process
and whether the organizational structure aids the transition. Gunz (1988) posited that
organizations exert influence on the direction of their managers career goals. Gunzs
suggestion may be an important observation in considering influence as an enabling
factor for transitioning into a new role. In a study of aspiring hospital CEOs conducted by
Parsons et al. (1997), participants reported that their organizations assisted with skill
40
development and financial support of education and enhanced their ability to be decision
makers.
Kwesiga and Bell (2004) noted organizational socialization tactics are influential
to the career advancement of women. Concerning the relevancy of workplace issues such
as the bias and gender discrimination women often experience, Kwesiga and Bell
advocated for supportive organizational changes as a means of enhancing womens
ascension to executive positions. Organizational support, then, is one way to examine the
transition to executive roles.
Hemmila (2005) described the transition from patient carethe traditional
domain of the nurseto business and financial executive positions as not being easy. In
an interview of nurse CEOs, Hemmila noted the importance of a business education for
successful transition into CEO roles. Similarly, Rothenberg (2001) posited that
organizational behavior and financial management are essential educational elements for
nurses migrating into CEO roles. In a study of CEOs and chief nursing officers,
Wiseman, Minnick, Dienemann, and Cassard (1995) identified the joint Master of
Science in nursing and Master of Business Administration (MSN/MBA) degree as the
best educational preparation for nurses who want to ascend to upper management roles.
Thus, an abundance of literature contends that educational background and preparation
are essential as transitional factors for nurses aspiring to CEO positions.
Mentorships
Mentoring relationships should start early in a career, especially when an
individual has ambitions to lead organizations (Ashby & Miles, 2002). For female nurses
who desire to ascend into executive positions traditionally dominated by men, mentoring
41
may be a key component of a transitional process. In a study conducted in Australia by
Tharenou (2005), the importance of a mentoring relationship on the advancement of
female careers was significantly higher than in males.
Tharenous (2005) study indicated a mentoring relationship, as a developmental
initiative to assists womens advancement in their careers, was relevant to their success.
Indeed, in the study by Tharenou, women regarded their mentors as advisors, sponsors,
teachers, path pavers, and career guides (pp. 80-81). Tharenous results revealed that
mentoring is a key transitional factor that influences the advancement of women to
hierarchal positions and, thus, its importance may be relevant in nurses aspiring to
executive health care positions that are traditionally male dominated.
In contrast, Roemer (2002) revealed that 54% of female CEOs in health care
claimed to have had the guidance of a mentor as they ascended into their positions. Many
of these female CEOs thought their advancement into their positions was easier by
having a mentor, but did not feel having a mentor was a requirement for attaining their
CEO positions. If Roemers finding is a prevailing sentiment among female health care
CEOs, then the importance and relevancy of mentoring in a CEO position and whether
mentoring is a significant factor that facilitates the transition of nurses into CEO positions
is debatable.
The transition of nurses into CEO roles will identify which factors enable the
achievement of these executive positions in a health care organization. The importance of
these factors can reveal successful strategies and competencies required for facilitating
nurses ascension to top leadership positions in health care. The literature established that
a health care executive needs behavioral and managerial competencies to lead

42
organizations effectively (Shewchuk, OConnor, Fine, & Tyler, 2005). Other factors such
as mentor relationships seem to enhance the transition into higher executive positions, as
noted by Roemer (2002) and Tharenou (2005).
In general, the literature review provided adequate information regarding
transition, expounding on the transition into executive roles from a broad perspective and
not simply limiting the focus to nurses migrating into specific roles, such as CEO. The
review yielded an empirical definition of transition offered by Bridges (1991) that linked
to literature specifically identifying the relationship of transition to a new role and the
various factors associated with it. Thus, the review of literature narrowed the gap of
knowledge about transitional factors related to the ascension of nurses into senior
executive health care positions. The narrowing of the gap helped to support the literature
review related to the influential factors, resulting in a causal or thematic relationship
between all variables identified in the study.
The literature review included multiple perspectives of different studies
recognizing the relevancy of influential factors associated with transition to executive
health care positions. Roemers (2002) study presented a contrasting view of the
relevancy of mentoring relationships (as perceived by female health care CEOs) to the
successful transition into CEO positions. Although Roemers participants were not all
nurses, there were similar findings identified by the participants in the study (who are all
nurses) and the female CEO participants in Roemers study.
Clinical and Educational Backgrounds
The importance of a clinical background as an advantage to health care CEO
leaders has been widely debated (Schultz et al., 2004). The debate stemmed from the
43
relevancy of leaders with a clinical background versus those with a finance background
regarding who was better equipped to manage and lead health care organizations. In
organizations that are strategy focused, leaders must exhibit various dimensions of
knowledge that empower them to make better decisions. Nurses are setting the trend in
health care leadership at the CEO and COO levels by using a key advantage: their clinical
expertise enables them to make sound decisions in terms of patient care in their executive
roles.
In an interview with nurse CEOs, Smith (2002a) extrapolated from interviewee R.
Anderson the relevance and importance of clinical background in her duty as COO.
Anderson commented on her incremental ascension into nursing executive positions that,
along the way, fostered her growth, confidence, and ability to function in the CEO role.
Most notably, Smith highlighted Andersons acknowledgment of being patient centered
in her position because of being a nurse.
McPeck (2001) found a sample of nurse CEOs who mutually agreed their clinical
background enabled them to be successful in their CEO roles. McPeck determined the
ways that nurse CEOs were successful in managing care due to their clinical background,
in addition to their ability to manage costs. Nurse CEOs contended their ability to fall
back on their experience with clinical and patient care issues kept them focused on
patient care needs and outcomes (McPeck). Gaskill (2004) declared that decision making
related to patient care is a primary advantage that nurse CEOs may have in leading health
care organizations. Gaskill posited that CEOs with business backgrounds have a tendency
to look more at cost rather than patient-care needs. Gaskill asserted that nurse CEOs are
able look at cost and patient-care needs effectively.

44
Clinical experience is integral to the relationship between the nurse CEO and
physiciansessential stakeholders in any health care organization (Gaskill, 2004). Nurse
CEOs acknowledged that physicians prefer having a clinical person in the role of CEO
(Wood, 2004). Nurse CEOs, unlike non-nurse CEOs, can relate to physicians concerns
and interests in patient care through the common thread of clinical backgrounds. In an
interview with a nurse CEO, Grazier (2005) found that having a clinical background was
important in understanding the complexities of hospital administration and the special
needs of patients.
The literature brings to light a debate regarding whether the masters of health
administration or the MBA was the ideal educational preparation or degree for health
care executives (Miller, Hagen, & Johnson, 2002). According to Hudak, Brooke,
Finstuen, and Riley (1993), both degrees provided knowledge of fundamental business
strategies imperative for leading health care organizations. Waldman et al. (2006) noted
the importance of the graduate degree in a survey of 670 health care CEOs, of which 90%
held advanced degrees. Seventy-nine percent (n = 529) held a masters degree in public
health or health administration (n = 200), in business administration (n = 168), or in the
sciences, arts, or other fields. In addition, 9% of these CEOs held doctoral degrees
(Waldman et al.).
The literature identified one of the barriers that stagnates nurses and womens
ascension to top leadership positions as the lack of a financial and business background.
Cappelli and Hamori (2005) conducted a study of CEOs from various industries.
Included in Cappelli and Hamoris study were women CEOs (primarily nurses), who
represented 32% of health care CEOs in the study sample. Many of these CEOs
45
possessed additional degrees, principally MBAs. As more nurses continue to acquire
CEO roles in health care organizations, knowledge of finance and business will become
increasingly necessary to manage the non-clinical aspects of health care. The Johnson
and Johnson Corporation along with the Wharton School of Business have provided
business and management education to nursing executives for over 20 years (Nurse
executives, 2002). In essence, the educational background that prepares nurses to manage
business aspects as a CEO is an important transitional factor in enabling success.
Leadership Style
The success of an organization correlates to the leaders ability to achieve goals
and objectives that result in successful outcome performance (Bennis, 1994; Corrigan,
2004; Mayo & Nohria, 2005). Nurses demonstrate their ability to lead organizations by
utilizing their varied backgrounds in patient-care needs, clinical expertise, and
collaborative working relationsamong other factorsto provide competent and
confident visionary leadership (Carroll, 2005; Shea, 2005).
Transformational leadership principles provide volumes of workable, realistic,
and researched theory to extrapolate how nurse CEOs incorporate the transformational
leadership style in creating a visionary organization. Transformational leaders must
indicate congruency between their personal value systems and theoretical value systems
to achieve success. Krishnan (2001) suggested that transformational leaders give greater
importance to values pertaining to others than to values pertaining to themselves. Burns
(1978) posited that transformational leadership evolved from the role of deliberate
purpose drawn from values. Hence, value identification is crucial to have successful
relationships and to articulate a clear vision that followers can perceive.

46
Although transformational leadership is an inspirational attribute that may assist
nurses in transitioning to CEO positions, other important attributes of leadership is
worthy of consideration. Sankar (2003) emphasized that a leaders characteras opposed
to charismais essential to exceptional leadership. Sankar purported that character is
noteworthy in an organizations value system and emanates from the leaders
demonstration of valued-based decision-making. Historically, nurses have exhibited
credible, ethical, and moral character that evolved from being sensitive to the care needs
of patients (Day, 2005). High-caliber ethical and moral character can be the foundation
for developing strong leadership skills. Sankar also observed that leaders with good
character had integrity, a key ingredient for leaders to elevate the performance of their
organizations.
Emotional Intelligence
Early stereotypes of women leaders gave little credence to their ability to manage
efficiently and with success because of traditional gender role stereotypes (Potterfield &
Kleiner, 2005). Much of the criticism leveled at women by males forced women to face
challenges such as demonstrating proof of their abilities and their willingness for
commitment. As well, women were customarily prone to microscopic analysis of their
leadership styles. Societal changes brought modifications in values, opinions, and
abilities probably accounts for the rise of women in executive roles in various businesses.
To meet the needs of an endlessly changing work environment, a leader must
develop various competencies inclusive of emotional, spiritual, and analytical skills. The
evolution of leadership theory is composed of numerous approaches such as the one-man
theory, power theory, and trait theory, among others. In essence, leadership categorically
47
has many perspectives. The aspiring leader is fortunate to have a wide array of choices to
consider when developing a personal leadership style. However, the personal factors
associated with leadership are important and worthy of consideration in understanding
their uniqueness in leaders. Bass (1990) suggested there was an emergence of interest in
the personal factors of leadership, in relation to the life-span development of the
transformational leader (p. 897). Bass explained there is a need to learn more about the
contributions of self confidence, self-determination, and freedom from inner conflict of
the charismatic leader for long term predictors of successful leadership (p. 898).
Keen awareness of emotional intelligence and its bearing on effective leadership
is a positive outcome of transformational leadership (Potterfield & Kleiner, 2005). To
foster motivation and inspiration in others, the transformational leader has to develop
appropriate skills to meet the needs of followers. Compared to transactional leadership,
transformational leadership is more emotion-based and requires heightened emotional
levels (Yammarino & Dubinsky, 1994).
Palmer, Walls, Burgess, and Stough (2001) noted that the inspirational motivation
and individualized consideration components of transformational leadership significantly
correlated with the ability to monitor and manage emotions in the self and in others.
Hence, leaders must be able to develop a comfortable mastering of emotional competence
and intelligence to achieve the goals and expectations of organizational leadership (Higgs
& Aitken, 2003).
In a contemporary research study on male and female managers, Robinson and
Lipman-Blumen (2003) revealed distinct leadership behaviors were gender related. The
study captured data about gender leadership behavior over an 18-year period that spanned
48
3 decades (1984 to 2002). The length of time is very important in Robinson and Lipman-
Blumens study, because it significantly contributed to a large sample size and revealed
the trend of more women managers in organizations. Rosener (1990) indicated changes in
the managerial environment had converted womens purported liability in management
into an asset. Robinson and Lipman-Blumen noted the importance of collaboration and
nurturance necessary for female managers as opposed to power and control, attributed to
male managers. The observation may be indicative of emotional intelligence among
female managers and could be a manifest characteristic in nurse CEOs.
Executive leadership consists of many factors, but a pertinent component
necessary to heighten the operations of an organization is the emotional intelligence (EI)
of its leaders. Maximizing the benefits of EI concept entails integrating the competency-
based model of emotional intelligence described by Goleman (2001). Golemans model
considered workplace applications and consisted of competencies that result in
outstanding performance. Golemans competencies outline four leader abilities: self-
awareness, self-management, social awareness, and relationship management. These four
abilities permit the leader to distinguish and control emotions within the self and others.
Two of the four abilities, self-awareness and relationship management, are marked for
100% compliance in the plan of leadership. Self-awareness and relationship management
are crucial for being an effective, emotionally competent leader.
Gardner and Stough (2002) surveyed managers (n = 110) with high levels of
emotional intelligence and found they were more likely to desire success, lead an
effective team, and be more satisfied working with others. Additionally, emotional
intelligence in leaders is vital for the leaders to manage complex organizations (Cann,
49
2004). Barling, Slater, and Kelloway (2000) and Palmer et al. (2001) showed linkages
between successful leadership and emotional intelligence. Similarly, other researchers
have linked the importance of emotional intelligence to productive leadership and
business success despite leaders demonstration of intellectual intelligence (R. K. Cooper
& Sawaf, 1997; Potterfield & Kleiner, 2005). The evidence of emotional intelligence to
effective leadership demonstrated in the aforementioned literature indicates its
importance as an influential factor in executive roles.
Upward Influence
Influence tactics have proven to be important in the management of people (Cable
& Judge, 2003). The effectiveness of influence tactics may depend on the leadership style
of the individual. The transformational leader, for example, will employ motivational and
inspirational strategies when exerting upward influence (Cable & Judge). Yet, few
studies exist that identify the nature of upward influence as a factor in the ascension to
higher-level executive roles.
Early empirical studies (Kipnis et al., 1980; Mowday, 1978) explored various
influence strategies used by managers to achieve the goals of the organization. Other
studies noted how managers in lower positions have used upward influence tactics with
high-level executives to increase their base of power (Kotter, 1990; Yukl & Falbe, 1990).
Enns and McFarlin (2003) associated background and functional roles with choice and
type of influence used on peers. Enns and McFarilin noted backgrounds such as
education and socialization affected how the leaders ability to influence developed. In
understanding how nurse CEOs may use upward influence tactics in transitioning to
50
executive roles, the relevancy of education and socialization may lend credence to
proposing their importance as background factors that assist in the process.
Nurse CEOs are predominantly female and thus the issue of influence and gender
requires consideration in the transition to executive roles. In a study of 109 male (n = 74)
and female (n = 35) managers conducted by Rajan and Krishnan (2002), gender was
found to be a factor in perceiving authoritarianism, thereby influencing the effects of
influence and power. Rajan and Krishnan declared that authoritarianism was a trait of
human personality notable for determining influence strategies. Rajan and Krishnan
found that authoritarianism has a negative effect on women, resulting in the perception of
them as unfriendly and subsequently affecting their capacity for influencing those around
them. Rajan and Krishnans results are an important consideration in understanding why
women may have difficulty influencing others, especially in a high-level position such as
CEO. Most importantly, the ascension of nurses who are mostly females to CEO
positions could have adverse effects if they are unable to influence key people in the
organization.
Likewise, a study conducted on 658 middle- and executive-level managers by
Bartol, Martin, and Kromkowski (2003) identified how gender norms influence leader
behaviors. The results of the study indicated gender leader behavior may be advantageous
at the executive level and thus can be beneficial for women in executive positions. Other
results from the study indicated that leader behaviors that exhibit concern for and value of
interpersonal relationships are dominant in female executives and are a source of strength
in female leadership (Bartol et al.).

51
Mentorship
Women executives have articulated their need for help in ascending into
hierarchal positions in organizations (Van Velsor, 1987). In interviewing female CEOs in
health care organizations, Roemer (2002) noted that 19 of 35 women (54%) stated
mentoring relationships were helpful to their success. The effects and influence of
mentoring relationships on the promotion and achievement of success is identifiable in
the literature (Walsh, Borkowski, & Reuben, 1999). Walsh et al. identified mentoring
relationships as a crucial aspect of grooming for executive positions in health care
organizations. As an influential factor in nurses transitioning to health care CEO
positions, mentoring relationships are regarded to be instrumental in the ascension of
nurses to the CEO position in a hospital (Smith, 2002a, 2002b).
Tharenou (2005) concluded that mentoring had a greater influence on the career
advancement of women than of men. Tharenou identified vital elements such as
coaching, sponsoring, and assigning challenging work as components of mentoring
relationships that aided the career advancement of women. Most of the mentoring
relationships in the Tharenou study were women providing tutelage to other women.
With the increase of nurses ascending to health care executive positions, individuals in
these high-level roles may need to consider mentoring emerging nurse leaders for
succession in CEO roles. The breadth and depth of the review of the themes and factors
associated with nurses ascension to hospital CEO positions revealed various inferences
in how clinical and educational backgrounds, leadership style, emotional intelligence,
upward influence, and mentor relationships are variables in the transition to hierarchal
health care executive positions. Successful leadership and organizational performance

52
linked with leaders acquisition of skills related to the aforementioned variables. The
literature described various influential factors that assist in an easy transition to health
care CEO and other executive roles.
The review of transformational leadership theory revealed a relationship between
a leaders style and influencing factors that aid in transitioning to hierarchal positions.
Furthermore, for nurses transitioning to health care CEO positions, the literature review
made inferences to the relevancy of clinical and business backgrounds as important to
performance and success in the role. Finally, the literature indicated the positive influence
of mentoring relationships among women aspiring for health care executive roles.
Stratified systems theory (SST) notes that as individuals ascend in leadership
roles in an organization, leaders must perform critical tasks that allow them to lead their
organizations effectively (Jaques & Clement, 1991). Stratified systems theory explores
the ascension of leaders in an organization and the qualitative and complex nature of the
changes in tasks (Hunt & Philips, 1992; Kur & Bunning, 2002). Stratified systems theory
also provides a framework for understanding how the environment in bureaucratic
organizations may affect leadership effectiveness (Hunt & Philips).
The concepts associated with stratified systems theory was useful in dissecting the
layers of hospital organizational structure that nurse CEOs encounter in their leadership
strategy (Hunt & Philips, 1992). Stratified systems theory notes that the number of layers
in an organization prepares leaders to maximize their skills and talents (King, 2003). In
essence, stratification within organizational layers may enhance ascension into high-level
positions because of the opportunity to develop at various levels (King). An important

53
factor is the difference in decision-making abilities at the higher level of leadership. The
foundational work of SST evolved from studies dominated by male participants. Male
domination is an important variation from the study where females were the predominant
participants. The variation may prompt the argument that males and females operate
differently in leading organizations, although SST does not consider gender theory.
Traditionally, nurses have mastered leadership tasks within the domain of their
profession. The relevancy, however, of nurse leadership tasks to the roles and
responsibilities of being a CEO is unsubstantiated by existing studies. Stratified systems
theory provides a framework to identify attributes or behaviors needed in nurses as they
ascend to senior leadership positions in health care organizations and a method to
examine whether nurses are a suitable fit as hospital CEOs.
Grounded Theory
Grounded theory provides relevant predictions, explanations, interpretations, and
applications (Glaser & Strauss, 1967). Grounded theory looks at interpretation of
qualitative data to generate new theory (Glaser & Strauss). Thus, a qualitative study that
describes the lived experiences of nurses and their perception of influential factors in
their transition to CEO positions has the general underpinnings of grounded theory.
Grounded theory allows a theory to be derived based on data and is common to
qualitative research studies (Neuman, 2003).
The identification of influencing factors that enable nurses to transition into
executive roles will provide an explanation of which factors are crucial for success and
are applicable in predicting the leadership qualities necessary in these roles. In addition,
examining the lived experiences of nurses in hospital CEO positions through sensitive
54
coding and interpretation of emerging themes are important considerations in applying
grounded theory concepts in qualitative research (Charmaz, 2006).
A grounded theory framework enables researchers to examine predictive
behaviors, interpret results, and apply relevant information to construct a valid theory that
evolves from data analysis. Grounded theory enables the data collection process and
analysis to be compared so new theory can be developed and refined from information
retrieved from the data (ODonoghue & Punch, 2003). The constant comparative nature
of grounded theory should be used in qualitative studies, especially with the purposive
sampling procedure, coding of data, analysis of data, categorizing data, and refining
evolving theory (ODonogue & Punch, p. 11).
Because of the qualitative design of the study, new theory evolved from the
analyses of themes associated with nurses lived experiences in the role of hospital CEO.
The principles attributed to grounded theory may help to understand how influential
factors identified by nurses may help to assist future nurses who may desire to acquire
hospital CEO roles. Thus, the theory substantiates the rationale for its inclusion in the
study, as it is an acceptable approach to obtain data retrieved from the actual experiences
of participants and not based on hunches about possible phenomena.
Conclusion
The ascension of female nurses to executive health care positions such as CEO is
a relatively new trend as organizations are embracing the attributes and skills of nurses
that enable them to lead at the executive level. Leadership in the early 21st century health
care environment has various challenges that present opportunities for nurses to lead an
institution to performance success. Hospitals throughout the United States are beginning
55
to embrace alternatives in CEO leadership as more females transition into these executive
roles. Many of these females began their health care profession as RNs. The study used
the demographic data on nurse CEOs in the states of Connecticut, Maine, New Jersey,
and New York to explore the influential factors that enabled nurses to reach top executive
leadership positions such as a CEO. Based on the review of the literature, the studys
contextual factors, and the proposed population, a salient relationship emerged among
factors influencing the ease of transition of nurses into CEO roles in hospitals.
Summary
The literature is ample in identifying the characteristics of executive leadership in
hospitals. However, the influences of women on hospital leadership, especially those who
are nurse CEOs, are devoid in the literature and subsequently present an opportunity for
inquiry. Exploration of historic and contemporary factors in assessing the rise of nurses
into health care executive roles will benefit hospital organizational leadership by
providing opportunities to enhance strategies for helping these leaders to surface.
The literature review entailed a comprehensive approach to exploring the chief
influential factors that enable nurses to transition into health care CEO roles in hospitals.
A review of the literature considered various factors such as the significance of (a)
clinical background (Gaskill, 2004; McPeck, 2001), (b) leadership style (Bass, 1990;
Bryant, 2003; Burns, 1978; Krishnan, 2001), (c) emotional intelligence (Gardner &
Stough, 2002, Goleman, 2001), (d) mentoring relationships (Tharenou, 2005; Walsh et
al., 1999), and (e) upward influence (Cable & Judge, 2003) as influential factors in nurses
performing in the CEO role.

56
Chapter 3 discusses the research approach, method, design, and appropriateness
of the selected methodology. A description of the studys population and the process of
selecting participants for the study are also included in chapter 3. The remaining sections
of chapter 3 include a description of the process for data collection and analysis, as well
as an explanation of the studys validity and reliability.

57
CHAPTER 3: RESEARCH METHODOLOGY
The purpose of this qualitative phenomenological research study utilizing a
modified Van Kaam method with semi-structured taped and transcribed interviews was to
explore and describe the lived experiences of nurses in hospital CEO positions. A
qualitative approach allowed a lens to view the human lived experience that is a
foundation of phenomenological studies and thus provided a clear autobiographical
description of the participants in the research (Moustakas, 1994). Nurses were
participants because they have lived the experience associated with the phenomenon of
influential factors enabling their transition to hospital CEO roles. Chapters 1 and 2
provided the introduction, background, and review of the literature associated with the
study. Chapter 3 describes the design of the study, research approach, interview
questions, data gathering process, and data analysis.
Research Design
The exploratory research began with an extensive literature review that included
transformational leadership characteristics, influential factors that enable effective
leadership, and theoretical explanations of leadership ascension in organizations. Despite
the thorough review of the literature, there appears to be a lack of convincing notation of
the success of nurses in CEO roles in hospitals. The qualitative phenomenological
research design was appropriate for the study because the approach entailed objective
exploration of an understudied area. The study incorporated the elements of a
phenomenological study by exploring certain characteristics and phenomena associated
with the participant population of nurse CEOs (D. R. Cooper & Schindler, 2003). Thus,
the research employed a modified van Kaam method as defined by Moustakas (1994)
58
along with empirical phenomenological methods to examine the lived experiences of
nurses in hospital CEO roles. The following definitions and descriptions of the qualitative
phenomenological design provide a rationale for selecting the methodology and its
appropriateness for the study.
Phenomenological Approach
Moustakas (1994) noted the phenomenological approach involves a return to the
experience in order to obtain comprehensive description that provide basis for reflective
structural analysis that portrays the essence of the experience (p. 13). Notably, van
Kaam (1966), in his germinal description of the phenomenological approach, noted
phenomenology seeks to disclose and elucidate the phenomena of behavior as they
manifest themselves in their perceived immediacy (p. 15). Both of the aforementioned
descriptions of the phenomenological approach indicate that empirical phenomenology
research should consider what an experience means to the participant from having lived
the actual experience (Moustakas). Moustakas and van Kaams (1966) suppositions lay a
firm foundation for the objectivity of choosing a phenomenological research design in
exploring the meaning of participants lived experiences.
Moustakas (1994) indicated, The method of reflection that occurs throughout the
phenomenological approach provides a logical, systematic, and coherent resource for
carrying out the analysis and synthesis needed to arrive at essential descriptions of
experience (p. 47). The phenomenological approach enables understanding of the
logistics of the phenomenon to arrive at a conclusive interpretation of lived experiences.
Larkin, Watts, and Clifton (2006) supported Moustakas view of the phenomenological
researcher and noted, researchers must approach their data with two aims; to understand
59
their participants world and to describe what it is like (Larkin et al., p. 104). Larkin et
al. contended that the ability to achieve these two aims allows a researcher to present data
as itself (p. 108) or on its own terms (p. 108). Ehrich (2003) described four distinct
qualities of phenomenology: description, reduction, essences, and intentionality that were
originally the foundational work of Merleau-Ponty. These qualities, according to Ehrich,
enable researchers to investigate the given (description), suspend predetermined
assumptions (reduction), get to the core of an individuals experiences (essences), and
examine each individuals unique experience (intentionality). Thus, the
phenomenological approach to research facilitates the interpretation and description of
unique themes from the examination of lived individual experiences.
Qualitative Design
Creswell (2002) noted, The inquirer keeps the direction for a study open to best
learn from participants (p. 145). Thus, a researcher employing a qualitative design
should allow participants to describe their experience in their own words (Creswell,
2002). The qualitative inquiry is typically used to answer questions about the complex
nature of phenomena from the participants point of view (Leedy & Ormrod, 2001, p.
101). There is consensus that a researcher plays an integral role in interpreting qualitative
research (Creswell, 1998; Larkin et al., 2006). Creswell (1998) opined that, The
researcher builds a complex, holistic picture, analyzes words, reports detailed views of
informants, and conducts the study in a natural setting (p. 15).
The study involved an examination of phenomenological themes associated with
the lived experiences of nurses in hospital CEO positions. The ability to understand and
make sense of possible themes or emerging factors is a foundation of qualitative research.

60
Qualitative research investigates a phenomenon by employing strategies such as
comparing, replicating, and contrasting the object of a study (Creswell, 2003). The
research included purposeful sampling, considered a qualitative approach, where
researchers intentionally select individuals and sites to learn or understand the central
phenomenon (Creswell, 2002, p. 194). The purposeful approach is appropriate for the
selection of a representative sample of an accessible specific population of nurse CEOs
and does not solely rely on data that are conveniently available within the sites chosen for
the study (Gilner & Morgan, 2000).
Appropriateness of Design
A qualitative phenomenological design was appropriate for the study of the lived
experiences of a purposeful sample of nurse CEOs in hospitals in the states of
Connecticut, Maine, New Jersey, and New York. The phenomenological research design
allowed the study to accomplish the goal of examining the relevancy of certain factors in
the ascension of nurses to CEO positions in hospitals. The study explored the influential
factors that ease the transition of nurses into hospital CEO positions through an
exploration of common themes evolving from the analysis of lived experiences.
The nature of the studys focus, rarely explored in the literature, fits appropriately
with the phenomenological method because in qualitative studies, the research problem
desires to be explored because concepts and theories are not fully developed (Creswell,
2003, p. 8). The qualitative unstructured interview in the phenomenological method
allows the participant to create response possibilities (Creswell, 2002, p. 205) and
retrieve lived experiences of transitional factors associated with nurses transition to CEO
roles in hospitals. The description of the lived experiences of subjects in a qualitative

61
study when analyzed may result in the construction of new theory from the phenomenon
studied. In essence, phenomenology is not a hypothesis-testing approach to research
typical of quantitative studies (Wilson, 2002). Instead, qualitative phenomenological
studies seek to qualify the importance of lived experiences of participants, making it
appropriate for qualitative inquiry. The emergence of common themes is notable of
qualitative research and discovering them is important as apposed to the interpretation of
statistical data (Donalek & Soldwisch, 2004).
Leedy and Ormrod (2001) noted a distinct difference between qualitative and
quantitative inquiry and posited, Quantitative inquiry is used to answer questions about
relationships among measured variables with the purpose of explaining, predicting, and
controlling phenomena (p. 101). Qualitative inquiry is typically used to answer
questions about the complex nature of phenomena, often with the purpose of describing
and understanding the phenomena from the participants point of view (Leedy &
Ormrod, p. 101). The description offered by Leedy and Ormrod supports the rationale
choosing the qualitative approach, which is to understand and describe the lived
experiences of nurses in hospital CEO roles. As previously noted, there is paucity in the
literature about nurses in hospital CEO positions and the lack of research of the
phenomenon is another reason the qualitative phenomenological method was most
appropriate for the study. Consideration of the qualitative phenomenological concepts led
to the following questions investigated in the study:
attainment?
62
Creswell (2002) referred to a unit of analysis as a predetermined level of data
collection that a researcher must identify to determine who best can answer your
research questions and hypotheses (p. 159). The qualitative phenomenological studys
unit of analysis was limited to measuring influential factors by collecting data from the
lived experiences of nurse CEOs. Influential factors identified by participants highlighted
the importance or relevancy to the ascension of nurses into CEO positions in hospitals.
The study investigated several background variables rarely identified in previous research
studies for correlation and causal relationships associated with the successful leadership
of nurses in CEO positions.
Population
The targeted population included RNs who hold CEO positions in hospitals in the
states of Connecticut, Maine, New Jersey, and New York. The American Hospital
Association (AHA) was a source for retrieving information on potential participants for
the study. To participate in the study, nurses had a qualifying limit of a minimum of 2
years of experience in their positions as CEO in a hospital. The characteristics of the
participants included RNs that maintained current licensure issued by a board of nursing
that grants permission to practice registered professional nursing in the United States
(U.S. Department of Labor, 2006) and were in a CEO position in a hospital setting for a
63
qualifying minimum of 2 years at the time of the study. Contact of participants was by
e-mail or direct written correspondence for invitation to participate in the study
(Appendix A).
The goal of selecting an appropriate sample was to identify a well-defined group
of nurse CEOs to satisfy suitable saturation for a qualitative research study. Patton (2002)
wrote, There are no rules for sample size in qualitative inquiry (p. 244). Yet, Boyd
(2001) suggested a minimum of 2 to 10 participants was acceptable to reach saturation in
a qualitative study. The final sample size of 19 nurses provided ample insight into their
lived experiences as hospital CEOs in the four states selected. Sampling was determined
based on the availability of suitable participants that met the criteria for inclusion in the
study. Thereby, 19 nurses who held hospital CEO positions for a minimum of 2 years and
registered to practice registered professional nursing in their respective states became the
final choice for participation in the study.
Informed Consent
To maintain an ethical component to the intended study, the process for obtaining
consent from potential participants incorporated a twofold approach. An initial interview
of potential participants consisted of notifying the participants of the studys purpose and
design format (Appendix B). All participants were required to submit consent to be a
participant in the study (Appendix C). Meltzoff (2003) posited that, Signed informed
consent is a cornerstone of participant protection in all except minimal-risk studies in
which the identity of individual participants is not disclosed (p. 148). The signed
consent from participants did not exclude the participants rights to discontinue
individual participation in the research study. Groenewald (2004) provided an excellent

64
means of obtaining informed consent. Groenewald noted that an informed consent should
notify participants of the following:
1. That they are participating in research,
2. The purpose of the research (without stating the central research
question),
3. The procedures of the research,
4. The risks and benefits of the research,
5. The voluntary nature of the research participation, and
6. The subjects (informants) right to stop the research at any time. (p. 10)
Sampling Frame
The criteria for sample selection included 19 participants who were licensed RNs
with a minimum of 2 years of experience in the role of CEO in hospitals located in the
states of Connecticut, Maine, New Jersey, and New York. Hospitals were the choice for
the setting of the study because many nurses, who work in that setting, may have
experienced an easier transition to high-level executive positions. The definitive
description of the sample criteria excluded nurses who were CEOs but were not in
possession of a RN licensure. The exclusion was noteworthy because of the studys intent
to examine the significance of being a nurse who was able to ascend to the CEO position
in a hospital.
The study excluded nurse CEOs with less than 2 years of experience and those
nurses who were CEOs in a hospital at some time but not at the time of the study because
of the limitations of the retrieval database from the AHA that profiled current CEOs.
Although nurses who previously occupied CEO positions may have added depth and
65
breadth to the study, locating them for participation was problematic because their
profiles were not in current databases.
Creswell (2002) noted that purposeful sampling used in qualitative research
enables a researcher to intentionally select individuals and sites to learn or understand
the central phenomenon (p. 194). Howard, Linn, and Miller (2004) concurred, noting
how purposeful sampling, along with criterion-based selection, ensures particular
settings, persons, or events are selected deliberately in order to provide important
information that might not be obtained from other sources (p. 39).
The qualifications of all participants were determined from the responses of the
letter of invitation to participate in the study that included a reference to the number of
years in the CEO role in a hospital and licensure as a RN. Validation of current licensure
consisted of checking online sources from Connecticut, Maine, New Jersey, and New
York State Education Department that provided data on current licensure as a RN. Nurse
CEOs became participants in the study after returning a signed informed consent.
Confidentiality
Participants received a signed contractual statement that clearly assured them their
anonymity (Appendix C). All of the participants were guaranteed full protection of
information exchanged during the interviewing process. As suggested by Creswell
(2002), protection of information is achievable by coding all interview documentation.
Cone and Foster (2004) suggested that data collection forms not contain participants
names; rather, code the forms with specific keys that identify the participants. The
research process incorporated Cone and Fosters suggestion in the data collection phase
of the study.
66
Data collected by taped interview received codes to maintain the participants
confidentiality and will be stored for 5 years after completion of the study. Information
collected from the taped interview remained private to ensure the participants
confidentiality. Each taped interview of nurse CEOs received tracking codes labeled
Nurse CEO-01 through Nurse CEO-19.
Instrumentation
Qualitative research studies allow researchers to obtain information from
participants derived from the construction of data forms used during the interviewing
process (Creswell, 2002). According to Creswell, In qualitative research, the inquirer
does not begin data collection with a set instrument to measure distinct variables (p. 55).
In essence, the qualitative researcher is the primary instrument in gathering data in
qualitative studies. A list of questions for gathering data during the interview process
enabled the conduction of research into the examination of lived experiences of the
participants. The list of questions (see Appendix D) constructed by the researcher was the
primary instrument used to gather data from the participants. Cone and Foster (2004)
noted that the qualitative researcher should be apt in creating an instrument that produces
desirable reliable data. To comply with Cone and Fosters suggestion and to promote
desirable data, the interview questions were test-piloted before asked to the participants.
The qualitative design includes the ability to set aside predetermined thoughts
about the phenomenon under study. Moustakas (1994) described the researchers ability
to diminish pre-conceived thoughts as the epoche. Accordingly, Moustakas noted that,
In the Epoche, we set aside our prejudgments, biases, and pre-conceived ideas about
things (p. 85). Moustakass view gives credence to not using a set instrument to measure
67
variables in qualitative studies, thus fostering the development of new tools that give new
perspectives of the phenomenon.
Pilot testing of the 10 interview questions (Appendix D) with a select group of
nurses who were CEOs and who were not part of the study was done prior to engaging
the questions in the participant interviews. Verbal feedback from the pilot participants
gave insight into difficulty of readability and comprehension of the questions. Overall, all
pilot participants reported no difficulty in answering the 10 questions. The pilot testing
served as the main source for validating the use of the instrument.
To achieve meaningful data gathering, the study employed semi-structured taped
interviews. A list of open-ended questions that solicited responses to lived experiences in
the role of CEO in a hospital is in Appendix D. The use of open-ended questions to
obtain data is common in qualitative studies and allows retrieval of information about
personal experiences of participants. Because the study explored and examined factors
about nurse CEOs perception and experiences of the transition into their executive
positions, the interview questions were appropriate for the qualitative phenomenological
design of the study.
Direct observations of participants are common in qualitative studies but were not
appropriate to measure lived experiences of the participants. Direct observations would
not reveal information such as the impact of mentoring, clinical and educational
backgrounds, and other similar factors in the transition of nurses into the hospital CEO
role. Thus, the taped interview was an appropriate instrument because the taped
interviews provided a close approximation to what occurred and a permanent record that
others can review (Neuman, 2003, p. 386).

68
Data Collection
Data collection included the use of a 10-question format (Appendix D) in a
structured taped interview session. A qualitative semi-structured interview in the
phenomenological method retrieved lived experiences of transitional factors associated
with nurses transition to CEO roles in hospitals. Semi-structured interviews provide
information about the personal experiences of participants and are sources of primary
data. Transcription of the taped and live interviews was necessary to examine the lived
experiences of the participants and received codes before data analysis using the software
NVivo.
Moustakas (1994) provided a three-phase process that facilitates data collection in
phenomenological investigations that consists of the methods of preparation,
organization, and analysis of data. The three-phase process suggested by Moustakas
included seven steps that assist in obtaining scientific evidence. The seven steps
according to Moustakas consist of the following:
1. Discovering a topic and question rooted in autobiographical meanings
and values, as well as involving a social meanings and significance,
2. Conducting a comprehensive literature review,
3. Constructing criteria to locate appropriate participants for the study,
4. Providing participants with instruction on the nature and purpose of
the study,
5. Developing appropriate questions to guide the interview process,
6. Conducting and recording a person-to-person interview, and

69
7. Organizing and analyzing data to facilitate development of individual
textural and structural descriptions, a composite textural description, a
composite structural description, and a synthesis of textural and
structural meanings and essences. (pp. 103-104)
The process described by Moustakas (1994) helped to facilitate the interviewing
process and subsequent organization and analysis of data. Participants communicated
their lived experiences and perceptions of factors that enabled the transition to CEO
positions in hospitals. Prior to conducting the interviewing process, all participants
received a reminder that their information was confidential and participation was
voluntary.
Semi-structured Interview Questions
The purpose of the qualitative phenomenological study using a modified Van
Kaam method as described by Moustakas (1994) with taped and transcribed interviews
was to describe influential factors that may ease the transition of nurses into CEO roles in
hospitals. The semi-structured interview process was effective in soliciting information
on the lived experiences of nurses that are CEOs in hospitals in Connecticut, Maine, New
Jersey, and New York. The semi-structured interview questions (Appendix D) were
explored the phenomenological experiences of the nurse who ascended to the role of a
CEO in a hospital. Semi-structured interview procedures allowed the interviewer and
participant to clarify what each other mean at the time of questioning and response
(Darlington & Scott, 2002). The process also ensured flexible data collection and directed
the flow and direction of the discussion (Darlington & Scott). The questions were
directed to the participants experiences, feelings, beliefs, and convictions about the
70
theme in question (Welman & Kruger, 1999, p. 196) and subsequently responses were
generated that provided information on the lived experiences and perceptions of nurses in
hospital CEO positions.
Data Analysis
Neuman (2003) posited, Data analysis means a search for patterns in data,
recurrent behaviors, objects, or a body of knowledge (p. 447). In the study, the computer
software NVivo that organized the raw data from interviews to enable coding of themes
(Walsh, 2003) facilitated data analysis. Analyzation of the data used the seven steps of
Moustakas (1994) modified van Kaam method, namely:
1. Listing and Preliminary Grouping: List every expression relevant to
the experience (Horizonalization).
2. Reducing and Eliminating: Determine the invariant constituents: Test
each expression for two requirements:
a. Does it contain a moment of the experience that is a necessary and
sufficient constituent for understanding it?
b. Is it possible to abstract and label it? If so, it is a horizon of the
experience.
Expressions not meeting the above requirements are not included for analysis.
Overlapping, repetitive, and vague expressions are not included for analysis or may
require presentation in terms that are more descriptive. The horizons that remain are the
invariant constituents of the experience.
3. Clustering and Thematizing the Invariant Constituents: Cluster the
related invariant constituents of the experience that are related into a

71
thematic label. The clustered and labeled constituents are the core
themes of the experience.
4. Final Identification of the Invariant Constituents and Themes by
Application: Validation includes checking the invariant constituents
and their accompanying theme against the complete record of the
research participant.
a. Are they expressed explicitly in the complete transcription?
b. Are they compatible, if not explicitly expressed?
c. If they are not explicit or compatible, they are not relevant to the
participants experience and should be deleted.
5. Constructing Individual Textural Description: Using the relevant
validated invariant constituents and themes, construct for each
participant an Individual Textural Description of experience. Include
verbatim examples from the transcribed interview.
6. Constructing Individual Structural Description: Construct for each
participant an Individual Structural Description of the experience
based on the Individual Textural Description of the experience and
Imaginative Variation.
7. Constructing Textural-Structural Description: Construct for each
research participant a Textural-Structural Description of the meaning
and essence of the experience, incorporating the invariant constituents
and themes. (pp. 120-121)

72
In the modified van Kaam methodology as described by Moustakas (1994), the
initial phase of data collection, horizontalization, captured all the participants
expressions for grouping, categorizing, and the development of themes (Leedy &
Ormrod, 2001). Elimination of insignificant or vague responses after horizontalization
considered whether vague or duplicate responses were substantial and described the
participants lived experiences or satisfactory and labeled invariant constituents of the
lived experiences.
Identification of the invariant constituents facilitated clustering and coding of the
data. Coding achieves two important processes required in qualitative data, namely,
mechanical data reduction and analytic categorization of data into themes (Neuman,
2003, p. 442). Coding was an essential aspect of beginning to understand the relevancy of
the data to the research questions (Neuman).
Validity and Reliability
Validity is uncertain in research and Giorgi (2002) questioned the notion in
asking, How valid is the knowledge gained from a qualitative research situation (p.
10)? Giorgi asked the question because of the tradition of viewing qualitative studies as
questionable valid research. However, Giorgi suggested phenomenologys goal is to
attempt to identify the role of subjectivity in knowledge attainment. Thus,
phenomenology recognizes the presence of subjectivity and still makes objective
knowledge claims (Giorgi, p. 11). Giorgi described the presence of subjectivity and
objectivity in phenomenological studies as having a direct reciprocal relationship, thereby
declaring there cannot be any separation between the two.

73
Validity
To protect threats to internal validity, in particular experimenter expectancy,
information obtained from knowing nurses who were in CEO roles during the
interviewing process remained confidential. The strategy was intentional so that
unintentional communication did not reach the participants. Neuman (2003) reported,
Researchers may be highly committed to the hypothesis and indirectly communicate
desired findings to subjects (p. 255). Hence, it was imperative that there was no
divulging of personal knowledge of the experiences of knowing nurses in CEO roles
while conducting personal interviews with participants.
Validity received protection by an earnest effort in selecting participants who
were trustworthy and committed to honestly answering the interview questions. Ten
nurse CEOs participated in a pilot study to examine interview questions for readability
and clarity of information. After completion of the pilot testing, there was no refinement
or adjustment to the construct of questions because the pilot testers did not reveal any
difficulty in answering questions.
Triangulation enhanced the accuracy of the data collected in the study. In
triangulation, the inquirer, corroborates evidence from different individuals, types of
data, or methods of data collection in descriptions and themes in qualitative research
(Creswell, 2002, p. 280). The ultimate attempt to validate data is to allow the participant
the opportunity to review and confirm or alter the research data to correspond to her or
his perception of the experience (Moustakas, 1994, p. 110). To preserve the accuracy of
information retrieved from participants, all of the participants had the opportunity to
review the transcripts of their interview.

74
Reliability
Fraenkel and Wallen (2001) noted that, Validity refers to the appropriateness,
meaningfulness, and usefulness of the inferences researchers make based on the data they
collect, whereas reliability refers to the consistency of these inferences over time (p.
476). To ensure reliability, horizontalization, the systematic process for the collection of
data suggested in the modified van Kaam (1966) methodology, provided the basis for
consistency and for future replication of the study. To promote replication and to enhance
reliability, all of the methods and processes used during the research were consistent
(Gurak & Lay, 2002). For example, all participants received the same questions during
the interview (see Appendix D). Analyzation of the taped recorded responses facilitated
coding. The modified van Kaam analysis method as suggested by Moustakas (1994),
guided the process for transcribing each participants experience.
Summary
The purpose of this qualitative phenomenological study using a modified Van
Kaam methodology (Moustakas, 1994) with taped and transcribed semi-structured
interviews was to describe the personal lived experiences of nurses in hospital CEO roles.
Chapter 3 presented the research methodology, study design, study approach, protection
of participants by informed consent, and confidentiality assurance that are the foundation
of the inquiry. Chapter 3 included a discussion of the characteristics of all participants
and rationale for choosing an appropriate instrument suitable for the phenomenological
qualitative design of the study.
Chapter 3 included sections to describe the process of confidentiality as well as
the process for maintaining participants anonymity. Supportive literature (Cone &
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Foster, 2004; Creswell, 2002; Fraenkel & Wallen, 2001; Giorgi, 2002; Moustakas, 1994;
Neuman, 2003) provided support for the studys design, appropriateness, reliability, and
validity of instrumentation.
Chapter 4 presents a detailed discussion of the results of the phenomenological
study with a qualitative design that explored and examined the lived experiences of
nurses in hospital CEO roles. Chapter 4 includes the results of participants detailed
responses to each of the interview questions and the process of coding responses for
analysis of themes. The chapter presents the statistical analyses of themes generated from
participants responses analyzed by NVivo qualitative software.

76
CHAPTER 4: RESULTS
The purpose of the qualitative phenomenological study using Moustakas (1994)
modified Van Kaam method, which included semi-structured, tape recorded, and
transcribed interviews of 19 nurse CEOs in hospitals in the states of Connecticut, Maine,
New Jersey, and New York, was to examine the nurse CEOs lived experiences and
perceptions of their transition into hospital CEO positions. Moustakas described the lived
experiences as a method of reflection that provides a logical, systematic, and coherent
resource for carrying out the analysis and synthesis needed to arrive at essential
descriptions of the experience (p. 47). Data from the study will provide hospital
administrators, leadership theorists, and nursing leaders with information regarding
influential factors that contribute to nurses transitioning into hospital CEO positions.
The phenomenological research approach used in the study enabled the
examination of lived experience of nurse CEOs. The following is the four research
questions that guided the study:
attainment?
Chapter 4 presents the details of the results of the qualitative phenomenological
study of the exploration and description of the lived experiences of 19 nurses who are
77
hospital CEOS in Connecticut, Maine, New Jersey, and New York. Each participant
answered 10 questions in a semi-structured interview process that was recorded and
transcribed. The chapter includes the data collected from each participant for each of the
10 interview questions (see Appendix D) and concludes with a summary of the findings
based on the analysis of the data. Data collection and analysis were conducted using
Moustakas (1994) modified van Kaam methodology. The steps taken to collect the data
were similar to those followed by Moustakas and consisted of the following:
1. Purchased the 2006 American Hospital Association database for names of
CEOs in the states of Connecticut, Maine, New Jersey, and New York
2. Sent the invitation to participate in research study letter (see Appendix A) and
introductory letter (see Appendix B) via e-mail to potential participants.
3. Checked e-mail for responses to participate in the study and recorded positive
responses.
4. Disseminated informed consent (see Appendix C) information to individuals
agreeing to be participants.
5. Upon receipt of informed consent arranged a date and time for the face-to-face
or telephone interview.
6. Provided more information about the study and informed participants of time
involved in conducting the interview. Answered and questions and reiterated
participation in the study was voluntary.
7. Asked the 10 questions (see Appendix D) and recorded the participants
responses.
8. Concluded each interview by thanking the participant.

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9. Repeated the process in Steps 3-8 for all 19 participants.
10. Researcher transcribed the recorded tapes of all 19 participants.
The responses from the participants were recorded, transcribed, and interpreted by
the qualitative software NVivo to analyze the emerging themes from the data collected in
the interviews representing lived experiences and perceptions of the purposive sample of
19 nurses that are CEOS in hospitals in Connecticut, Maine, New Jersey, and New York.
The study was originally designed to explore the lived experiences of a purposive sample
of 20 nurse CEOs but the sample size ended at 19 when several nurses who changed
scheduled appointments did not respond in a timely manner to give consent to be a
participant and when data saturation was reached. All 19 participants had a minimum of 2
years experience in the title of hospital CEO. Data were analyzed by employing
Moustakas (1994) modified van Kaam by using the following approach: (a) transcribed
recorded tapes into a Microsoft Word document, (b) printed the document, (c) reviewed
the responses to each question and checked for accuracy in transcription of information,
(d) listed every experience relevant to the phenomenon, and (e) analyzed the data for
themes by using the qualitative analysis software NVivo.
Review of Data Collection Process
The data collection period spanned 34 days that commenced January 24, 2007 and
ended February 27, 2007. Interview periods averaged 20 minutes (minimum) to 60
minutes (maximum). The difference in the length of interviews was due to those
interviews conducted in person (60 minutes) and those that were telephone taped
recorded (20 minutes). Originally, the research considered the states of Connecticut, New
Jersey, and New York. However, due to slow response from nurse CEOs in these three
79
states, the geographic location required expansion to include participants who met the
same criteria in the state of Maine. Maine became the choice because of the availability
of the number of eligible participants that responded to the Introduction to Participate in a
Research Study (see Appendix A). Additionally, the research sought to examine the lived
experiences of a sample of at least 20 nurse CEOs.
Several participants changed the interview date at the last minute and offered to
reschedule at a time that would be inconvenient for the timely completion of the study.
The final population of 19 nurse CEOs interviewed captured the essence of the study and
emerging themes were present in their responses to the 10 interview questions to reach
data saturation. Data saturation occurs when the researcher is no longer hearing or
seeing new information. Unlike quantitative researchers who wait until the end of the
study to analyze their data, qualitative researchers analyze their data throughout their
study (Siegle, 2006, 11).
The AHA database and information from ACHE provided ample databases for
recruiting participants for the study in the four states. Data collection consisted of the
verification of all participants eligibility to be part of the study, scheduling of interviews,
and the collection of responses to the 10 questions. All of the participants in the study
received contact by telephone and e-mail for their voluntary participation in the study.
Participants received a copy of the Invitation to Participate in a Research Study (see
Appendix A), An Introduction Letter to Participants (see Appendix B), and Consent to
Act as a Research Participant (see Appendix C). The participants signed, dated, and
returned the consent by faxing the informed consent form to a designated number.
80
Upon consenting to be a participant in the study, each participant received a copy
of the 10 research questions (see Appendix D). The consent form received a special code
of Nurse CEO-01 through Nurse CEO-19 based on the date scheduled for the interview.
The final sample of 19 nurse CEOs received the 10 questions in advance (see Appendix
D) of the face-to-face or telephone interview so they could have time to gather their
thoughts about their lived experiences. All of the participants requested a copy of the
completed dissertation and there was mutual agreement to honor their requests via e-mail.
Each interview followed a two-part format that consisted of a brief introduction to
the background of the study and establishing that the participant was a nurse in a CEO
position in a hospital. To proceed with the interview, each of the 19 participants
established they were in the CEO role for a minimum of 2 years before answering any of
the 10 questions. Each participant was asked the same 10 questions in the same order
with a follow-up question, if necessary, to clarify or validate a response.
Interviews were conducted in person and via telephone conference, depending on
the participants location and individual schedule. Due to geographic location and the
request of the participants, 17 interviews were via telephone and two interviews occurred
in person. Before conducting the interview, the researcher explained the purpose of the
study, obtained an informed consent, verified that the participant had agreed to the
voluntary telephone or face-to-face interview, and reminded participants that their
responses to the questions are part of the study. During the interviewing process, careful
attention to details of what the participants said and how the respondent answered each
question was important in minimizing the need to validate responses. If needed, follow-
81
up questions helped to clarify the participants response to any particular question before
proceeding with the next sequential question.
After each interview, the taped responses were listened to for accuracy and the
necessity to validate the responses with the participant. Each tape received a coded label
with Nurse CEO-01 through Nurse CEO-19 in place of the name of the participant to
ensure anonymity and confidentiality and the taped interviews transcribed into a Word
document. Each of the 19 participants received a transcribed copy of their responses to
check for validity and accuracy. Four of the 19 participants modified a portion of their
responses. The remaining 15 participants agreed that the transcription of their responses
was accurate. The validated responses were then grouped document into one concise
document (see Appendix E).
Demographics
Table 2 is a breakdown of the sample by gender, state, ethnicity, and bed size of
hospital. Although both male and female nurse CEOs was eligible to participate in the
study, only 1 participant was male. Eight participants were from New York, seven from
New Jersey, and two each from Connecticut and Maine. The population of 19 nurse
CEOs had a range of experience in the title of CEO from 2.5-25 years. The difference in
the years of experience in the title of CEO might have contributed to variations in the
responses to questions during the interviews. As noted in Table 2, the majority of nurses
(14 out of 19) were CEOs of hospitals with less than 300 beds. Although bed size of a
hospital was not a qualifying factor in the selection of participants, it might have
contributed to the type of lived experiences nurse CEOs experienced in their roles
because of differences in governance and organizational structure.

82
Table 2
Distribution of Sample by Gender, State, Ethnicity, and Bed Size of Hospital
Participants Gender State Ethnicity Hospital beds
Nurse CEO-01 Female Connecticut Caucasian 397
Nurse CEO-02 Female New Jersey Caucasian 200
Nurse CEO-03 Female New Jersey African American 518
Nurse CEO-05 Female New Jersey African American 709
Nurse CEO-06 Female Connecticut Caucasian 94
Nurse CEO-09 Male New York Caucasian 132
Nurse CEO-10 Female New York Caucasian 90
Nurse CEO-13 Female Maine Caucasian 100
Nurse CEO-17 Female New York African American 1477
Nurse CEO-18 Female New Jersey Caucasian/Asian 605
Nurse CEO-19 Female Maine Caucasian 200

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Findings
The analysis of the data employed the suggestion noted by Moustakas (1994) and
his modification of the van Kaam methodology for analysis of rich and descriptive data
collected in a qualitative phenomenological study. The following section describes the
intent and purpose of the 10 interview questions asked of the 19 participants and reports
the findings from the participants who met the criteria within the context of the modified
van Kaam methodology. A further description of the findings of each interview question
is located in Appendix F.
Research Questions, Purpose and Findings
Interview Question 1
How long have you desired to be a CEO in a hospital? The intent of the question
was to determine whether the nurse had always envisioned a career path that led to the
CEO position in a hospital. In a series of interviews with nurse CEOs, Smith (2002b)
found that nurses in CEO positions self-discovered the role and did not intend to acquire
such roles.
The question allowed for probing of whether the nurse desired to ascend to the
CEO role after being in traditional nursing executive positions and whether the nurse
made career adjustments that prepared them for a CEO position.
Findings from Interview Question 1
All 19 participants answered the question (see Appendix F). Of the 19
participants, 8 of 19 had a desire initially to become CEO, and 11 of the participants did
not initially desire to become CEO. Two participants desired to be CEOs between 2 and 5
years, 2 participants desired to be CEOs for at least 10 years, and 1 participant noted
84
between 5 and 10 years. Two participants had a desire to be CEOs for at least 20 and
another participant wanted to be a CEO for 27 years. The other 11 participants did not
have a desire to be a hospital CEO.
Seven of the 19 nurse-CEOs volunteered information regarding what helped to
persuade their lack of desire in the direction of desire and 12 participants did not
volunteer the information. Nine of the 19 participants did not volunteer whether they
received any type of inspiration from a source such as mentors or self-motivation, and 10
participants volunteered information concerning inspirations. Nine of the 19 participants
noted that in the beginning, they had no desire to be CEO, but over the course of time,
becoming a hospital CEO was a career goal. Therefore, 9 of the 19 participants noted a
change in career aspirations to the CEO role, and the remaining 10 participants did not
volunteer any similar information. The following relevant comments support the findings
from Interview Question 1.
Nurse CEO-03: Within the last 5-10 years.
Nurse CEO-04: I would say for the last 5 years.
Nurse CEO-05: Probably about 20 years ago.
Nurse CEO-09: . . . and the last 27, I have desired to be a CEO.
Nurse CEO-10: I would say about 10 years.
Nurse CEO-12: About 2 years before I actually became a CEO.
Nurse CEO-16: I have desired to be a CEO for 20 years.
Nurse CEO-18: Ten years.
The following participants expressed their original lack of desire for a position as CEO
Nurse CEO-01: I had no desire.

85
Nurse CEO-02: I do not think I ever desired to be a hospital CEO.
Nurse CEO-06: I did not start out deciding to be a CEO.
Nurse CEO-07: I never really desired to be a CEO. This is not something that I
planned to be.
Nurse CEO-08: It was never my desire or my goal.
Nurse CEO-11: I never gave it a thought.
Nurse CEO-13: I never desired to be a CEO.
Nurse CEO-14: I never wanted to be a CEO.
Nurse CEO-15: I never had the desire to be a CEO.
Nurse CEO-17: This role was not on my radar screen.
What emotional behavioral factors do you regard as necessary to ascend to a
hospital CEO role? The intent of Interview Question 2 was to determine if nurse CEOs
regarded certain emotional factors as necessary in their ascension to the hospital CEO
position. The question allowed for the examination of whether emotional intelligence, as
noted by Goleman (2001), was an influential factor in nurses ascension to hospital CEO
positions.
All 19 participants responded to the question. The comments fell in three
categories: general, personal reflection and patient centered. General comments were
those that are universal in nature. Personal reflection comments were reflecting personal
insight and or experience from the participant with the attributes discussed. Patient-
centered comments were those that included or focused on patients. There were a few
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comments that overlapped in more than one category. Additionally, there were comments
that did not overlap with another category; it was a stand-alone category, such as general
comments. Of the three categories of comments, personal reflection was the one that
most comments fell under, with seven comments. The general comments category had six
comments and the patient-centered category had one comment.
Some of the participants comments were general, while others reflected a focus
on personal characteristics and organizational attributes. The table of frequency counts
identified 74 comments captured by 19 participants (see Appendix F). As illustrated in
the table, some comments were unique but there were overlapping comments as well.
Examples of unique comments were possess passion for job and patients and be calm in
nature. Examples of overlapping comments that were dominant and shared by most
included listening, communication, know thyself, and empathy.
There were eight main emotional behavioral factors of importance for the
participants. Factors such as good integrity, being visionary, and having a sense of
balance and good sense of environment each received 3%. Critical thinking and patience
each had 4%. Knowing thyself and communication each scored 5%, but the important
factor for the participants was listening skills. Listening skills scored 11% in the
frequency count of comments in Interview Question 2 (see Appendix F).
What specific personal characteristics, if any, would you say contributed most to
your ascension to the CEO role? The intent of the question was to understand what nurses
perceived as important characteristics to possess in their ascension to the hospital CEO
position. Responses to the question may benefit nursing profession efforts by accelerating
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the number of leaders in the CEO position in hospitals. For instance, Gaillour (2004)
noted physicians that wanted to be a CEO should possess finesse and be accountable in
order to ascend to the role. Likewise, Kaplan (2006b) found personal factors such as
listening, allowing oneself to make mistakes, and relationship skills were critical in the
ascension of physicians to the CEO role. Because no previous study identified the
aforementioned characteristics in nurses in CEO positions, the research focused on
whether nurse CEOs, like physician CEOs, would identify these characteristics in the
ascension to the CEO role. The question allowed for the understanding of the relevancy
of personal characteristics nurses possessed as an influential factor in their ascension to
the hospital CEO position.
All 19 participants offered comments on the specific personal characteristics that
contributed most to their ascension to CEO in a hospital setting. Some comments focused
in a general manner, others focused on personal characteristics and organizational
attributes. The table of frequency counts of responses to the question identified 49
comments captured by 19 participants (see Appendix F). As demonstrated in the table,
there were unique comments noted and overlapping comments as well. Examples of
unique comments were diversity in cultures and diversity in settings. Examples of
overlapping comments that were dominant and shared by most were possessing self-
confidence, good listening skills, caring about people, transformational leadership, and
relationship building.
Ten specific personal characteristics contributed most to the participants
ascension to the role of CEO. The 10 specific personal characteristics noted were having
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good integrity, a good sense of humor, care for the organization, being responsible, being
honest, possessing self-confidence, good listening skills, care about people,
transformational leadership, and relationship building. The first five specific
characteristics (having good integrity, a good sense of humor, care for the organization,
being responsible, and being honest) each received a score of 4%. The remaining five
specific characteristics (possessing self-confidence, good listening skills, care about
people, transformational leadership, and relationship building) each received a score of
6% (see Appendix F). The following comments from some of the 19 participants support
the findings of Question 2.
Nurse CEO-06: My ability in relationship building. I am a relationship-based
person. I do very well with people.
Nurse CEO-04: Relationship building and interpersonal communication. An
individual also needs to be persistence and resilient.
Nurse CEO-08: My people skills and my ability to interact and care about
people.
Nurse CEO-13: Others have identified some of these for me along the way. I
have been called a transformational leader.
Nurse CEO-13: People can challenge me if they feel that they need to and I
listen.
How would you describe any institutional support you may have received in your
career path to the role of CEO? The question probed whether nurses perceived
institutional support as an important factor in their ascension to the CEO position.

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Kwesiga and Bell (2004) noted the importance of a supporting environment in successful
executive leadership. Interview Question 4 allowed for the understanding of how a
supportive environment may be an influential factor for nurses ascension to the CEO
position in hospitals.
All 19 participants responded to Interview Question 4. During the questioning,
participants had an opportunity to provide insights from personal experience, interactions,
hands-on knowledge, and observations. One of the 19 participants did not feel supported
by the institution. The remaining 18 felt supported by the institution, although the
institutional support varied by description. Examples of the varying situations included
from a systems perspective, limited reasons, and specific reasons such as education and
hierarchical pathways. The relevant comments that supported Interview Question 4s
findings were:
Nurse CEO-01:
I was always very curious and wanted to try things. My previous organization
where I spent 18 years was supportive and helped me by allowing me to make
mistakes and take risks, and encouraged me to do so. This helped me to develop
to the path to being a CEO.
Nurse CEO-04:
One is the organizational flexibility to have broader administrative
responsibilities through a series of executive positions where I had more
opportunities to contribute to the organization before being the CEO. Secondly,
the organization supported my continuing education such as supporting me to

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become a fellow in the American College of Healthcare Executives and a
Wharton Nursing Fellow.
Nurse CEO-08:
Coming from the nursing department where 60% is the hospital staff, you
immediately have institutional support. Nurses want to see other nurses succeed. I
also came up through the ranks in this hospital and was supported throughout the
organization. Institutional support is extremely critical to success.
Nurse CEO-10:
I was in the role of VP of Medical Affairs and came into the CEO role as a very
different type of individual. The Board was looking for a change and someone
very different and supported me in the new role of CEO.
Nurse CEO-11: I had great support from the Board of Directors, the nursing
staff, and doctors. The organization allowed me to go to different roles, make
mistakes, and to learn from those mistakes.
What leadership skills do you perceive as necessary for nurses to acquire to
facilitate acquisition of CEO roles in hospitals? Leadership theorists and authors
described transformational leaders as often associated with specific skills and values
(Bass, 1985, 1990; Burns, 1978; Matey, 1991). Interview Question 5 intent was to probe
the leadership characteristics of the participants and to identify what specific leadership
skills were common to all participants.

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All 19 participants responded to Interview Question 5. Each participant provided
insights from personal experience, interactions, hands-on knowledge, and observation.
The insights of the participation are in seven skills categories. These categories were
critical skills, adaptive skills, dealing with data, transferable/critical transferable skills,
people skills, leadership skills, and management skills (Creative Job Skills, 1997).
Critical skills are those skills needed for survival in various settings (Creative Job
Skills). Examples of these skills noted by the participants were honesty and being
responsible (Nurse CEO-10). Adaptive skills are those skills needed to be able to adapt to
different situations in life (Creative Job Skills). Some examples of these skills noted by
the participants were being highly motivated, flexible, and friendly (Nurse CEO-12).
Critical transferable skills tend to get an individual to higher levels of
responsibility and pay (Creative Job Skills, 1997). Examples of these skills such as
solving problems and project planning appeared in 3 participants responses:
Nurse CEO-04: The ability to engage in strategic planning and being able to
make tough decisions are things that are particularly looked at in nurses.
Nurse CEO-05: They also need to have very good problem solving and
delegation skills.
Nurse CEO-13: For example, the ability to manage conflict resolution is very
important.
People skills are those skills that assist individuals to function successfully with
others in the world (Creative Job Skills, 1997). Examples of these skills noted by
participants were communication, helping others, and having respect.

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Nurse CEO-11:
The whole communication area is also important. Some of the things I learned in
my Masters program in psychiatric nursing such as group dynamics,
communication skills, conflict resolution, and organizational development theory
have helped me handle a myriad of issues that come my way.
Nurse CEO-09: Team leadership skills are important; how to work with a variety
of people at a variety of levels and how to lead, assist, encourage, and re-direct
them in a way that is positive and respect for others.
Nurse CEO-10:
I always tell the physicians, I respect you as a doctor and you need to respect me
back as a human being and know that we are both here for the same purpose; that
is to take care of patients.
Leadership skills are those needed in a work environment to work independently
of and dependently on others (Creative Job Skills, 1997). Examples of these skills
noted by participants were delegation and problem solving (see Appendix E). Examples
noted by 2 participants were as follows.
Nurse CEO-05: They also need to have very good problem solving and
delegation skills. In addition, they need to know and master following up on
issues.
of people at a variety of levels and how to lead, assist, encourage, and re-direct
them in a way that is positive.

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Dealing with data are those skills needed to help a business run successfully on a
day-to-day basis (Creative Job Skills, 1997). An example of these skills noted by
participants was financial management, noted in responses from the following
participants.
Nurse CEO-03: Business administration, financial accounting, and systems
design.
Nurse CEO-04:
I would clearly say financial assessment. I think there is a prejudice that women
and nurses do not understand finance. One of the things I did was to complete the
Whartons nurse executive program and Whartons special executive financial
program. The financial program was pivotal for me to be able to speak that
financial language in very clear terms and to understand what was transpiring.
Nurse CEO-11:
I think the financial piece is extremely important. A lot of times people really
downplay that. One must understand the financial mechanism that brings in
revenue and understanding general investment risks. Understanding people and
organizational dynamics issues are also important.
Management skills are those such as teamwork and being visionary that are evident in
individuals in management positions (Creative Job Skills, 1997). Examples of these
skills noted by the participants were:
Nurse CEO-15: Conflict management, team building, informal and formal
communication, and visibility.

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Nurse CEO-17: You have to be an independent thinker, be visionary, objective,
and fair.
Nurse CEO-19: I think they need to learn teamwork; this is a key issue for
nurses.
What advantages, both negative and positive, would you say that your clinical
background as an RN had in your ascension to the CEO role? Interview Question 6
probed the participants identification of the advantages and disadvantages of the clinical
background as an influential factor to the ascension to the CEO position. Literature
identified the clinical advantage nurses have as an important factor in their climb to CEO
positions (Gaskill, 2004; Grazier, 2004; McPeck, 2001; Schultz et al., 2004; Smith,
2002a). Interview Question 6 intent was to explore the similarities and differences
identified by the participants as to whether a clinical background was perceived to be an
advantage in their climb to be a CEO.
Results from Question 6
All 19 participants responded to Interview Question 6. During the question,
participants had an opportunity to provide insights from personal experience and their
interactions. The answers to the question are in two categories (see Appendix F), which
were advantages positive (AP) and advantages negative (AN). Some of the comments
from the participants overlapped into both categories. There were no single elements of
the clinical background identified as a negative advantage; however, there was a
significant number of AP/AN comments noted by 9 of 19 participants and 10 of 19 of the
population noted positive advantages of the clinical background.

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Overview of Advantages Positive and Negative for Clinical Background
All 19 participants offered comments on the advantages and disadvantages of
their clinical background as an RN and their ascension to the role of CEO in a hospital
setting. The table of frequency counts (see Appendix F) of the responses to the question
identified 51 comments captured by 19 participants. As demonstrated in the table, there
were unique comments for both advantages and disadvantages of their clinical
background as an RN and their ascension to the role of CEO. Examples of unique
comments of advantages were administration recognized former nursing positions, using
critical thinking for problem solving and making assessments. Examples of disadvantages
were clinical background makes it difficult with financial decisions for patients and the
questioning of authority.
Examples of overlapping of advantages that were dominant and shared by most
were; helped to keep my eyes on clinical outcomes of hospital, push and remind staff to
be patient centered, and help to understand the language of physicians (see Appendix F).
The latter comment was present in several of participants responses and related the
clinical background as important in communicating with physicians. There were no
overlapping examples of disadvantages expressed by the participants.
Participants noted four major areas of advantages that helped nurses to ascend to
the role of CEO that are noted in the frequency counts of responses to Interview Question
6 (see Appendix F). Of these four, the one most highly favored received a score of 14%
(clinical background was positive). One of the remaining three scored 9% (helps to
understand the language). Another of the remaining two scored 6% (helped to keep my
eyes on the clinical outcomes of hospital) and the final area scored 4% (push and remind
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staff to be patient centered). The most common finding in the frequency table of
responses to the question is that 39 of 51 (76%) of the responses identified the clinical
background as a positive advantage in the ascension of nurses to hospital CEO positions
(see Appendix F).
What importance if any, would you say obtaining a business or finance degree
may assist nurses in acquiring the CEO role? Rothenberg (2001) suggested a graduate
degree, specifically the MBA, was an important consideration in the CEO role.
Rothenberg further emphasized financial management was also important. Interview
Question 7 intent was to probe whether nurse CEOs regarded the business or finance
degree as a necessity to succeed in the CEO role.
Findings from Question 7
All 19 participants offered comments on the importance of obtaining a business or
finance degree and the degrees assistance or not of helping nurses acquiring the CEO
role. The table of frequency counts for the question (see Appendix F) identified 19
comments captured by 19 participants. As demonstrated in the table, there were unique
single-element comments noted relative to the question sought and unique single-element
comments noted not relevant to the question sought. Examples of unique single-element
comments of relevant notes were as follows: could not advance without the additional
education in these areas, merely taking courses in business and finance are fine, and need
a strong financial background. Examples of unique single-element comments of
nonrelevant notes were, needed to make decisions for the future, knowing the
lingo/language is a good thing, and gives credibility especially for non-clinical people.
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Examples of overlapping comments that were dominant and shared were these degrees
are critical and must have understanding of business side as well.
14 Extremely
Important
12
Did not answer
10
8 Preferred
6
4 Not Preferred
2
Choice of
0 Individual
Level of Degree
Not Answered
Importance Needed
Figure 2. Responses to Interview Question 7.
Of the 19 participants that provided some type of insight to the question, 13 noted
it is extremely important for nurses to obtain business and finance degrees if they are
considering the role of CEO. Six participants provided some type of insight but the
insights provided did not answer the primary question. Additional information shared
during the answering of the question was whether a degree was necessary from the
perspective or lived experience of the participant. Of the 19 participants, 8 of 19 noted
degrees were necessary, and 4 of 19 noted degrees were not needed. One participant
noted that it was an individuals choice and the other 6 participants did not offer
information on the need for degrees.
The answers to Interview Question 7 moved from general to specific at times.
Specific topics mentioned were business and finance (see Appendix F). As illustrated in
the Figure 2, 13 of 19 participants identified the business or finance degree as extremely
important, 6 of 19 of the participants did not answer, 8 out of 19 answered the degrees are
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needed, and 4 of 19 answered the degrees are not needed. One participant felt it was the
choice of the individual. The major concern with the responses to Interview Question 7 is
that not all of the responses correlated with the question. Some participants answered the
question centered on MBAs, their importance or lack of importance, and other unrelated
topics.
Describe any mentorship relationship you had with someone you considered
influential in your ascension to the CEO role. The intent of the question was to
understand if a mentoring relationship was an important influential factor that assisted the
nurses in acquiring the CEO role. Roemer (2002) found more than 54% of female CEOs
in hospitals regarded mentorship relationships as helpful in their success. Tharenou
(2005) found mentoring relationships were important in women advancing to hierarchal
positions. Question 8 provided for the exploration of whether there were differences and
similarities in participants responses as to whether mentoring relationships were
important in their ascension to a hospital CEO position.
All 19 participants responded to the question. Participants had an opportunity to
provide insights from personal experience, interactions, and hands-on knowledge. Nurse
CEOs gave advice that originated from mentoring relationships. The answers to Interview
Question 8 are in five specific categories as noted in the table of responses (see Appendix
F). The five categories were as follows: had mentors, if so, how many; gender and
position of mentor, if any; was the relationship influential; and was the relationship
positive, negative, or both (see Appendix F).

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The 19 participants provided answers such as yes, sort of and no, but had role
model. Fifteen of the 19 participants answered yes to having mentoring relationships
and 3 of 19 answered they had sort of a mentoring relationship with someone during
their careers. One individual (Nurse CEO-08) answered no to having a mentoring
relationship, but developed good habits and characteristics from role models encountered
during life and along the career path. Twelve of 19 participants stated they had one
mentor, 5 of 19 had two mentors, 1 of 19 had three mentors, and 1 of 19 had no mentors,
but did have role models.
There were 21 responses to the gender of mentors, as noted in Table 3, because
some participants had more than one mentor. Fifteen of 21 responses identified
mentoring relationships with males, and 6 of 21 responses identified mentoring
relationships with females. Eighteen of 19 participants noted the mentoring relationship
was influential to their ascension to the CEO position, while the remaining participants
response was not applicable as an ascension factor to the CEO position.
Table 3
Gender of Mentors
Number of responses
Gender (n = 21) %
Female 6/21 29
Male 15/21 71
100
16
14
12
Females
10
8 Males
6 Executive Level
4 Middle Level
2 Lower Level
0 Not noted
Gender Position
of Level
Mentor
Figure 3. Gender of mentor and position level held.
The number of male mentors was much larger than number of female mentors
(Figure 3). The positions identified are in three categories, which are executive, middle,
and lower. The executive level positions were individuals that were Chairman of the
Board, CEOs, and chief financial officers (CFOs). The middle level is positions such as
nursing instructors and directors of nursing. The lower level is positions such as other
nurses. Two responses did not note the position of the mentor. The positions of the
individuals who are nurse CEO mentors are as follows:
1. Nursing Instructors [NI] 5%
2. Chief Financial Officer [CFO] 5%
3. Major in the Air Force 5%
4. Nurse 10%
5. Held High Position 5%
6. Chairman of the Board 5%
7. Chief Executive Officer [CEO] 38%
8. Systems Chief Executive Officer [SCEO] 5%

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9. Director of Nursing [DON] 5%
10. Chief Operating Officer [COO] 5%
11. Chief of Pathology [COP] 5%
12. Not noted 10%
There were 21 responses noted for the positions (see Appendix F); however, 10% of the
total population did not identify a position.
What advice would you give a nurse aspiring to a hospital CEO position within a
hospital setting? The intent of the question was to explore what the nurse CEOs
suggested as good advice for future nurses who may be interested in a career path that
leads to a hospital CEO position. Gruver and Spahr (2006) noted that CEOs offer
important advice to evolving leaders in an organization. Advice from senior leaders in
organizations is important for the transference of knowledge from todays great leaders
to tomorrows leaders (Gruver & Spahr, p. 24). Interview Question 9 helped to discover
whether the participants would offer similar advice to a nurse who may want to aspire to
a hospital CEO position.
The top three categories were individual, organization view; and education. A
fourth category was program (see Appendix F). From the individual view, 19 of 19
participants offered advice that included being self-confident (Nurse CEO-19),
mentoring, being open to being mentored (Nurse CEO-03), and volunteering time (Nurse
CEO-07). The participants offered excellent insights for nurses to be humble in their
journey to becoming a CEO. From the organizational view, 12 of 19 participants

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provided advice such as being involved with committees, networking in the organization,
and being flexible in crossing over to general operations. From an educational viewpoint,
6 of 19 participants provided advice on seeking further education, especially in business
and finance. Although many of the participants did not have financial or business
backgrounds before becoming a CEO, many of them noted the importance of obtaining
education in business and finance.
The table of frequency count for Interview Question 9 (see Appendix F) identified
44 comments captured by 19 participants. As demonstrated in the table, there were
unique comments but there were overlapping comments as well. Examples of unique
comments were as follows: consider learning to improve health system (Nurse CEO-09),
get involved in committees, activities, or operations (Nurse CEO-02, Nurse CEO-16) and
learn to deal with setbacks (Nurse CEO-19). Examples of overlapping comments that
were dominant and shared by most were take advantage of opportunities or promotions,
engage in educational opportunities, have an understanding of the entire operation, seek
mentoring relationships, set aside the nursing mentality, and do not forget the nursing
side of the job (see Appendix F).
The participants noted eight major areas of advice as indicated in the frequency
table for question 9 that would help nurses in ascending to the role of CEO (see Appendix
F). Of these eight, the one highly favored received a score of 7% (engage in educational
opportunities). The remaining seven each scored 5%. It was interesting to note that one
participant advised to set aside the nursing mentality for the good of the organization at
times (Nurse-CEO 10) and other participants advised not to forget the nursing side of the
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job (Nurse-CEOs 6 & 11). These two statements could be both contradictory and
complementary.
Identify three key areas in hospital administration where expanded knowledge
may ease the transition of nurses into CEO positions. Although not stated as a question,
the statement intent was to probe what nurse CEOs perceived hospital training
departments could offer for the administrative development of future nurse CEOs.
All 19 participants offered comments for the keys areas in hospital administration
needed to ascend to the role of CEO in a hospital setting. The table of frequency count for
the question (see Appendix F) identified 50 comments captured by 19 participants. As
demonstrated in the table, both unique and overlapping comments were noted. Examples
of unique comments were how to plan for programs (Nurse CEO-15) and exposure in the
community (Nurse CEO-19). However, examples of overlapping comments that were
dominant and shared by most were finances (Nurse CEO-01, Nurse CEO-02, Nurse
CEO-03, Nurse CEO-04, Nurse CEO-05, Nurse CEO-07, Nurse CEO-08, Nurse CEO-09,
Nurse CEO-10, Nurse CEO-11); strategic planning skills (Nurse CEO-01, Nurse CEO-
04, Nurse CEO-19) and leadership skills (Nurse CEO-05, Nurse CEO-06.
Ten key areas noted by participants that would help individuals in ascending to
the role of CEO. The 10 areas noted were finance; strategic planning skills; general
principles of hospital finance; budgeting; human resources; leadership skills; knowledge
of reimbursement finance; understand the importance of community and business
relationships; ability to formulate teams; and acquiring knowledge and understanding of

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quality improvement, Joint Commission on Accreditation of Healthcare Organizations,
Centers for Medicare and Medicaid Services, and other regulatory agencies. The first
seven key areas (general principles of hospital finance; budgeting; human resources;
knowledge of reimbursement finance; acquiring knowledge and understanding of quality
improvement; Joint Commission on Accreditation of Healthcare Organizations, Centers
for Medicare and Medicaid Services, and other related regulations; and ability to
formulate teams, understand the importance of community and business relationships)
each received a score of 2%. Two of the remaining three key areas received a score of 4%
(strategic planning skills and leadership skills). The key area that received the highest
score of 11% and was important to 11 of the 19 participants is finance.
Reliability and Validity of Research Instrument
The research instrument must have the necessary criterion that it produces data
that are reliable and consistent (Cone & Foster, 2004; Leedy & Ormrod, 2001). To
enhance the reliability of the research instrument, the instrument should always be
administered in a consistent fashion; in other words, it should be standardized from one
situation or person to the next (Leedy & Ormrod, p. 100). To enhance the reliability of
the qualitative phenomenological study and to acquire consistent results, a standard
approach was useful to conduct the semi-structured tape-recorded face-to-face and
telephone interviews. Each of the 19 participants had ample time to answer each of the 10
questions and to validate their responses before the interview concluded. In several
instances, there was a need to clarify some responses before proceeding with the
sequences of questions.
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Summary
Chapter 4 described the qualitative phenomenological research study that
examined the lived experiences of 19 nurse CEOs using the Moustakas (1994) modified
van Kaam method by means of semi-structured, recorded, and transcribed interviews.
The chapter included details of the intent and purpose of the interview questions and the
findings of responses of the 19 participants. Chapter 5 provides a summary of the
findings that includes conclusions drawn from the data analysis of the responses of the 19
participants. Chapter 5 also discusses the implications of the study for health care
leadership, who may wish to consider nurses to be CEOs in hospitals. Chapter 5 includes
the implications of the study for nurses who may aspire to be hospital CEOs.
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CHAPTER 5: CONCLUSIONS AND RECOMMENDATIONS
The purpose of this qualitative phenomenological study using Moustakas (1994)
modified van Kaam method was to explore the lived experiences of nurses relating to
influential factors that may have eased their transition to the CEO position in a hospital.
The participants, who were from the states of Connecticut, Maine, New Jersey, and New
York, were selected from a purposive sample that included being a registered
professional nurse with a minimum of 2 years experience in the title of CEO of a
hospital. The minimum years of experience was necessary so that participants would be
able to provide information about their perception of influential factors that enabled them
to transition to the CEO position after being in the position for at least 2 years. Data from
the study might provide hospital leadership and nurses with information regarding
influential strategies and factors that may contribute to mentoring and developing nurses
in the ascension to the CEO position in a hospital. Chapter 5 provides a description of the
significance of the study, summarizes chapters 1 through 4, and offers recommendations
for future study.
The qualitative approach of the study included using the principles of gathering
and exploring data to construct a rich and meaningful description of the phenomenon
(Leedy & Ormrod, 2001; Moustakas, 1994). The rationale for using the
phenomenological approach in a qualitative study is appropriate to describe the
perception and experiences of a small sample of 5-25 participants who have lived the
experience (Leedy & Ormrod). The final sample of 19 nurses in the study met the
prescribed criteria and provided rich data from which to form composite descriptions of
the influential factors that eased the transition of nurses to CEO positions in hospitals.
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The study is significant because there remains a disparity in the number of women
in hospital CEO positions when compared to the number of men in these positions
(Burda, 2003; Weil & Mattis, 2003). As hospitals look to diversify, executive leadership
positions such as the CEO, women, in particular those that are nurses, are beginning to
embrace the challenge of being the CEO in hospitals (Gaskill, 2004; Philips, 2005). The
qualitative phenomenological study described the professional and personal experiences
perceived by 19 nurses CEOs in hospitals. The data analyzed identified influential factors
that enabled nurses to attain CEO positions in hospitals. The study is unique in that no
previous research examined the lived experiences of nurses that are in CEO positions and
factors that may ease their transition to the role.
The study participants experience as a hospital CEO ranged from 2 to 25 years
with the size of the hospitals ranging from 33 to 1477 beds. These two factors were
beyond the scope of the study but could account for the diversity of some of the
responses in that leadership of a large 1477-bed hospital versus a 33-bed hospital may
require different skills. Additionally, the search criteria for a CEO at a larger hospital
may be different from that of a smaller hospital due to budgetary constraints. Often, at
smaller hospitals, a position filled with a candidate who meets the minimum
qualifications rather than one who is best qualified may be the result of budgetary
constraints. The study did not include any professional designations that the CEOs may
have held such as certification in advanced health care administration.
Although some responses from the participants did not provide insight into
specific leadership styles or skills, participants identified traits and characteristics
associated with leadership theory. For example, being visionary and listening to people
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are characteristics of transformational leaders (Leavy, 2003; Matey, 1991) and not a
leadership skill. Question 5 asked participants to identify leadership skills necessary to
facilitate acquisition of a CEO position and responses varied and did not reflect typical
skills noted in leadership theory discussed in chapters 1 and 2. An explanation of the
responses could be due to the varying levels of professional education of the participants
of the study, which was outside the scope of the study.
All participants for the study volunteered to share their lived experiences as nurse
CEOs. Participants response bias by those individuals who like to participate in studies
versus those individuals who do not care to be involved with studies could have affected
the results of the study. Fifty-one possible candidates were potential participants for the
study. Thirty nurse-CEOs were from New Jersey, 15 from New York, 8 from
Connecticut, and 8 from Maine. After the receipt of 21 positive responses, no further
solicitation for participants occurred. Two nurse CEOs were removed from the
participant pool after acceptance due to the inability to schedule a convenient time to
conduct the interview because of busy schedules. It could be that the remaining 30 nurse
CEOs may have provided greater insight into the study.
However, several responders were able to articulate traditional leadership skills
such as delegation and problem solving as necessary for the CEO position. Yet, modern
concepts such as innovation technology, innovation diffusion, and innovative leadership
did not receive any mention during the interviewing process. Thus, the participants
interpreted the concept of leadership skills differently, resulting in a myriad of responses
despite clarification of the question during the interview process. The construct of
question 5 may have limited the participant responses or may not have gotten the desired
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response but as in qualitative research, responses to questioning are from the lived
experiences and perceptions of the participant. There was no attempt to assist the
participants in their response to the questions except when clarification was necessary.
Significance of the Study to Leadership
The identification of nurse CEOs lived experiences and influential ascension
factors may provide health care leaders with strategies for developing emerging nurse
CEOs in the hospital environment. The study may serve to empower and encourage
nurses that are aspiring to a career path that leads to the acquisition of the CEO position
in hospitals. The study may also provide nurses with relevant information about key
factors that might ease the transition to the CEO position in hospitals.
The study may provide health care leadership with strategies for attracting more
nurses to the CEO position, especially because hospitals remain challenged in to
recruiting and retaining CEOs (Spinelli, 2006). The results may help hospitals and other
health care organizations in developing leadership and educational strategies to enhance
the transition of nurses to hospital CEO positions. The results may also help nurses that
are interested in becoming hospital CEOs to construct strategic career and educational
plans that enhance their path to the CEO position.
Core Themes and Composite Description
The data analysis using Moustakas (1994) modified van Kaam methodology and
NVivo software resulted in emerging themes analyzed for their relationship to the four
research questions posed in the study. The themes that emerged were consistent among
the 19 participants and provided a good understanding of factors that eased the transition
of nurses to hospital CEO positions. The following is an analysis of the themes that
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emerged from the data collected from the 19 participants in relationship to the four
research questions that guided the study.
The data suggested that there were several themes associated with the facilitation
of nurses ascension to a hospital CEO position as illustrated in the Figure 4 personal
attributes identified included the desire and inspiration to be a CEO. The Figure 4
illustrates the themes that provided the foundation to nurses ascension to a hospital CEO
position. Each of the themes is a horizontal support that enabled nurses to ascend to the
CEO position in a hospital. An influential strategy such as the use of persuasion by others
also contributed to nurses ascension to a hospital CEO role. Nurse CEOs tended to use
their clinical backgrounds in focusing their thinking on the needs of patients and the
organization. Prior leadership skills acquired in progressive leadership experiences within
nursing and exposure to collaborative experiences with other areas in the hospital are also
key factors in nurses ascension to a hospital CEO role. Institutional support was an
instrumental factor that enabled nurses to ascend to the CEO position and was especially
important because many of the participants evolved to the CEO position from prior
leadership positions within their hospitals. In addition, acquisition of relevant education
especially in business and finance were common factors in the career path to the CEO
position.
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Factors that Led

to CEO Positions
Desire and Business and Persuasion Leadership Institution Clinical Thinking

Inspiration Finance by Others Skills Support Background of
Knowledge Patients
Figure 4. Cross-theme analysis and Research Question 1: What factors practiced by nurse
CEOs facilitate executive leadership attainment?
The experiences that led to executive leadership attainment for nurse CEOs
according to the lived experiences of the 19 participants were both positive and negative
(Table 4). It is evident that the negative lived experiences noted by the participants served
as motivation and inspiration to each of them because despite the negative experiences,
they acquired the position of CEO in a hospital setting. The negative lived experiences
did not deter participants from their desires and goals in their careers.
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Table 4
Cross-Theme Analysis and Research Question 2: What Are the Experiences That Lead to
Executive Leadership Attainment Interpreted by Nurse CEOs?
Positive experiences Negative experiences
Emotional behavioral factors Gender bias
Mentoring relationships with males Hindrance of working relationships between
and females doctors and nurses
Taking advantage of opportunities Being viewed as having human-side or as being
and programs touchy feely
Executive-, middle-, and lower-level Resentment and use of scary tactics
positions Receiving negative notes from doctors
Use of the clinical background Questioning of authority
Self-natural progression
Cross-Theme Analysis and Research Question 3: What Meaning Is Construed from These
Experiences?
The meanings construed from the participants experiences were that despite both
negative and positive experiences while nurses were acquiring the role of CEO in a
hospital, with a little bit of persuasion, drive, and inspiration anything was conceivable
and achievable. Participants were able to attain the position of nurse CEO with the
positive influences from both male and female mentors, by taking advantage of
opportunities that presented themselves, through programs, and through continuing
education. When negative situations arose, the participants were able to continue to work
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through the challenges by using their skills, abilities, and background, such as a clinical
background. The following responses illustrated how the clinical background was an
advantage for many of the participants in their CEO role.
Advantages of clinical background.
Nurse CEO-01:
I can talk to doctors and I can talk their language. I have a great deal of interest in
science and in new ways of caring for patients. I ask a lot of questions to the
physician group. When I am trying to do something in the organization that may
be a little controversial to the physicians, I can talk to them about it in terms that
they can understand. This is the biggest advantage to me in this role.
Nurse CEO-02:
I think my clinical background has been a positive advantage in my role.
However, when it comes to making the tough financial decisions having the
clinical background makes it difficult because you do worry about how it will
affect the patients and the staff. Overall, I think the clinical background is an
advantage because you have been at the bedside and you know what really is
involved.
Nurse CEO-07:
My clinical background was positive. I was in an institution where doctors were
on one side and administration was on the other. With my clinical background, I
was able to speak to the physicians in their language and thus, I was able to build
a better team. A physician once said to me, I cannot believe you are so clinical
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and I take pride in that because I truly believe that the best people to run a facility
are nurses and physicians.
Nurse CEO-12:
The understanding of the clinical arena is most certainly a huge advantageyou
know when something is not right, like a smell test, if you will. The disadvantage
is that you may not be exposed to the financial side or you are not perceived as
having financial savvy. The nursing background sometimes makes folks think of
you as having more of a human-side or being more touchy-feely and this
perception can be a distinct disadvantage.
Nurse CEO-13:
I cannot think of any negatives. The positive is that you are very aware of the
clinical mission of the hospital because as a nurse that is what you go into nursing
for. Many hospital CEOs come from the business or banking backgrounds and so
I think the field is looking more and more at some clinical background for CEOs
because it is vital. Having the clinical background has kept my eyes always on the
clinical outcomes when we are having conversations about finance or any other
area of the hospital.
Specific characteristics participants noted any nurse ascending to the role of CEO
in a hospital setting needs included being honest, being responsible, having a good sense
of humor, caring about people and the organization, having good listening skills, having
good integrity, possessing self-confidence, and being a transformational leader. Each of
the participants possesses these specific characteristics and more. It is important to use
the skills, abilities, and background one possesses and to apply it to each situation and
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job. Some advice noted by the participants based on their lived experiences was as
follows:
Nurse CEO-05: Know the business you are in; Try to be seen as a can do person;
Learn to sacrifice for a short period of time; Learn to network.
Nurse CEO-06: Cross over to general operations.
Nurse CEO-07: Be assertive and seek out opportunities; be willing to sacrifice
sometimes; Take on opportunities and be the best you can.
Nurse CEO-11: Let go of how a nurse thinks to gather and obtain new
perspectives of the field of nursing.
Nurse CEO-16: Get involved in committees that are cross-functional.
These comments are examples of the manner in which the participants in one
facet of their life and career learned to overcome obstacles as they pursued their goals.
Participants described support and inspiration from institutions and mentors, as well as
hard work. The following experiences explain the importance of having a mentor in the
ascension of nurses to the hospital CEO position.
Mentors.
Nurse CEO-02:
My mentor groomed me to take over his position (CEO) and allowed me the
latitude to grow. He was the most influential; he taught me that you always have
to groom people as a CEO and I hope I am doing the same thing.
Nurse CEO-04:
I think most nurses tend to devalue their contributions and minimize their
contributions and assets, as compared to male colleagues or other colleagues with

116
different educational backgrounds. Early in my career when I was a Director of
Nursing (DON) a colleague always encouraged me to share what I know with the
rest of the world. She encouraged me to believe in myself and to believe in what I
was doing. This took me out of analysis paralysis into hey listen: I am doing an
interesting project. This made a big difference in me being able to move forward
and in believing in me.
Nurse CEO-10:
This is easy for me. I still call my mentor to this day. He was a CFO at the
hospital where I became the VP of Medical Affairs. He became the CEO. He
taught me a lot about finance and health care finance. He taught me a lot about
how to present my frustrations in a manner in which would not be offensive to the
rest of the senior management team.
Some of the participants identified institutional support as an important factor in
their ascension to the CEO position. Institutional support included allowing individuals to
recover from mistakes and to take risks. Nurse CEO-03 identified support as being given
the opportunity to take a sabbatical leave to be a White House Fellow while others noted
the ability to pursue educational goals as being an important means of support from the
institution. The following are specific examples cited by the participants regarding how
their institutions supported them in ascending to the CEO position.
Institutional support.
Nurse CEO-01:
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My previous organization where I spent 18 years was supportive and helped me
by allowing me to make mistakes and take risks, and encouraged me to do so.
This helped me to develop to the path to being a CEO.
Nurse CEO-03:
Years ago, a little more than 10 years ago, I was given administrative sabbatical
leave in one of my roles to be a White House Fellow for 1 year. This was defining
as a trajectory for me in my path to being a CEO. This experience opened my
eyes about leadership at the highest level, that being the Presidency of the United
States.
Nurse CEO-11: I had great support from the Board of Directors, the nursing
staff, and doctors. The organization allowed me and to learn from those
mistakes.
Nurse CEO-13:
The institution supported me to use my leadership skills in other places. I was a
past President of the American Psychiatric Nurses Association. It supported me
financially, during my time way, and the many leadership conferences that
attended. The support I got as a director of nursing (DON) was very important in
me being able to get other roles and the CEO position. There was a lot of
education and financial support that was built into my being able to get this
position.
In summary, a multitude of meanings is derived from the lived experiences of the
participants, both positive and negative. However, the greatest meanings were to utilize
the skills, abilities, and background one brings to a job and situation. For instance, many
118
of the nurses relied on their clinical background to understand the importance of patients
needs when having to make financial decisions. The clinical background was also
important to many of the nurses when communicating with physicians.
Additional meanings from the participants experiences identified the importance
of mentoring relationships and institutional support. Having a mentor was significant for
the nurse CEOs in their ascension to the CEO position. One may conclude that
meaningful mentoring relationships enabled nurses to aspire to their CEO positions
because of the confidence and encouragement their mentors gave them. Having
institutional support enabled nurses to pursue educational goals, lead by making mistakes
and learn from them, and be given the opportunity to take on responsibilities outside the
nursing domain.
The prior skills noted by the participants used in the ascension to the CEO
position in a hospital setting were critical skills, adaptive skills, transferable/critical
transferable skills, people skills, leadership skills, dealing with data, and management
skills. An explanation of the aforementioned skills is discussed in the findings of question
4 in chapter 4. Figure 5 depicts the skills the participants used to attain the CEO position.
The center of the figure represents reaching the CEO position in a hospital after
acquisition of the identified skills. Participants did not articulate the priority of skill
acquisition but were sure to express how the skills depicted in the Figure 5 enabled easier
transition to the CEO position. Collectively, the skills provided sufficient support for
nurses who were able to attain their CEO position.

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Critical
Skills
Management Adaptive
Skills Skills
Ascension to
a Hospital
Dealing with Transferable/
CEO
Data Critical
Transferable
Leadership People
Skills Skills
Figure 5. Cross-theme analysis and Research Question 4: What Types of Prior

Leadership Skills Contributed to Nurse CEOs Ability to Ascend to CEO Positions in
Hospitals?
Chapter Overview and Summary
Chapter 1 introduced the problem and the intent of the study to explore the lived
experiences of a purposive sample of 20 nurses that are CEOs in hospitals. Chapter 1
gave a historical perspective of male domination in health care executive positions and of
the difficulty; women have in penetrating the glass ceiling of health care leadership. The
chapter provided an overview of how women, in particular those who are nurses, are
beginning to acquire hospital CEO positions. Chapter 1 also included an explanation of
the significance of the study to health care leadership, the nature of the study, and the
theoretical framework. The chapter concluded with a definition of terms, scope,
assumptions, limitations, and delimitations.

120
Chapter 2 introduced the review of the literature associated with factors such as
the importance of mentoring relationships, emotional intelligence, and the relevancy of a
clinical background in the transition of nurses to hospital CEO positions. The chapter also
included an explanation of stratified systems theory and its implications of key behaviors
and performances when leaders ascend to higher positions in an organization. Grounded
theory, as explained in chapter 2, provided a framework for understanding how predictive
behaviors can construct a valid theory from data analysis. In the study, the lived
experiences of nurses as they transitioned to hospital CEO positions were associated with
several behaviors that could be interpreted to construct a theory of the phenomenon.
Chapter 3 identified the rationale for choosing a qualitative phenomenological
methodology for the design of the study and provided a description of the participants,
their eligibility, informed consent, and confidentiality. Chapter 3 detailed the procedure
for the use of the instrument for data collection, the method of data analysis, and the
description of the studys validity and reliability. The chapter included an explanation of
the steps of Moustakas (1994) modified van Kaam method of analysis that described the
analysis of data.
Chapter 4 presented the details of the data of the lived experiences of nurses in
hospital CEO positions. The chapter included identification of themes that emerged from
the data analysis facilitated by the NVivo qualitative analysis software. The presentation
of data included tables, figures, and textural descriptions of the experiences of the studys
population. The chapter provided an explanation of the intent of the 10 interview
questions in probing the lived experiences and perceptions of the studys participants.
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Chapter 5 presents an overview of the studys findings in relation to the four
research questions: What factors practiced by nurse CEOs facilitate executive leadership
attainment? What are the experiences that lead to executive leadership attainment
interpreted by nurse CEOS? What meaning is construed from these experiences? What
types of prior leadership skills contributed to nurse CEOs ability to ascend to CEO
positions in hospitals? An explanation of the themes that emerged from the study and
interpretation of results are also in chapter 5.
Chapter 5 provides a summary of chapter 1, which described the intended focus
and problem of the study. Chapter 5 also provides a summarization of chapter 2, which
was a review of the literature of influential factors that may ease the transition of nurses
to the CEO position in a hospital. The chapter also briefly summarizes the studys
methodology and appropriateness explained in chapter 3, along with the presentation and
interpretation of the data analysis from chapter 4 and its implications for recommendation
for further research. The chapter concludes with recommendations for further research.
Findings from Study and Linkage to Conceptual Frameworks
The three conceptual frameworks described in chapters 1 and 2 for the study were
leadership theory, stratified systems theory, and grounded theory. The following section
provides an explanation of how the studys findings may link to the concepts included in
these three theoretical frameworks.
Leadership Theory
It was difficult to link the results of the study to the explanation of leadership
theory by notably theorists such as Bass (1990), who posited the importance of
transformational leaders ability to inspire their followers. However, participants

122
identified team-building skills, caring about people, and human relationship building as
personal characteristics. Whether or not these characteristics led to inspiring others is
unclear based on the participants responses. Yet, Burns (1978) view of transformational
leadership evolvement from values may reflect the participants responses that centered
on honesty, and integrity. Kouzes and Posner (2002) also spoke to honesty and integrity
being important leadership qualities. Kouzes and Posner affirmed that leadership and the
relationship between leaders and followers centered on the integrity of the leader. In their
study, Kouzes and Posner identified the ability to inspire others and honesty as behaviors
that built trust and established credibility. A characteristic of transformational leadership,
being visionary (Carroll, 2005) was also present in the findings of the study. The studys
findings are inconclusive as to a definitive indication of unique leadership practices in
nurse CEOs in hospitals. Rather, the studys findings revealed traits and characteristics of
transformational leadership were present in the sample of 19 nurse CEOs.
The results of the study proved relevant to the description of stratified systems
theory (SST) posited by Jaques and Clement (1991) which identified the importance of
leaders performing critical tasks as they ascend in an organization. Although not directly
articulated, the participants in the study reported emotional and behavioral factors such as
having emotional intelligence, learning how to communicate effectively, and mastering
finance as necessary as they ascended the hospital corporate structure.
Kings (2003) postulation that SST allows leaders to maximize talents and skills
within the layers of an organization links with the participants acquisition of leadership
roles in their hospitals that positioned them for the CEO position. However, the majority
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leaders in the study did not have the opportunity to acquire leadership roles that were
outside of nursing. This could be due to the size of their hospitals and the complexity or
simplicity of the organizational layers. Since most of them were CEOs in hospitals with
less than 300 beds, it is questionable whether many opportunities for maximizing skills
and talents existed in 30 bed or 200 bed hospitals at the same level as a 1400 bed facility.
Grounded Theory
The findings of this qualitative study could generate new theory about what
factors may influence the transition of nurses to hospital CEO positions. Grounded theory
provides relevant predictions, explanations, interpretations, and applications (Glaser &
Strauss, 1967). Based on the studys results, mentoring relationships, knowledge of
business and finance, and institutional support were important factors that eased the
transition of nurses to CEO positions. Grounded theory examines the interpretation of
qualitative data to generate new theory (Glaser & Strauss). The theory that may generate
from the results of the study is that nurses who want to be CEOs may need to have
mentors, business and finance skills, and institutional support.
The linkage of the findings to the three conceptual frameworks is not entirely
conclusive or justifiable because of the variation of participants experiences and
perceptions. Despite the results, some of the findings clearly demonstrated an association
to the general explanation and description of the three conceptual frameworks that guided
the study. More research on the phenomena examined in the study may validate the
theoretical linkage.
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Recommendations
The results of the study have provided several recommendations for health care
leadership and RNs in the capacity of enabling more nurses to ascend to the hospital CEO
position. These recommendations may ease the transition of nurses to the CEO position
in hospitals by providing a base for enhancing their career path directly to the role.
Nurses interested in being CEOs should engage in leadership activities that expose them
to different areas outside of nursing leadership to gain a fuller perspective of the needs of
the entire organization.
Health Care Leadership
The study is significant to health care leadership, especially in the context of
understanding the influential factors that enable nurses to transition to hospital CEO
positions. As the largest population of employees in hospitals, nurses are a potential
source of emerging CEO leaders. The study provided insight into the lived experiences of
19 nurses that are hospital CEOs. The participants perceptions and understanding of
influential factors that eased the transition to the role of CEO provided perspectives of
how nurses may be able to charter a career path that leads to a CEO position in a hospital.
Based on the data collected from the nurse CEOs, health care leaders may wish to
consider incorporating training and educational courses in finance and business to
supplement knowledge deficits nurses have in these two critical areas of the CEO role.
Further, hospitals and other health care organizations may want to consider developing
formal mentoring programs, in particular, for senior-level executives to serve as mentors
as a means of nurturing and empowering future nurse CEOs. Hospital leadership may
want to create challenging opportunities for nurse leaders to work outside of their
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traditional nursing domain so the nurse leaders can gain understanding of working
relationships that encompass the total hospital environment. This is a worthwhile
recommendation because the research revealed many of the participants identified having
the opportunity to work in different areas outside of nursing was an important aspect of
gaining confidence in being able to ascend to the CEO role. For example, Nurse CEO-02
noted that, I definitely think that being in a position as a Chief Operating Officer for 8
years helped because my superiors got the chance to observe me. Nurse CEO-10 stated
that, I was in the role of VP of Medical Affairs and came into the CEO role as a very
different type of individual. The Board was looking for a change and someone very
different and supported me in the new role of CEO. Nurse CEO-11 commented that,
The organization allowed me to go to different roles and make mistakes and to learn
from those mistakes.
The research revealed how all the nurses did not initially desire to be CEOs, and
that the CEO position evolved from their career path. This is important information for
health care leaders to consider in identifying nurses who are skilled and capable of being
hospital CEOs. By challenging nurses to lead in diverse areas within and outside of the
hospital environment, health care leadership may be able to design CEO succession
plans, which consider the talent and leadership skills of nurses. Furthermore, hospital
leadership may wish to ensure environments are supportive to emerging nurse CEO
leaders and might assist nurses by providing creative opportunities to expand leadership
skills, as many organizations prefer to promote from within.

126
Registered Nurses
Based on the lived experiences of the 19 participants in the study, nurses
interested in being a hospital CEO may want to consider several factors. Nurses may
need to seek further education in business and finance to understand how they influence
the operations of a hospital. A second recommendation is that nurses consider using
mentors, especially those that may be influential to their ascension to the CEO position.
Nurses may need to seek experiences and opportunities outside of nursing to gain a fuller
understanding of participating in other areas of leadership in the organization. Nurses
may need to understand the importance of relationship building, emotional intelligence,
and effective communication in undertaking the CEO position.
Recommendations for Further Study
Based on the research that examined the lived experiences and perceptions of
nurse CEOs, certain factors such as mentoring, acquisition of business and financial
skills, having a clinical background, and relationship skills were important in nurses
ascension to the CEO role in a hospital. The study may serve as a foundation for other
researchers to expand the inquiry of whether nurse CEOs are successful in their roles and
have lower turnover rates than non-nurse CEOs. It is also desirable that future studies
consider the turnover rates of nurse CEOs versus those of non-nurse CEOs for healthcare
leadership to gain insight of positive and negative factors that influence turnover.
Another area worthy of exploring is whether nurse CEOs are mentoring other
nurses to empower them to become CEOs. The study revealed that mentoring was a
significant finding in nurses ascension to a hospital CEO position. It would be

127
interesting to explore whether nurse CEOs are availing themselves to meaningful
mentoring relationships with nurses who may aspire to a CEO role.
The factors identified by nurses in CEO positions in hospitals that eased their
transition to the role have provided the foundation for future research in exploring how
nurse CEOs are having an impact on the outcomes and performances of hospitals. Further
studies may consider a change of methodology from semi-structured interview to a
survey format to accommodate potential participants time and availability to participate
in the research. A mixed methodology study is worthy of consideration for further
research where quantitative findings on hospital performance may correlate to nurse CEO
leadership styles. This study focused on nurses in hospitals in four eastern states with a
minimum of 2 years experience in the CEO position. Future studies need to consider
nurse CEOs in other health care organizations and other geographic locations.
Final Summary and Conclusion
Hospital leadership looking to attract more nurses to senior executive roles and
RNs aspiring to higher leadership positions outside of their traditional nursing domain
may need to consider the influential factors identified by the participants in the study that
enable the successful transition of nurses to the CEO position in a hospital. Enabling
factors such as acquisition of business and financial knowledge and the benefits of having
mentors could assist emerging nurse senior executives in charting their career path
directly to a hospital CEO position. However, strategies that include providing
opportunity for nurses to manage non-nursing areas and nurturing emerging nurse CEOs
by challenging them with progressive leadership positions may enable easier transition to
executive positions. Nurses aspiring to hospital CEO positions may want to consider the
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factors identified in the results of the study as a passageway to transitioning from nursing
executive positions to that of being a CEO.

129
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APPENDIX A: INVITATION TO PARTICIPATE IN A RESEARCH STUDY
Dear Potential Study Participant,
I am a doctoral candidate at the University of Phoenix working on a Doctor of Health

Care Administration dissertation. As a doctoral dissertation project, I am conducting a
research study entitled: A Phenomenological Study of the Career Transition of Nurses
into CEO Positions in Hospitals.
The study will entail an interview lasting approximately one (1) hour about your
experiences in the role of CEO in a hospital. I am requesting your participation in this
study if you currently licensed as a registered nurse (RN) and have a minimum of 2 years
experience in the title of CEO in a hospital.
Please be assured that after the initial contact, your name, phone number and E-mail
address will be separated from the information, and a code will be used so that only the
researcher will identify your information. Upon your acceptance and agreement to
participate in this study, an informed consent and further details of the study will be given
to you.
Thank You,
XXX-XXX-XXXX
148
APPENDIX B: AN INTRODUCTION LETTER TO PARTICIPANTS
Dear Nurse CEO,
I am a doctoral candidate at the University of Phoenix working on a Doctor of Health

Care Administration dissertation. As a doctoral dissertation project, I am conducting a
research study entitled: A Phenomenological Study of the Career Transition of Nurses
into CEO Positions in Hospitals. The purpose of the research project is to explore the
lived experiences of nurses in CEO positions in hospitals in Connecticut, New Jersey,
and New York. I would like to invite you to participate in this study. Your participation
in this study is very important to the exploration of influential factors that enable nurses
to acquire hospital CEO roles.
Your participation will involve an interview with research focusing on sharing your
knowledge and experiences of factors that may have influenced your ascension to the role
of CEO in a hospital. The interview will be a maximum of two hours, and to ensure the
information is accurate, the interview will be audio recorded. Your participation in this
study is strictly voluntary, and if you choose to withdraw from the study, you can do so at
any time. The results of the research study may be published; however, your name will
not be used and your comments will be maintained in confidence. In this research, there
are no foreseeable risks to you.
I believe there is a profound value in examining factors that may enable more nurses to
acquire high-level executive hospital positions such as CEO, and how these factors may
influence more nurses ascending to the role of CEO. I also believe the results of this
study can assist hospitals in crafting appropriate succession planning programs for nurses
who may be interested in acquiring the CEO role.
If you have questions concerning this research study, please call me at (###) ###-####.
Sincerely,
University of Phoenix, Doctoral Candidate

149
APPENDIX C: CONSENT TO ACT AS A RESEARCH PARTICIPANT
___________________, a Doctoral learner at the University of Phoenix and an

independent investigator, has been given permission by
____________________________________ to conduct a research study on exploring the
career transition of nurses into hospital CEO positions.
I, ____________________________________________, have volunteered to participate

in this research study. My participation in this study is strictly voluntary. I understand
that:
1. I may refuse to participate and/or withdraw at any time.

2. Research records and list of interviewees will be confidential.
3. Personal anonymity and confidentiality is guaranteed.
4. Results of the research data will be used for presentation and publication.
5. As these data are presented, I can choose to be identified as the source of that
information for group discussion and publication purposes.
6. ______________________has explained this study to me and answered my
questions. If I have any other questions or research related issues, I can be reached
at _____________________.
There are no other agreements, written or verbal, relating to the study beyond that
expressed in this consent and confidentiality form. I, the undersigned, understand the
above explanation, and give my consent to voluntarily participate in this research.
Interviewee___________________________________________Date:_______________
Investigator____________________________________________Date:______________
150
APPENDIX D: SEMISTRUCTURED INTERVIEW QUESTIONS
1. How long have you desired to be a CEO in a hospital?
2. What emotional behavioral factors do you regard as necessary to ascend to a
hospital CEO role?
3. What specific personal characteristics, if any, would you say contributed most
to your ascension to the CEO role?
4. How would you describe any institutional support you may have received in
your career path to the role of CEO?
5. What leadership skills do you perceive as necessary for nurses to acquire to
facilitate acquisition of CEO roles in hospitals?
6. What advantages, both negative and positive would you say that your clinical
background as an RN had in your ascension to the CEO role?
7. What importance if any, would you say obtaining a business or finance degree
may assist nurses in acquiring the CEO role?
8. Describe any mentorship relationship you had with someone you considered
influential in your ascension to the CEO role?
9. What advice would you give a nurse aspiring to a hospital CEO position?
10. Identify three key areas in hospital administration where expanded knowledge
may ease the transition of nurses into CEO positions.

151
APPENDIX E: TRANSCRIBED RESPONSES TO INTERVIEW QUESTIONS
How long have you desired to be a CEO in a hospital?
Nurse CEO-01: I had no desire. If you had said to me 10 years ago that I you are
going to be a hospital CEO, I would have said you were crazy. I had very good mentors
that encouraged me to do things and to try things. They made me find something within
myself. They said to me that you can do it. This was not my career goal.
Nurse CEO-02: I dont think I ever desired to be a hospital CEO. I went from
Vice President (VP) of Patient Care Services to the Chief Operating Officer position and
this just naturally transpired. I thought I had reached my career pinnacle as VP of Patient
Care Services.
Nurse CEO-03: Within the last 5-10 years.
Nurse CEO-04: I would say for the last 5 years. It became clear to me as I moved
from the VP of patient care services to a senior VP and then to a COO that my best
contribution would be eventually made as a CEO because I tend to be strategic in
thinking.
Nurse CEO-05: Probably about 20 years ago.
Nurse CEO-06: I took my career in steps. I did not start out deciding to be a CEO.
I started out as a staff nurse and realized I liked administrative things. My ultimate goal
was to be a VP of patient care and I achieved that goal by the age of 30. I enjoyed it and
began to realize and believed that if you can run a nursing division, you are really
running the operations of a hospital. Nurses understand the needs of patients; they are
very involved with all components; labor relations, physicians, and other concerns. I then
152
decided to be a COO and was running the hospital. When I began to realize that I was the
go to person for just about everything, I said to my boss, I think I would like to take
on some departments outside of nursing. My boss was a wonderful mentor and he
allowed me to do that. Then I decided I wanted to be a COO. I gained confidence in the
COO role but did not really think about being the CEO. At that time, I realize I was in
fact running the hospital and decided to become a CEO. I never had a burning desire to
be a CEO in a hospital; it kind of evolved in my career.
Nurse CEO-07: I never really desired to be a CEO. This is not something that I
planned to be. When I started out in nursing, it was not that I did this to become a CEO.
Opportunities presented themselves to me over the past 18 years that made me realize
that this is something I could do. As VP of nursing, I took on ancillary areas and became
the VP of Operations. The job that I really wanted was the COO position. When the CEO
left the organization, I still did not think of applying for the CEO position until someone
else applied that did not have any hospital experience.
Nurse CEO-08: It was never my desire or my goal. I was in nursing
administration when the CEO was terminated. As the Director of patient care services, I
had many of the departments reporting to me such as pharmacy, dietary, respiratory,
infection control, and dietary. I was asked to step up to be the interim CEO and it turned
out to be wonderful for me personally and professionally and for the hospital that I have
remained in the CEO position for the past 11 years.
Nurse CEO-09: I have been working in healthcare for 47 years and the last 27; I
have desired to be a CEO.

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Nurse CEO-10: I am the president and a CEO for a health system. I would say
about 10 years.
Nurse CEO-11: I never gave it a thought until I was a senior vice president and
had the opportunity to step in and be an interim CEO. It wasnt until then that I had any
desire.
Nurse CEO-12: About two years before I actually became a CEO.
Nurse CEO-13: I never desired to be a CEO. It was not a career goal or career
choice. It just happened. I was a Director of Nursing here for 11 years and through
succession planning became the CEO. It was never something I thought I could do or
wanted to do.
Nurse CEO-14: I never wanted to be a CEO. I have been in this organization for
35 years and started as a charge nurse. I had several positions during theses years that
included acting in an interim CEO role for six months. I became the CEO over four years
ago.
Nurse CEO-15: I never had the desire to be a CEO.
Nurse CEO-16: I have desired to be a CEO for 20 years.
Nurse CEO-17: This role was not on my radar screen. However, the President of
this corporation called me in 1994 and told me he was planning to make changes and
asked me to consider this CEO role.
Nurse CEO-18: Ten years
Nurse CEO-19: I never desired it.
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What emotional behavior factors do you regard as necessary to ascend to a
hospital CEO role?
Nurse CEO-01: I dont think that you can differentiate any emotional behaviors
by the position in the organization. I think if you are going to be a leader, whether it is in
nursing or in any field you have to have a very strong moral fiber. You have to know
yourself very well. You have to be able to expose yourself your faults as well as your
strength. You have to be able to say I made a mistake. So, I think those characteristics
are important whether you are a nurse manager, or a director of a lab, or a hospital CEO.
Nurse CEO-02: Patience and I think you have to be able to listen. You have to be
a real good listener. You cannot react emotionally to anything. You have to take the time
to position yourself. I think in a sense it is very important for women to develop the skill
of listening. You cannot jump to conclusions. You cannot shoot from the hip. You really
have to have the ability to act when it calls for it.
Nurse CEO-03: Be visionary, strategic, and be fair. Be firm in your resolution to
get things completed and sustained. I guess this all means one must be very focused.
Nurse CEO-04: Emotional intelligence literature is highly predictive of CEO
success. I think maintaining a sense of executive protocol and being able to maintain a
calm demeanor helps the individual as well as helps to contain the anxiety within the
organization.
Nurse CEO-05: Very good people skills, mastery of information, and above all,
perseverance. Good organizational skills are paramount because there is a large volume
of information that comes to you on a daily basis. Without being well organized or not
having that quality, then you must have good people around you
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Nurse CEO-06: One must have a strong sense of confidence in the self. You have
to have a fire in your belly, be motivated, and have a drive that propels you and helps you
to evolve. You have to have a tough skin and should not take things personally at all. You
cannot be too sensitive. For example, if something is going wrong, do not always think it
is your fault. Be objective, look around, and not always think you have to save the issue
that is going on. You cannot act too feminine; one must almost be gender-less. You
cannot call your gender to attention too much because many times, you are with men and
they are uncomfortable with the emotions that women may express.
Nurse CEO-07: Emotionally, you need the empathy and the compassion that you
want to care for patients. You also need assertiveness to get the job done.
Nurse CEO-08: Keeping priorities in the right order are an important behavioral
factor. As a nurse working in the emergency and critical care areas, I know that there are
devastating things that can happen to people. It is important not to sweat the small stuff.
Not reacting to issues that are not all that important and knowing which areas require
your energy and attention is an important behavioral factor. Learning to truly use the
nursing process everyday and in every situation is a tool that is invaluable.
Nurse CEO-09: Communication skills, a small ego, and sound financial sense.
Nurse CEO-10: The qualities for a CEO or anyone in leadership are honesty,
integrity, and listening. Being able to hear, empathize, and sympathize with the staff that
is working for you. Women have a tendency to listen. We all have egos but we need to
learn to keep them in check and this is very important, especially for women.
Nurse CEO-11: There are a number of factors. The key ones are having a positive
attitude and to have common sense. It is important to have a vision as well as the ability
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to see the bigger picture. I was a contributing author to a book and in that book were 20-
30 traits that I think are important for a CEO Some of them include, having a sense of
curiosity and knowing how to foster it. Good communication skills and knowing how to
understand others is also very important. Do not being afraid to learn and to take risks.
One must be able to develop meaningful relations and to navigate the political landscape.
Do not having a personal agenda but be always able to attend to the organizational
agenda. Finally, to understand the use of power and to treat that with respect is very
important. It is key that anyone in the position separate the task from the emotion and I
think that men tend to have more negative emotions that women do, especially in certain
situations
Nurse CEO-12: I think you need to be extremely flexible or adaptable. You also
need to be a good listener and you need to like people. You have focus on being
accountable and holding people accountable. You must be able to articulate very complex
issues. You must have integrity, be self-motivated and self-directed in focusing on the
challenge at hand. The key is to be able to network effectively, particularly as a nurse
CEO.
Nurse CEO-13: You have to a lot of belief and faith in yourself. You need to have
a balance or a good sense of the environment and think things through before reacting.
Use critical thinking, which is something that nursing, is known for and which is a key
factor in using data before making decisions.
Nurse CEO-14: I think consistency, fairness, and the ability to juggle many tasks
at the same time is important. The person must be a good listener and communicator and
must care about the organization and understand how it works.

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Nurse CEO-15: You have to be able to listen to employees from various
departments and different levels in the hospital. Negotiation skills and listening skills are
importing behavioral skills.
Nurse CEO-16: I think it takes critical thinking, multi-tasking, having a high
stress tolerance, definitely relationship building skill, and communication skills. I think
communication skills is critical because it probably is the best indicator of your ability to
be successful than your financial acumen. If you have the ability to communicate with
your staff and touch people in a way that motivate them in a service industry, that is key.
I think women are far better in communicating than men.
Nurse CEO-17: It is very important that one has good composure, know oneself,
and to have passion for the job and patients. Patients are the product that you serve and
market. It is very easy to get caught up in the budget and everything else, but if you have
passion for the patient you will always try to make sure that the patient comes first.
Nurse CEO-18: I think it is important to be more calm and patient in nature, or to
train your self to be that way. To be able to show some restraint, especially in thinking
before you speak. One must have a sense of fairness and think the best of people.
Nurse CEO-19: Integrity is number one, followed by having patience, and good
listening skills. A critical factor is to learn to listen to the whole story before making a
decision. Sometimes we tend not to do that. As nurses, we want to save the situation, so
oftentimes we are ready to jump in with two feet before we get all the facts.
What specific personal characteristics, if any, would you say contributed most to
your ascension to the CEO role?

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Nurse CEO-01: I think that it is hard to see yourself as others do. What has been
helpful in my career is a strong sense of good interpersonal relationships as well as
having very high standards. I expect that I can always do better and the ability to be what
I am, not to work to be something else. My style, personality, and characteristics had to
work in this job, in this organization. I cannot be someone that I am not.
Nurse CEO-02: I am a strong leader and have always demonstrated good
leadership skills in other roles.
Nurse CEO-03: A CEO has to have social skills, political aspirations. This is a
male-dominated environment, so as a woman, I think one has to learn how to participate
in some team sports.
Nurse CEO-04: Relationship building and interpersonal communication. An
individual also needs to be persistence and resilient.
Nurse CEO-05: I am honest and have good integrity.
Nurse CEO-06: My ability in relationship building. I am a relationship-based
person. I do very well with people. I am a good facilitator. I know not to draw a line in
the sand and then all of a sudden take sides. I know how to not allow someone else do
that so you protect them. I believe in honesty, integrity, and mutual respect, it is just part
of who I am.
Nurse CEO-07: One of the characteristics that I have is that I am able to formulate
a team and earn respect and support. The staff stands behind me in supporting projects
that are undertaken in the organization.
Nurse CEO-08: My people skills and my ability to interact and care about people.
I know these were instrumental in my ascension to the CEO role. I know my employees. I
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have approximately 400 employees at this facility and I can tell you that I know at least
300 of them by name and that I know a little about them. The only reason people will
stay with you is for that personal characteristic. I have 75-80% of the staff still here from
when I became the CEO 11 years ago.
Nurse CEO-09: I think my clinical experience was helpful. I have good financial
knowledge and a strong financial acumen.
Nurse CEO-10: I am very open and easy to talk to. I listen and I have a rule called
a 24-hour rule where I do not react to any situation for 24 hours. I do not shoot from the
hip and believe in not doing a knee jerk reaction. I wait to see if I still feel the same
tomorrow and it is then that I would take action. I am a caring individual and am sensitive
when it comes to dealing with people but I do not have sensitive toes. This job is all
about taking care of patients. I try very hard to keep a smile on my face, especially when
I make rounds throughout the hospital. I make a point of caring and listening to
individuals.
Nurse CEO-11: I cared about the organization and did not put myself first; I put
the health care of the people first. I am a risk taker and many people saw me as
aggressively assertive, while I saw it as doing what needed to be done. I would
orchestrate everything to make things happen in a creative way. I am dedicated to being
accountable and responsible.
Nurse CEO-12: I think I have the ability and willingness to network effectively,
especially outside the area of nursing. I have found my ability to think on my feet and my
sense of humor (ability to diffuse a tense situation) has helped me tremendously. You
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must also be able to have the appearance of being confident whether or not you are under
water, paddling like a duck.
Nurse CEO-13: Others have identified some of these for me along the way. I have
been called a transformational leader. I am visionary and know how to bring people
together to do that. I am very open, approachable, and have an open door policy. People
can challenge me if they feel that they need to and I listen. I have a strong belief in what I
do and I love what I do.
Nurse CEO-14: I think being a nurse and being here for the right reasons. I really
do care about the patient that walks through these doors and my employees. Because I am
a nurse, I think I bring all the aspects to this position of what healthcare is all about.
Healthcare is a business; there has to be heart within that business. Personally, my
listening and communication skills have helped me.
Nurse CEO-15: I think it takes a component of confidence. I have held many
positions in various health systems, so the characteristic there is the flexibility to move us
in different environments. My confidence and flexibility were very helpful.
Nurse CEO-16: Mentally, I was prepared to be more of a professional executive
than I felt that I was after graduating and working as a staff nurse back in 1984. I had a
desire to continue my education and be more at a professional or executive level in the
organization. My drive to become an executive made me leave nursing after three years
to go back to school to acquire a MBA. I am not the traditional track of the typical nurse
CEO. I spent more years as an executive than in nursing.

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Nurse CEO-17: I always worked hard and this role is hard work. I have always
demonstrated that I was ready to take on more responsibilities. At the same time, you
have to be responsible and accountable, while being a good decision maker.
Nurse CEO-18: I appreciate diversity; my background is of two cultures and I
think growing up with this background made me appreciate different cultures. I like the
diverse setting that I work in and appreciate what diversity brings to the table.
Nurse CEO-19: I think I have always had excellent organizational abilities and
analytical skills. I have been told I have a great charismatic style and can get people
together to work as a group. I also have a great sense of humor; you have to be able to
laugh at yourself in this job.
How would you describe any institutional support you may have received in your
career path to the role of CEO?
Nurse CEO-01: I was always very curious and wanted to try things. My previous
organization where I spent 18 years was supportive and helped me by allowing me to
make mistakes and take risks, and encouraged me to do so. This helped me to develop to
the path to being a CEO.
Nurse CEO-02: I definitely think that being in a position as a Chief Operating
Officer for 8 years helped because my superiors got the chance to observe me. I felt
supported in that role and although the organization conducted a search and I was
interviewed along with other people for the CEO role, I was able to obtain the position.
Nurse CEO-03: Years ago, a little more than 10 years ago, I was given
administrative sabbatical leave in one of my roles to be a White House Fellow for one
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year. This was defining as a trajectory for me in my path to being a CEO. This experience
opened my eyes about leadership at the highest level, that being the Presidency of the
United States.
Nurse CEO-04: One is the organizational flexibility to have broader
administrative responsibilities through a series of executive positions where I had more
opportunities to contribute to the organization before being the CEO. Secondly, the
organization supported my continuing education such as supporting me to become a
fellow in the American College of Healthcare Executives and Wharton Nursing Fellow.
Nurse CEO-05: It was a mentor that selected me for this position; he was my
former boss when I was a section chief in this facility. I was in charge of one of the five
patient care areas. He saw the qualities that I had and when he was called to another
position, he contacted me to take over this role as CEO.
Nurse CEO-06: I did not get support. I fought for it all the way.
Nurse CEO-07: It was a combination of the chemistry of my managers and the
staff and the teamwork behind it that really pushed me to apply for the CEO position. The
CEO when he left did not support me in going into the position but the board did.
Nurse CEO-08: Coming from the nursing department where 60% is the hospital
staff, you immediately have institutional support. Nurses want to see other nurses
succeed. I also came up through the ranks in this hospital and was supported throughout
the organization. Institutional support is extremely critical to success. If all comes back to
those people skills, knowing your employees, interacting with them on a regular basis,
walking the walk, talking the talk and then institutional support will be generated. I am
one of the long-term CEO of a hospital in my area here in NJ. The closest hospital to be
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has turned over CEOs 5 times in the 11 years that I am my organization. As a CEO, if
you do not have institutional support you will sink and if you do have it, then you will
enjoy long-term success.
Nurse CEO-09: I would say that support began when I was in nursing school.
Two individuals in nursing school encouraged the students to increase their
responsibilities to improve the care given to people and to accept responsibilities up to a
level we felt comfortable with. There were 2 CEOs in hospitals where I worked; one was
an excellent planner and had good people skills. A second CEO supported me by
teaching me how to view day to day operations from an elevated position and be able to
function at a level that would allow the organization to grow over time.
Nurse CEO-10: I was in the role of VP of Medical Affairs and came into the CEO
role as a very different type of individual. The Board was looking for a change and
someone very different and supported me in the new role of CEO.
Nurse CEO-11: I had great support from the Board of Directors, the nursing staff,
and doctors. The organization allowed me to go to different roles, make mistakes and to
learn from those mistakes.
Nurse CEO-12: I had a very good mentor who indicated that my involvement and
participation in professional organizations such as ACHE would provide some
educational opportunities, as well as a venue for networking. My institution supported my
membership in this organization and in sending me to educational sessions.
Nurse CEO-13: The institution supported me to use my leadership skills in other
places. I was a past President of the American Psychiatric Nurses Association. It
supported me financially, during my time way, and the many leadership conferences that
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attended. The support I got as a director of nursing (DON) was very important in me
being able to get other roles and the CEO position. There was a lot of education and
financial support that was built into my being able to get this position.
Nurse CEO-14: I worked with many of the individuals in this organization. In
addition to that, I am a resident of this community. I have had tremendous support
internally by going through the entire ranks but I am very active in my community,
everyone knows who I am and supported me. I have taken care of many people in this
community, so they know my values. The majority of my professional moves in this
organization were solicited. They came to me to assume responsibilities. I think they saw
my commitment, excellent work ethics, and knew I wanted to do the best for the
organization. As I moved up the ranks, I took on more responsibilities and everyone in
the organization knew of me. My community activities had a lot to do with the support I
received here at this organization. Many of the medical staff has worked with me from
when I was a staff nurse and there is a very special rapport and trust that developed
between us. Many of the medical staff pushed me into this position. The support I
received made a tremendous difference in this role.
Nurse CEO-15: I received an enormous amount of institutional support from
being a director of nursing to having a hospital CEO encourage me to apply for the chief
nursing officer position, mentoring, and tuition assistance. When I was the COO at
another hospital, I got full support for my MBA tuition so that I could progress beyond
COO.
Nurse CEO-16: I came to this organization in 1987 as a graduate of the local
university MBA program, to do an administrative residency. That was a great opportunity

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to get a lot of exposure to the board and different committees in a way that I could not
have had access other than working my way up through the ranks. At the end of the
residency, I was offered an administrative position, and then got a series of promotions
until this position became available. I interviewed for this CEO position and got it. So, I
would say that the previous administration and board was supportive of me and mentored
me into the CEO position.
Nurse CEO-17: It all began with my previous mentors. They helped me and gave
me the reassurances that I had what it takes to become a CEO. People believed in me and
the vision that I outlined. In my various roles in the corporation, people knew me and
supported me in all my roles.
Nurse CEO-18: I got support by being allowed to act in positions although they
did not pay me. This is interesting because I really think that most men would not do that
(work in positions without being paid), most men would ask, and how much am I going
to be paid.
I think being able to act, and therefore try things out, and make mistakes was sort of like
an internship. I got the opportunity to act in positions with full institutional support. I got
visibility and can not place a number on that.
Nurse CEO-19: It was varied; in the past, I think I worked very well with physicians and
I had some good mentors. I had a very good nurse mentor when I was the director of
home care before the CEO role. She was an excellent role model and I learned a lot from
her management style. She gave me a lot of latitude and the opportunity to make a
mistake. I knew she would never pull the rug from under me, or take it away from me.
She would give it back to me, along with some advice.

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What leadership skills do you perceive as necessary for nurses to acquire to
facilitate acquisition of CEO roles in hospitals?
Nurse CEO-01: You have to learn as much as you can about every part of the
hospital. Sometimes nurses can be myopic and therefore, they must learn to take off the
blinders. Must be able to facilitate a process where one can get people to see it is all
about the patient. One has to be an active listener and sometimes as women, we are not
good listeners. I often go back to the nursing process because every time I get stuck, I
think about what I learn at the bedside; assessment, planning, intervention, and
evaluation. That critical thinking process has helped me a lot.
Nurse CEO-02: I have always maintained an open door policy. I think you have
to be visionary and have an understanding of what the true mission of the hospital is. You
have to be sure that your values are based on the mission of the hospital.
Nurse CEO-03: Business, administration, financial accounting, systems design.
They are all very important.
Nurse CEO-04: I would clearly say financial assessment. I think there is a
prejudice that women and nurses do not understand finance. One of the things I did was
to complete the Whartons nurse executive program and Whartons special executive
financial program. The financial program was pivotal for me to be able to speak that
financial language in very clear terms and to understand what was transpiring. The ability
to engage in strategic planning and being able to make tough decisions are things that are
particularly looked at in nurses.

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Nurse CEO-05: Nurses need to be very diverse in terms of how they manage
situations. So I guess I am implying that nurses need to acquire situational leadership
skills. They also need to have very good problem solving and delegation skills. In
addition, they need to know and master following up on issues.
Nurse CEO-06: The hardest thing to do is to transition from nursing to another
role. Even when you are in nursing, you have to be aware of the whole hospital. Nurses
cannot be too nurse focused, because they will get pigeon holed and do not get a good
perspective.
Nurse CEO-07: You have to have the need to want to manage people. You have
to have the assertiveness to want to produce better quality.
Nurse CEO-08: You must be resilient I have the confidence that nurses make
great CEOs and there are many others in the state of New Jersey. One must be able to
integrate other departments and philosophies in getting beyond nursing. You have to be
able to see the big picture in complimenting the delivery of patient care.
of people at a variety of levels and how to lead, assist, encourage, and re-direct them in a
way that is positive. Secondly, one must be able to set priorities as most health care
executives have far more on their plates than they can accomplish, so they must work on
the most important and most future effective issues.
Nurse CEO-10: I would say do not forget to tell me that you are a nurse. I tell
individuals all the time that I feel very strongly; I have enough clinical knowledge to be
dangerous but I also have enough clinical knowledge to know whether or not we are
providing the appropriate care. I always tell the physicians, I respect you as a doctor and
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you need to respect me back as a human being and know that we are both here for the
same purpose; that is to take care of patients. I tell nurses that nurses chose the caring
side of health care and that physicians chose the healing side. I feel that caring, that
ability to listen and being open and honest are qualities that nurses have that they can
bring to the CEO role.
Nurse CEO-11: I think the financial piece is extremely important. A lot of times
people really downplay that. One must understand the financial mechanism that brings in
revenue and understanding general investment risks. Understanding people and
organizational dynamics issues are also important. The whole communication area is also
important. Some of the things I learned in my Masters program in psychiatric nursing
such as group dynamics, communication skills, conflict resolution, and organizational
development theory have helped me handle a myriad of issues that come my way.
Nurse CEO-12: In my experience, I have found that some nurses with the desire
to progress administratively cannot get pass the clinical piece and see the administrative
pieces as easily as they would like. The ability to be flexible, to listen, and work with
their colleagues in the medical staff arena is most important to gain credibility.
Nurse CEO-13: The leadership skills that are required to do the DON position,
which is usually the biggest part of the staffing of any hospital or the 24/7 of patient care.
Those leadership skills fall naturally into the CEO role. For example, the ability to
manage conflict resolution is very important. One must also be able to understand the
financial picture.
Nurse CEO-14: Leadership starts with motivation. You got to be a good motivator
and show people what it is you are looking for. You have to be firm, consistent, and
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allow some fun within the environment. Again, listening, communicating, and working
through processes to make the positive outcomes is important.
Nurse CEO-15: Conflict management, team building, informal and formal
communication, and visibility.
Nurse CEO-16: The ability to speak finance is critical. Strategic planning and
organizational skills are very much needed for nurses. I find that nurses do not have the
best organizational skills because when they work as a staff nurse, the focus is around
patient care. They do not focus on things like running a meeting, making a presentation,
they do not seem to be able to collect themselves and be succinct.
Nurse CEO-17: You have to be an independent thinker, be visionary, objective,
and fair. I think these are some critical traits that are truly necessary to be a CEO.
Nurse CEO-18: I think nurses are educated to think each person is an individual
and they are really tuned into the individual. As a CEO, I found it necessary to learn to
look at systems, because you have to affect change through large groups. I also had to
learn about finances, and human resources. These were leadership skills I had to acquire.
Nurse CEO-19: I think they need to learn teamwork; this is a key issue for nurses.
They need to acquire a good sense of controlling their emotions; a high level of
emotional intelligence. I think this might be a gender issue in management still with
women and people look at us as though we are not able to cut it. But I think women tend
to get more emotional over things than men do. We need to work on developing good
orientation and analytical ways of dealing with issues. You do not have to be cold-
hearted because you do need a feminine touch; you have to learn how to be balanced.
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What advantages, both negative and positive would you say that your clinical
background as an RN had in your ascension to the CEO role?
Nurse CEO-01: I can talk to doctors and I can talk their language. I have a great
deal of interest in science and in new ways of caring for patients. I ask a lot of questions
to the physician group. When I am trying to do something in the organization that may be
a little controversial to the physicians, I can talk to them about it in terms that they can
understand. This is the biggest advantage to me in this role. When staff can come to me
about issues they think are important. I always ask them if that is the best thing for the
patient. My clinical background keeps me focused.
Nurse CEO-02: You really can never take your mind off the fact that you are here
for the patient and the needs of the patients family. I think my clinical background has
been a positive advantage in my role. However, when it comes to making the tough
financial decisions having the clinical background makes it difficult because you do
worry about how it will affect the patients and the staff. Overall, I think the clinical
background is an advantage because you have been at the bedside and you know what
really is involved.
Nurse CEO-03: My clinical background allows me to visit the nursing process all
the time. You look at a problem and try to develop a plan based on your assessment. The
fact that you have to put principles in place to implement your plan, you have to go back
and readjust your plan, and then line it up with the strategic agenda for the institution.
The nursing process gives trajectory principles for advancing to the next problem to
attack to move forward.

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Nurse CEO-04: I have a great deal of understanding the clinical arena and perhaps
I am more empathic about the plight of patients. I push my team and remind them that we
are here for the patient. I cannot be bamboozled because sometimes non-clinical CEOs
are bamboozled by clinical people who use scary tactics such as unsafe staffing; when
making a point about an issue. I am clear and would say, no, this is not unsafe staffing;
let us see what really is going on.
Nurse CEO-05: On the positive side the RN background allowed me to cut
through the major hurdles that non-clinical administrators may have. For example, from
the clinical background, triaging skills helps you to make good decisions based on
information that is in front of you. The clinical background also allowed me to have good
assessment skills, whereas non-clinical people may not know what to do. On the negative
side, on occasions the non-clinical people just see you as the nurse, they may not want to
acknowledge you, especially if you are supervising medical staff; they can be resentful. I
think the RN (especially if she is female) CEO may have a hard time because they may
not get the level of acceptance or acknowledgement. A major factor that plays into this is
due to gender because some male administrators still see you as just the nurse.
Nurse CEO-06: The clinical background is a double-edged sword. Initially when
you are trying to move out of a nursing track, they are many people that may want to
push back and say, She cannot do that, she is just a nurse. They want to keep you
pigeon holed. If someone is able to break through that and take on the non-nursing roles,
then the clinical background is an incredible plus because no matter what environment
you are in there is an automatic comfort level with the clinical issues. The clinical
background is invaluable.
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Nurse CEO-07: My clinical background was positive. I was in an institution
where doctors were on one side and administration was on the other. With my clinical
background, I was able to speak to the physicians in their language and thus, I was able to
build a better team. A physician once said to me, I cannot believe you are so clinical
and I take pride in that because I truly believe that the best people to run a facility are
nurses and physicians.
Nurse CEO-08: I believe that my background as a RN has contributed to placing
my focus on patient satisfaction and clinical outcomes. When I make rounds in the
hospital, I am very much seeing what is happening from a clinical perspective. If you are
not delivering constant patient care, you probably have a hospital that is not successful.
Therefore, it all goes back to making sure you can see it from a patient and family
perspective. I think that ability the RN has to do that; seeing things from the patient and
family perspective, gives him or an edge in the CEO role. On the negative side, since I
worked for a for-profit hospital and it was a great learning curve for me because I did not
have a very strong financial and business background.
Nurse CEO-09: I would say 99% has been positive. My clinical background
allowed me to be able to pitch in and help if it was needed. The negative side is when I
had to deal with a certain physician. He wrote me a note once that said, I thought that a
hospital that has a nurse as a CEO would be more interested in my ideas.
Nurse CEO-10: As I ascended in my entire career from working in quality
management to the VP of medical affairs, I believe that the nursing background allowed
me to have that knowledge base of clinical. I was also told that I was a flexible individual
and with my clinical background along with my flexibility, I believed that I could go
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further. The clinical background reminds all of us that this is patient care. Healthcare
became a business that is all about patient care.
Nurse CEO-11: It was positive in that I understood the clinical arena and what it
took to really deliver excellent patient care. My clinical background kept me focused on
the importance of quality.
Nurse CEO-12: The understanding of the clinical arena is most certainly a huge
advantage - you know when something is not right, like a smell test, if you will. The
disadvantage is that you may not be exposed to the financial side or you are not perceived
as having financial savvy. The nursing background sometimes makes folks think of you
as having more of a human-side or being more touchy-feely and this perception can be
a distinct disadvantage.
Nurse CEO-13: I cannot think of any negatives. The positive is that you are very
aware of the clinical mission of the hospital because as a nurse that is what you go into
nursing for. Many hospital CEOs come from the business or banking backgrounds and so
I think the field is looking more and more at some clinical background for CEOs because
it is vital. Having the clinical background has kept my eyes always on the clinical
outcomes when we are having conversations about finance or any other area of the
hospital.
Nurse CEO-14: For me, within this institution it played a significant role,
primarily because of the work I was doing. The patients recognized the care I gave, the
leadership recognized the nursing positions I held. This all played a major role in where I
am. Because of my nursing background, it helped me to understand all facets of the
organization and allowed me to better understand when the nurse talks about the nurse to
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patient ratios, or a negative outcome, or a process that is not working than someone who
has never been there.
Nurse CEO-15: The clinical background allowed me to understand organizational
and institutional issues much clearer than someone without a clinical background. It
enhanced my ability to discuss, debate, and negotiate issues with physicians who are in
leadership roles in the hospital. On the negative side, the perception of a nurse as CEO
versus a doctor was there. I think the feeling was that nurses work for doctors, and that
doctors do not work for nurses. It was getting beyond the doctor nurse stereotype. Also
on the negative side is that I think I get more questions or challenges because I know the
role of a CNO.
Nurse CEO-16: It gave me a lot of credibility when working with physicians. I
have had very good positive relationships with the medical staff here at this facility and
throughout the whole system. I can understand physicians and speak their language,
which I think has been helpful in my role.
Nurse CEO-17: I firmly believe that having a clinical background is a plus
because you are working with a great number of clinical people. Being able to understand
the language, being able to converse in the same language certainly helps. The clinical
background gives you that comfort level in dealing with physicians and in speaking with
them. My background as a RN really was very, very helpful to me.
Nurse CEO-18: When I meet with the medical staff, they give you some sort of
credibility because you worked as a nurse. On the negative side, the medical staff can
give you well you are not a doctor. Dealing with medical staff and being a nurse can
work for you both ways. You also know what people need, what departments need, what
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different things are needed in a hospital because you have experienced them yourself. So
having been there and working with patients and knowing what is needed, has helped me
to be able to affect the larger picture, in terms of spending money.
Nurse CEO-19: My nursing background definitely was a contributing factor. I
started from the bottom up. I had a variety of management positions and all the
opportunities in nursing, such as teaching in a nurse practitioner program, gave me a
strong background for the CEO role. The nursing clinical background is very important. I
can look at myself and some of my peers, there are so many issues where they are just
driven by the bottom line and do not see the clinical impact of the decision-making.
What importance if any, would you say obtaining a business or finance degree
may assist nurses in acquiring the CEO role?
Nurse CEO-01: I think you have to have competence in business and finance. I
think you have to absolutely understand about negotiation techniques, managed care, how
hospitals get paid, how to read a balance sheet. You have to be competent so that you can
do the right thing and make the right decisions for the organization. I do not have a
business degree. My background is all in management and nursing leadership. I was
married to the CFO of a hospital and he taught me everything I know about finance and I
taught him about taking care of patients. How one gets this competence is an individual
decision, maybe by a MBA, or just attending seminars by ACHE. It doesnt matter how
but one must know about business and finance.

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Nurse CEO-02: As far as finance, I do not think you can downplay it but I do not
think you need a MBA. I have a certificate from Whartons for non-financial managers.
This has been helpful to me. One needs a thorough understanding of basic accounting and
so a course in accounting would not hurt. You have to be competent to read a profit and
loss statement, a balance sheet, and how to analyze and defend your budget. You need to
understand what goes into a budget, as well as how to analyze it. I would not say you do
not need a degree but you need to be able to pick up an audit, understand it, and the
ability to speak to variances. Without the Whartons course, I would have been hard
pressed in my career. I attained my finance skills while I was first promoted to VP of
Nursing.
Nurse CEO-03: Analytical skills are most important in acquiring this role and
sustaining it. It takes more than the process I described as it relates to nursing. You need
to have courses in business and finance, but not necessarily a degree.
Nurse CEO-04: I do not believe that you need a degree and I know that many
nurses are fixated on obtaining the degree. I actually taught in a MPA program with a
nursing degree. I do not think it is essential but I think you must have the skill. I think it
is also helpful to have certification in these areas. For example, I went to Wharton to get
the finance skills that I needed. I think you do need something in business and finance but
not necessarily a degree.
Nurse CEO-05: It is important because it would add to ones personal skill mix
and may make a potential employer feel more comfortable because you would have more
than just the clinical background. As for me, I had to learn the financial business end of
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this role mainly by on the job training. It would have been nice to have a broader base of
knowledge regarding the financial aspect of the organization.
Nurse CEO-06: It might open some doors but I do not have a business or financial
degree. My degrees are all in nursing. At one point along the way, I did ask my mentor if
I should go and get the MBA and he told me that I was beyond that and I decided not to
get the degree. I never did and it did not hold me back. I am a fellow in the American
College of Healthcare Executives (ACHE) and have taken advantages of many of their
courses in business and finance.
Nurse CEO-07: People see nurses as Florence Nightingale and so they do not
think that nurses actually think. Some think that nurses need to have these degrees to tell
them what there is and what there isnt. The business or financial degrees just help your
background to be able to process the information at a faster rate because you can do
business dealings a lot better. If you want nursing management, you need to have some
sort of financial degree or business degree. It does not have to be a MBA but it should be
some sort of degree. I took a lot of business and financial courses when I was at
Columbia, especially for the ethical aspects of business and finance.
Nurse CEO-08: I think a business or finance degree is very complimentary to a
nursing degree. Getting beyond that exclusive nursing education, which is an outstanding
foundation, is important because if you are going to be a CEO, numbers are very
important. You need to understand all aspects of the business; how you are looking at
your staffing and your variable costs. These things are critical and so I believe getting a
business or finance degree is very important if a nurse wants to be a CEO.

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Nurse CEO-09: These degrees are good and are one measure of emphasis. The
CEO role does not require these degrees. There is a difference between financial
accounting and managerial accounting. I think CEOs need to have managerial accounting
skills. Financial accounting is accurately recording finance transactions. Managerial
accounting is knowing what to do base on the numbers. It is making decisions for the
future based on how we are doing right now.
Nurse CEO-10: You would not go anywhere in any healthcare organization
without attaining additional education in business and finance. You need both. You have
to have both. You would not be looked at without a Masters in Healthcare
Administration or a MBA. I think these degrees are important because they give you a
different perspective on business, especially for nurses. I put a lot of weight in it because
it is important.
Nurse CEO-11: It is essential to have the understanding of the financial area but I
do not know if it is essential to have the MBA to be a CEO. One must have an
understanding of the business and financial side but to have a degree in these areas is not
necessary.
Nurse CEO-12: I think it is extremely important and I can attest to that personally.
Instead of going through the hospital administrative route, I went through the MBA route.
I added additional classes onto my degree so that I could address some of those areas that
could be seen as a short fall; for example financing, marketing, law, and informational
technology. I think it adds to your credibility and your ability to discuss the financial
pieces.
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Nurse CEO-13: I recommend it but I do not have either a business or finance
degree. As a CEO, you have to have people who have expertise in various areas and I
happen to have an excellent chief financial officer (CFO) that consults with me and keeps
me apprised. Knowing the lingo and the language is a good thing but I know a lot of
people that think they need to have the MBA but I do not think it is necessary in the CEO
role. I think taking courses in the business and finance areas are fine.
Nurse CEO-14: I have a Masters in health care administration and the one thing
that I did not get much education in is the finance side. I think a MBA is very valuable to
this position. Number one, it is a business; it is financially driven because every year we
fight for every dollar we get from government, the change in mix of the payors, and from
negotiating contracts. You cannot just rely on patients to come, this is a business world
and you must know the aspects of the business world.
Nurse CEO-15: I think it is absolutely necessary. In my case it was not only
having the MBA, but it had to be a prestigious school.
Nurse CEO-16: I think it is very important because of course that is what I did. I
think it gives you credibility on the other side, especially with the non-clinical people. It
gives you a foot in both camps, which really helps.
Nurse CEO-17: Once you are in the CEO role, you really need to have a good
working knowledge of finance. Some folks may say you can hire a good CFO but if you
are the CEO and do not have the knowledge of health care finance, then you will be at a
disadvantage. I would say you need the business and finance knowledge in some form;
not necessarily by getting the MBA.

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Nurse CEO-18: I think these degrees are very important. I did not go for these
degrees but I took courses in business and finances when I was getting my graduate
degree. I felt I needed these courses because although I have the clinical background, the
other pieces, such as how to spend money, where it comes from, budgeting and positions,
and contracts are very important.
Nurse CEO-19: I think there is no question that these degrees are critical. I have a
Masters in Pubic Health. When I was approached to consider the position as an assistant
in this organization, I insisted the Order allow me to go to school to get a MBA. If you
are going to be a CEO, you definitely need a strong financial background and should take
some business courses. You do not need to be the financial officer but you need to have
enough financial background to be able to read the spreadsheets, know where the dollars
are going, and how to balance the budget.
Describe any mentorship relationship you had with someone you considered
influential in your ascension to the CEO role?
Nurse CEO-01: I had two mentors in my career. The first one was in nursing
school. She was a rough, tough, high performing instructor that everyone feared. She was
reassuring and encouraging. She said to me, your reason for being here in nursing school
is what will make you successful. My second mentor is the CEO that hired me. I worked
with him for 17 years. He gave me many opportunities, encouraged me, and created an
environment where I could take risks. This is how I got to where I am.
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Nurse CEO-02: I had a mentor who was the former CEO who took me from VP
of Patient Services to the COO position. The COO position exposed me to all areas of the
hospital. My mentor groomed me to take over his position (CEO) and allowed me the
latitude to grow. He was the most influential; he taught me that you always have to
groom people as a CEO and I hope I am doing the same thing.
Nurse CEO-03: In my career I have had Claire Fagin, Barbara Stephenson, and
Lucille Joel as mentors. All those nurse people that went before me for example, Rita
Dumas, the Dean of University of Michigan. Each was different and I learned from all of
them. They were honest with me. I was first a CEO in a community hospital and now at
an academic teaching hospital. Hazel, one of my mentors, clipped my wings from time to
time, which was OK with me. She told me to get into civic organizations with other
women. Because of her, I joined a womens group that mentors women. I think
mentoring is very important and I am about to implement a mentoring program here, not
just for nurses but for every one. I also mentor students from Cornell.
Nurse CEO-04: I think most nurses, tend to devalue their contributions and
minimize their contributions and assets, as compared to male colleagues or other
colleagues with different educational backgrounds. Early in my career when I was a
director of nursing (DON) a colleague always encouraged me to share what I know with
the rest of the world. She encouraged me to believe in myself and to believe in what I
was doing. This took me out of analysis paralysis into hey listen: I am doing an
interesting project. This made a big difference in me being able to move forward and in
believing in me. As a result of that work environment with this colleague, when I was
planning of leaving the organization (because I decided I wanted to be a VP of nursing), I

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was offered a position of Director of planning. A department that had 15 doctoral
prepared planners. I was glad to know the organization had confidence in me to be
responsible for a department since I did not have the particular skill set.
Nurse CEO-05: My former boss who was in a high position was my mentor. He
took me under his wing, believed in me, and had enough confidence in me to move me
forward into a deputy CEO role. Mentoring is very important, especially when one wants
to move up to a senior executive role.
Nurse CEO-06: The most influential person was the person that was my CEO
when I was the VP for Patient Care. He let me take on different areas of responsibilities
and he was the one that would look the anesthesiologist in the eye and say, she will run
the OR and you all will report to her. He was someone that did those battles for me,
although he did not have to do it too often. Sometimes he battled for me, especially in
arenas with physicians. He helped to break down some barriers for me and also helped
me gain confidence that I could do anything that I wanted to do. I was very lucky.
Nurse CEO-07: I had two mentors; one was a nurse who had a PhD and the other
was a CEO. The nurse told me that I could do anything if I put my mind to it. She helped
me when I was ascending to the Director of nursing position. When I became a VP of
nursing at this facility, my second mentor was a CEO that allowed me to think freely.
There was no punitive dialogue if you said I have these three options and this is the one
that I like out of these three options. He truly was a mentor that developed me and
allowed me to grow without putting any stigma to what I did or did not know.
Nurse CEO-08: I do not think there was one mentor or role model that I have had.
I have had outstanding directors of nursing and very interesting CEOs that I have
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watched over the years. Basically, there were not direct mentors but I would say since
when I was coming into the CEO role my immediate boss and a senior VP, both of whom
are non-nursing people were strong mentors for me. However, there has not been no
specific single mentor relationship that was critical or that influential to my ascension to
the CEO role. For me, it was watching different type of leaders and integrating some of
their qualities into myself.
Nurse CEO-09: The mentor that influenced me in this direction was a major in the
air force. He did not have a clinical background, but he had a Masters in health care
administration from Yale. He saw how well I did with clinical management and
delegation and suggested I go to hospital administration school.
Nurse CEO-10: This is easy for me. I still call my mentor to this day. He was a
CFO at the hospital where I became the VP of Medical affairs. He became the CEO. He
taught me a lot about finance and health care finance. He taught me a lot about how to
present my frustrations in a manner in which would not be offensive to the rest of the
senior management team
Nurse CEO-11: Ive had several mentoring relationships throughout my career
that has gotten me to where I am but the final mentoring role that moved me into the
CEO position was with a local businessman who was the chairman of the board. He
really became my mentor during this process. He respected what I had to say. He often
asked my thoughts on many issues and what I would do in a given situation. He was
always available to me no matter where he was in the world. He couldnt have been more
supportive.
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Nurse CEO-12: During my work with NYSDOH, I met an individual who was a
CEO and as he states it now, recognized someone with raw talent. He not only pushed
me to leave the regulatory arena, but to expand my horizons, challenging me frequently.
We talked at least three or four times every quarter and he often asked, What are you
doing? Why arent you doing something else? You are wasting your talents. He was
someone who applauded my successes, but always questioned as to what was next in my
career growth. This individual played a significant role in my advancement. He was
outside of my work environment and did not have any connection to my employment,
which I think was extremely helpful. The fact that he was a male gave me the perspective
of how men look at business in general and career development.
Nurse CEO-13: I had a couple of good mentors. The CEO that I helped to build
this hospital was my mentor. I worked for him for years and although I never thought to
be a CEO, he was a marvelous leader and a very open kind of guy. Our styles matched a
lot and I learned quite a lot from him. I also had a systems CEO who mentored me when
I was in the interim CEO role. He was an influential leader. Both of these men helped me
to understand the CEO role.
Nurse CEO-14: The mentor that was the most help in regard to the management
and leadership skills was the former DON. She was the mentor that told me I can do the
director of nursing position. I really did not have a mentor that guided me towards the
CEO position. What I had were former CEOs that I basically learned from them, what not
to do, versus what to do. Nurse CEO-15: The CEO that I worked for in a childrens
hospital 20 years ago. He encouraged me to progress to CNO. Even when we left the
organization, we stayed in touch and I bounced things off of him. I ended up working for
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him in a consulting role and as COO about 15 years after I left. He would ask my answer
to a question before he answered it. He assured that I was on the right train of thought
and that I was rationally getting to a solution and that I was factoring in all the variables;
the communication plan, the community impact, the financial impact, the patient care
impact. He made sure I saw all angles.
Nurse CEO-16: I had two mentors; one was a nurse, who was a previous
administrator and had her Masters in health administration. She was an incredible
mentor to me. She encouraged me, and put me out there and let me demonstrate what I
was able to do, to the right people, at the right time. The second mentor was a COO here
at this organization at the same time with my other mentor. He also was very helpful and
encouraging in wanting me to succeed.
Nurse CEO-17: Most of my mentors preceded me getting into the CEO role.
However, I had two mentors who were previously DONs and because of their ability to
lead and their attitude about leadership; which I regard as important traits, I was able to
adapt from them. Those two persons leadership styles, their ability to coalesce, and their
ability to get things done played a significant part in my entire career growth.
Nurse CEO-18: The CEO that preceded me was my mentor. He was excellent
because he was honest with me. He would be straight out and say, Why in the world did
you handle it this way? How would you handle it differently? We developed something
called the 20 20 rule: If this position was made public and your family and colleagues
had to watch it on 20 20, how would you feel about that decision? After one year in this
mentoring relationship, he began to see me as his successor and started to spend more
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time with me in terms of what he did. When he moved on to a promotion, he helped me
with interview questions for this position.
Nurse CEO-19: When the CEO resigned at this organization, I became the acting
CEO for a while before I got the position. The medical staff was not sure they wanted a
nun, much less a woman. So, I was ready to do battle with a few of them. I had a really
good chief of pathology who was very helpful. He would say to me, Do you want to win
the battle and lose the war? Or do you want to figure out how to take the issues
piecemeal? He made me realized that in my role as CEO, I had to adjust and the medical
staff had to also adjust. He was very beneficial and helpful in my first two years of being
the CEO; he was a good ally. I could always go to him and say, Off the record, what do
you think? He was straight enough to say things like, I think you are off track.
What advice would you give a nurse aspiring to a hospital CEO position?
Nurse CEO-01: I would say to learn as much as you can by asking many
questions. Take advantage of opportunities to be involved in committees and in bringing
about change in your department, on the unit. Take advantage of opportunity for
education that is outside of nursing so that you do not grow myopic.
Nurse CEO-02: You have to have an understanding of the entire operations of the
hospital. It is not a position that you can just walk into. You need to have had a leadership
role within the organization at some point and time. Try to get an understanding of the
entire operation before going into a CEO role.
Nurse CEO-03: I am working with someone now, who I hope will be my legacy
here. She is the current chief nurse here. I hope someday she becomes the CEO of the
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hospital, and possible CEO of the entire system. What I am doing is talking to her about
closing the loop of relationship management. Understanding decisions that have political
ramifications and implications for far bigger than one can imagine. My advice is for the
individual to seek mentoring relationship but also be available to mentor someone.
Nurse CEO-04: I would say that relationship building is pivotal. I think nurses
need to have service relationships with many people but they need peer relationships with
medical staff leaders as well as other leaders within the organization. They need to get
out of the box with their nursing colleagues and build equally strong relationships with
other internal colleagues, as well as with board members, and external constituencies
outside of the hospital; that means community leaders, professional groups, and political
groups.
Nurse CEO-05: My advice would be to know the business that you are in. Be
curious to find out as much as you can about the organization and try to be seen as a can
do person in the organization. One must be willing to work in positions where you may
not get the compensation but you are seen as someone who brings high energy to the
position. Learn how to network with the right people. I think sometimes networking is
not considered as an important aspect of acquiring leadership positions and therefore,
much attention is not given to networking. Sometimes, many executive leadership
positions are acquired from whom you may know or who knows of you that allow you to
be talked about in certain arenas.
Nurse CEO-06: I would say going up the route of nursing patient care is a very
good route to go because as you become an executive at the highest level in nursing in
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the organization, the cross over is relative easy if you can find the opportunity to cross
over to general operations.
Nurse CEO-07: I would say the nurse needs to seek out all opportunities and that
sometimes opportunities may not come knocking at your day. You may not get paid for
these opportunities and that sometimes one must volunteer to take advantage of
opportunities. The most important thing is to take on the opportunities and do them to the
best of your ability.
Nurse CEO-08: I would say persevere. Nurses can do it, we truly have the ability
to be very strong leaders and our basic education and the basic model from which we
come is a great foundation for any CEO. I believe nurses bring a very special quality to a
CEO position but they must make sure that they persevere to the goal of being the CEO
and then persevere through challenges, which maybe many, at the level of administrative
role.
Nurse CEO-09: I would tell them to consider learning best practices and how to
improve health systems. They should also consider; how do we do best practices and how
do we make an improvement each day in the way we do business?
Nurse CEO-10: I would tell them to get a Masters degree. Learn to listen to the
people they are working with. In particular, I am a firm believer that we are nothing
without our medical staff. If any nurse wants to aspire into a position of leadership and
into a CEO position, there is a division oftentimes between doctors and nurses. My
mentor used to say to me that I think with both the left side and right side of my brain. I
think all women do. Nurses ascending to CEO positions must set aside that nursing
mentality and take that nurse hat off. I remember having to teach a woman who was my
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VP of patient care services how to work with the medical staff. She was over the labs,
rehab, medical imaging and other services and needed to be taught how to take herself
out of the stereotypical role of nursing. However, nurses aspiring to the CEO position
should not forget that they have the nursing background because that makes you a real
person when it comes to dealing with people clinically. You can say, I have been there,
done that. However, you must be able to look globally and say how this impacts the rest
of the organization and not just nursing.
Nurse CEO-11: The nurse would have to let go of nursing thinking so as to get a
perspective of everything else that has to do with healthcare and other than nursing.
Nurse CEO-12: I would say, Do not just focus only on being a CEO in a
hospital, because the wave of the future is in the continuing care arena. Focusing on the
hospital may be extremely limiting. If they can find a venue in which to touch on, not
only the hospital side, but other venues in healthcare, they will be ahead of the curve. The
areas can include continuing care, long-term care or community-based services. These
are areas that will be greatly needed in the future. Nurses should think of other venues to
take on leadership positions. Although the hospital may be a good place to start,
sometimes you may have to come in from another door. I think the long-term care arena
and the continuing care arena are a little bit more open to nurses. I see them as a bridge to
the hospital, if that is where the nurse wants to go, ultimately. If people are aspiring to be
a CEO in a hospital, it may be very limiting. I am currently the CEO of a hospital that has
a long-term facility, behavioral health, and psychiatric facilities. My hospital experience
in the past did not give me a good understanding of the long-term care arena or the
behavioral programs. I had to learn about these other facilities, literally, on the job.
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Nurse CEO-13: I would say to that individual to get into nursing leadership roles.
There should go through the steps of being in the primary nursing leadership roles. I think
there is so much that is learned in primary nursing leadership roles that is three quarters
of the operation. The other quarter such as licensing, finance, and regulation can be
learned later. After you get the nursing piece, the other pieces are very easy.
Nurse CEO-14: I would say, work on leadership skills, advance education in the
business side of healthcare, and give them selves time to learn what nursing and
healthcare is all about. Unfortunately, I see many baccalaureate nurses that get out and
automatically feel that they want to go into leadership positions; they need to take time
and not rush into these positions. I would say try different areas and arenas as you are
getting the education and make decisions and think it all through very carefully.
Nurse CEO-15: I would say be a nurse manager on a unit for a long time. In that
position, you have patient satisfaction; you have staff that work for you, you have a
physical space that you are in charge of from a facilitys standpoint in getting those
things reported and upgraded. You have organizational sense because you know what the
role of your unit is. You have ownership for a service; you hire, recruit, and fire. You are
responsible for the development of your staff. I think it is the perfect growth, learning
position if you are aspiring to being a CEO.
Nurse CEO-16: If they do not have an advanced degree, I would tell them to lean
towards a business degree over nursing at the Masters level. I would tell them to get
involved outside of just nursing in the organization. Get involved in committees or
activities or opportunities that are cross-functional so that you get to know people in
finance, operations, and other areas. Take different promotions or opportunities along the
191
way to expand the breadth of their experience, to avoid getting pigeonholed as a nursing
leader.
Nurse CEO-17: The person should begin to do a lot of work around leadership.
As a CEO, you definitely need to have good leadership skills, coaching skills, and the
ability to manage. Further needs are learning about finance, and the issues in healthcare,
and what promulgates and what does not promulgates in terms of the ability to do the
operation. One has to have an open mind, learn about the different aspects of the hospital
because sometimes, nurses seem to function in boxes and not too many nurses get out of
their element.
Nurse CEO-18: I would tell that nurse to take on some projects that no one else
wants, do extremely well in it, and give yourself the visibility that you need. I would also
advise the nurse to take some business courses and try to put your self in a position where
you are not comfortable with; in other words, learn to push your comfort level.
Nurse CEO-19: The nurse should start to take some finance courses and look for
promotional opportunities to be a director or to move up in a management role. I think
the person should be willing to take on some special projects, seek mentoring, and ask the
CEO, if there is a project he or she can do. There are always projects that can give you a
feel for what is happening. I would also advise the nurse to assess how he/she get along
with doctors, and start to think of how he or she can develop a good working relationship
with them. The working relationship with doctors can be critical in the CEO role. Finally,
one must learn how to deal with setbacks and not let them disheartened you. Learn how
to say, I am sorry and realize that it is okay to start all over. Nurses also need to have
192
good self-esteem and self-awareness because I think sometimes; nurses tend to put
themselves down.
Interview Question10
Identify three key areas in hospital administration where expanded knowledge
may ease the transition of nurses into CEO positions.
Nurse CEO-01: More knowledge of finance. Experience and knowledge in
facilitation, negotiation of conflict resolution, and the third piece is the need to stretch the
challenge of creativity of problem solving. Come up with solutions that work and that
may not work and go back at it. I also want to emphasize that strategic planning skills are
needed because it is something that is not practiced at the bedside. In order to move the
organization forward, you must have strategic thinking, you must have a vision, and you
have to be able to put a plan in place.
Nurse CEO-02: An important area includes finance and knowledge of financial
vehicles. Additionally, knowledge of institutional planning and succession planning will
help anyone aspiring to this role. The ability to develop a vision because this is not a
business that stands still is also important. You also have to have an awareness of the
political environment that affect you on a daily basis.
Nurse CEO-03: Knowledge Systems design is important. General principles of
hospital finance because those are always changing due to government and legislative
changes. Key areas also include organizational development, organizational coaching,
and organizational design.
Nurse CEO-04: Strategic planning skills and metric based operations. Effective
finance skills, by this I mean you do not need to be the CFO but you need to know
193
enough to ask the tough questions. Peer relationship building and knowing how to bring
different people together that may not normally come together allows for innovation and
diversity of thinking.
Nurse CEO-05: Definitely finance and how it relates to budgeting. Acquiring
knowledge and understanding of quality improvement, JCAHO, CMS, and other related
regulations is also very important. The third would be leadership/management skills on
how to lead an organization. For instance, one needs to know how to be focused when
managing an organization.
Nurse CEO-06: Marketing and business development. Labor relations, knowing
how to lead in a union environment, the whole human resource (HR) piece is crucial.
Also very helpful is the whole quality area. This is where our clinical background is
important; knowing and understanding how to set the bar high and provide leadership to
actually excel in the quality indicators hospitals are being measured against.
Nurse CEO-07: The first area is finance. The second area is the ability to
formulate teams. Thirdly, developing listening skills is very important. You cannot be an
authoritarian because you need to listen to everything that goes on.
Nurse CEO-08: The first is to understand the importance of community and
business relationships. For any hospital leader, the greater community is more important
than I could ever imagine than when I began this role more than 11 years ago. Secondly,
political, regulatory influences in healthcare today are also more outstanding and
expanded knowledge in this is needed. Financial and business management is critical and
it is important that nurses grow in this area to be able to balance it all.

194
Nurse CEO-09: The first is knowledge of process improvement so that we can
improve what we do. The second is solid financial decision making. The third is team
leadership, all levels of administration is all about leading teams.
Nurse CEO-10: Working with the medical staff, acquiring the knowledge of
finance and human resources. Without your people, you are nothing.
Nurse CEO-11: Financial knowledge, organizational dynamics, and people skills.
Nurse CEO-12: First is to understand the measurements in the quality arena and
aspire to be truly transparent in sharing not only with community members but with the
facilitys staff. Secondly, I think an expanded knowledge and understanding of physician
relationships; how to interact and negotiate with physicians would be beneficial. Thirdly,
knowing how to work with Boards of Directors and community organizations, sharing
the organizations perspective and vision is very important.
Nurse CEO-13: He or she would need a good understanding of how to write a
good business plan. Knowledge is needed on how hospitals are financed; especially
reimbursement finance because it is much more complicated than people may realize.
Thirdly, one would need more knowledge about governance, especially on how to run a
board or attending board meetings. If you become a director of nursing you eventually
get into the boardroom, this is enormously helpful because personally, I was never in the
boardroom before JCAHO actually came along and made it a requirement. Because
nurses were kept out of the boardroom for so long, I think there was a lot of mystique and
mystery about finance.
Nurse CEO-14: Business acumen, finance acumen, and leadership acumen.

195
Nurse CEO-15: One would be the development of business plans, so the financial
or programmatic aspects would be critical. The second would be being involved in the
start up of a new service or a new department. Thirdly, communication skills would be
very helpful.
Nurse CEO-16: The typical nurse has no idea how reimbursement works, so I
think more knowledge is needed in reimbursement. The second area is in building
relationships and the third area is in finance.
Nurse CEO-17: Finance is definitely one. Leadership skills and building teams are
very important.
Nurse CEO-18: Human resources, business administration, and how to deal with
the media
Nurse CEO-19: Number one is exposure to finance and how the budget system
works; how you plan for programs. Number two is a need for exposure in the community,
especially areas outside of the hospital. It is important to understand the linkage between
the hospital and the community because hospitals are no longer isolated. There is now
more outreach between the hospital and the community. Thirdly, strategic planning is a
continuous drive; so getting more information in this area is beneficial.

196
APPENDIX F: TABLES OF FINDINGS FROM RESPONSES TO 10 INTERVIEW
QUESTIONS
Table 1
Interview Question 1_Length of Time Desired to be CEO
Participants Desired Length Helped to Received When Did It

of Being CEO! Persuade the Inspiration Become Your
Column 1 Change Column 3 Career Goal?
Column 2 Column 4
Nurse CEO-01 No desire Mentors Yes (Words) N/A
Nurse CEO-02 No desire N/A Yes (Self - Eventually
Natural Transition) Overtime
Nurse CEO-03 Last 5-10 years N/A N/A N/A
Nurse CEO-04 Last 5 years N/A Yes (Self - Natural Eventually
Transition) Overtime
Nurse CEO-05 20 years ago N/A N/A N/A
Nurse CEO-06 No desire Mentor/ Self - Yes (Self - Natural Eventually
Natural Transition) Overtime
Progression
Nurse CEO-07 No desire Opportunities/ Self Yes (From Outside Eventually
- Natural Source) Overtime
Progression
Nurse CEO-08 No desire/no goal N/A Yes (An Interim Eventually
Position) Overtime
Nurse CEO-09 Last 27 years N/A N/A N/A
Nurse CEO-10 10 years N/A N/A N/A
Nurse CEO-11 Never gave it a Opportunities/ Self Yes (An Interim Eventually
thought - Natural Position) Overtime
Progression
Nurse CEO-13 No desire Opportunities/ Self Yes (Self - Natural Eventually
- Natural Transition) Overtime
Progression
Nurse CEO-14 No desire Opportunities Yes (Self - Natural Eventually
Transition/An Overtime
Interim Position)
Nurse CEO-15 No desire N/A N/A N/A
Nurse CEO-17 No desire Opportunities/ Self Yes (President of Eventually
- Natural Corporation) Overtime
Progression
Nurse CEO-19 No desire N/A N/A N/A
Total All 19 Answered Only 7/19 Offered Only 10/19 Only 9/19 Offered
(100%) Insight (37%) Offered Insight Insight (47%)
(53%)
197
Table 2
Interview Question 2_Emotional Behavioral Factors
Categorical
Participants Column 1 Column 2 Column 3 Column 4 Selection
Nurse CEO- Very strong Know thyself Expose thyself General
01 moral fiber (strengths and Comments
weaknesses)
Nurse CEO- Patience Be able to Take time to Must have General
02 listen position thyself ability to act Comments
in all /Personal
situations Reflection
Comments
Nurse CEO- Be visionary Be fair Be strategic Be focused General
03 Comments
/Personal
Reflection
Comments
Nurse CEO- Maintaining a Maintaining a General
04 sense of calm Comments
Executive demeanor
Protocol
Nurse CEO- Good people Mastery of Perseverance Good Personal
05 skills information organizationa Reflection
l skills Comments
Nurse CEO- Strong sense Must be fired Have tough skin Avoid being Personal
06 of self up, and remove overly Reflection
motivated, personal bias sensitive and Comments
and possess Act
drive genderless
Nurse CEO- Must have Must have Care Be assertive Personal
07 empathy for compassion Reflection
patients for patients Comments/
Patient Focused
Comments
Nurse CEO- Setting Do not sweat Learning to Personal

08 priorities the small know and when Reflection
stuff to use the Comments
nursing process
daily
Nurse CEO- Communicati A small ego Sound financial General
09 on sense Comments
skills
Nurse CEO- Honesty, Being able to Controlling egos General
10 integrity, and hear, as women Comments/
listening empathize, Personal
and Reflection
sympathize Comments
with staff
Nurse CEO- Have a Be a Having a sense Good General
11 positive visionary, of curiosity and communicati comments
attitude and develop know how to on, know
198
common meaningful foster it; how to

sense; relationships, understand understand
eliminate and navigate position power others, take
personal political and treat others risks, do not
agenda, landscape with respect be afraid;
attend separate task
organizational from emotion
agenda
Nurse CEO- Be flexible Be a good Be focused, Personal
12 and adaptable listener and to accountable, and reflection
like people require comments
accountability
from others
Nurse CEO- Must have Good balance Critical thinking Personal
13 belief and and sense of reflection
faith in self the comments
environment
Nurse CEO- Good balance Critical Must be a good Must care the Personal
14 and sense of thinking listener and organization reflection
the communicator and comments
environment understand
how it works
Nurse CEO- Be an Negotiation General
15 attentive skills comments
listener
Nurse CEO- Critical Relationship Communication High sense of General
16 thinking and building skill stress comments/Perso
multi-tasking skills tolerance nal reflection
comments
Nurse CEO- Must have Passion for Know thyself Personal
17 good the patients reflection
composure comments/Patien
t-centered
comments
Nurse CEO- Be calm and Train Be able to show Good sense General
18 patient in yourself to be restraint of fairness comments/Perso
nature calm and and think the nal reflection
patient in best of people comments
nature
Nurse CEO- Integrity Having Good listening Gather all General
19 patience skills facts before comments/Perso
making nal reflection
decisions comments
Total All 19/19 All 19/19 17/19 offered 10/19 offered General
offered offered insight insight Comments 6
100% insight 89% 53% Personal
100% Reflection
Comments 7
Patient-centered
comments
1
199
Table 3
Question 2 Frequency Count of Comments
Comments Number Count Total Percentage

Strong moral fiber 1 1/74 1%
Know thyself 1111 4/74 5%
Expose thyself 1 1/74 1%
Patience 111 3/74 4%
Listener (Be a good listener or having good listening 11111111 8/74 11%
skills)
Position yourself 1 1/74 1%
Ability to act 1 1/74 1%
Be a visionary 11 2/74 3%
Be strategic 1 1/74 1%
Be fair 1 1/74 1%
Be firm 1 1/74 1%
Be focused 1 1/74 1%
Maintaining sense of Executive Protocol 1 1/74 1%
Maintain a calm demeanor 1 1/74 1%
Good people skills 1 1/74 1%
Mastery of information 1 1/74 1%
Perseverance 1 1/74 1%
Good organization skills 1 1/74 1%
Be motivated 1 1/74 1%
Be driven 1 1/74 1%
Have tough skin 1 1/74 1%
Do not take things personally 1 1/74 1%
Do not be overly sensitive 1 1/74 1%
Be objective 1 1/74 1%
Be observant 1 1/74 1%
Be gender-less 1 1/74 1%
Have empathy 11 2/74 3%
Be sympathetic 11 2/74 3%
Be assertive 1 1/74 1%
Prioritize 1 1/74 1%
Do not sweat the small stuff 1 1/74 1%
Utilizing nursing process daily 1 1/74 1%
Egos 1 1/74 1%
Sound financial sense 1 1/74 1%
Communication skills 1111 4/74 5%
Honesty 1 1/74 1%
Integrity 11 2/74 3%
Possess a positive attitude 1 1/74 1%
Have common sense 1 1/74 1%
Have a sense of curiosity 1 1/74 1%
Know how to foster your curiosity 1 1/74 1%
Understanding others 1 1/74 1%
Be a risk taker 1 1/74 1%
Develop meaningful relationships 1 1/74 1%
Navigate the political landscape 1 1/74 1%
Remove personal agenda 1 1/74 1%
Attend to organizational agenda 1 1/74 1%
Understand position power 1 1/74 1%
Respect position power 1 1/74 1%
200
Separate task from emotion 1 1/74 1%

Be flexible 1 1/74 1%
Do not be afraid to learn 1 1/74 1%
Be adaptable 1 1/74 1%
Learn to like others 1 1/74 1%
Be accountable 1 1/74 1%
Hold others accountable 1 1/74 1%
Believe 1 1/74 1%
Have Faith 1 1/74 1%
Have balance and good sense of environment 11 2/74 3%
Critical thinking 111 3/74 4%
Must care about organization 1 1/74 1%
Must understand how organization works 1 1/74 1%
Negotiation skills 1 1/74 1%
Multi-tasking 1 1/74 1%
High sense of stress tolerance 1 1/74 1%
Relationship building skill 1 1/74 1%
Good composure 1 1/74 1%
Possess passion for job and patients 1 1/74 1%
Be calm in nature 1 1/74 1%
Train yourself to be patient and calm 1 1/74 1%
Be able to show constraint in words, thoughts, and in 1 1/74 1%
speaking
Have a sense of fairness 1 1/74 1%
Think best of people 1 1/74 1%
Integrity 1 1/74 1%
Total 74 96/74 119%
(1.29%)
Table 4
Interview Question 3_Specific Personal Characteristics Needed To Be CEO
Participants Column 1 Column 2 Column 3 Column 4 Categorical

column
Nurse CEO- Good Having High Be myself and Be flexible Personal
01 Interpersonal Standards not someone and adaptable reflection
Skills else comments
Nurse CEO- Strong leader Demonstrate Personal
02 good leadership reflection
skills in other comments
roles
Nurse CEO- Social skills Political Be a team General
03 aspirations player comments/
Personal
reflection
comments
Nurse CEO- Relationship Interpersonal Be persistent Be resilient General
04 building communication comments/
Personal
reflection
comments
Nurse CEO- Honesty Good integrity Personal
05 reflection
201
comments
Nurse CEO- Relationship Good facilitator Honesty and Mutual Personal
06 building Integrity respect reflection
comments
Nurse CEO- Formulate a Earn respect Personal
07 team and support reflection
comments
Nurse CEO- People Skills Interpersonal Ability to care Personal
08 Skills reflection
comments/
Organization
focus
Nurse CEO- Clinical Financial Strong General
09 Experience Knowledge financial comments/
acumen Personal
reflection
comments
Nurse CEO- Very open and Good listener Caring Good Personal
10 Easy to talk too. individual and personality reflection
sensitive when comments/
working with Patient-
others centered
Nurse CEO- Care for Organization Risk-taker and Dedicated, Personal
11 organization was always 1st Aggressively accountable, reflection
assertive and comments/
responsible People-
centered
Nurse CEO- Ability and Critical Appearing General
12 willingness to thinking and confident comments/
network full of humor Personal
effectively reflection
comments
Nurse CEO- Transformation Visionary Open, Possess the Personal
13 al leader approachable, ability to reflection
and have an bring others comments/
open door together Reflection
policy from others
Nurse CEO- Genuinely care Have Heart Listening Communicati Personal
14 about patient skills on skills reflection
and employees comments/
Patient-
employee
comments
Nurse CEO- Confidence Flexibility General
15 comments/
Personal
reflection
comments
Nurse CEO- Education Professional Drive Personal
16 reflection
comments/
Educationally
and
Professionally
centered
Nurse CEO- Work hard Responsible Accountable Good Personal
202
17 decision- reflection
maker comments
Nurse CEO- Diversity in Diversity in Personal
18 settings cultures reflection
comments/
Organization
centered
Nurse CEO- Organizational Analytical skills Charisma and Possess good Personal
19 ability good sense of reflection
leadership humor comments/
skills Reflection
from others
Total All 19/19 All 19/19 14/19 9/19 Personal
offered insight offered insight offered insight offered reflection
100% 100% 74% insight comments
47% 6
General
comments
5
Personal
reflection
comments
with influence

9
Table 5
Comments Number Count Total Percentage

Good interpersonal 1 1/49 2%
relationships
Having high standards 1 1/49 2%
Have belief I can do 1 1/49 2%
better
Have belief I possess the 1 1/49 2%
ability to do better
Adapting to the 1 1/49 2%
environment and job
Being a strong leader 1 1/49 2%
Good leadership skills 1 1/49 2%
Possess social skills 1 1/49 2%
Have political 1 1/49 2%
aspirations
Be a team player 1 1/49 2%
Relationship building 111 3/49 6%
Interpersonal 1 1/49 2%
communication
Be persistence 1 1/49 2%
Be resilient 1 1/49 2%
203
Be honest 11 2/49 4%
Have good integrity 11 2/49 4%
Relationship-based 1 1/49 2%
person
Being a good facilitator 1 1/49 2%
Believe in mutual 1 1/49 2%
respect
Transformational 111 3/49 6%
leadership
Interpersonal skills 1 1/49 2%
Care about people 111 3/49 6%
Clinical experience 1 1/49 2%
Good financial 1 1/49 2%
knowledge
Strong financial acumen 1 1/49 2%
Easy to talk too and 1 1/49 2%
open with employees
Extremely sensitive with 1 1/49 2%
others
Good listening skills 111 3/49 6%
Care for the organization 11 2/49 4%
Risk-taker 1 1/49 2%
Aggressively assertive 1 1/49 2%
Being accountable 1 1/49 2%
Being responsible 11 2/49 4%
Networking effectively 1 1/49 2%
Critical thinking 1 1/49 2%
Good sense of humor 11 2/49 4%
Possess self-confidence 111 3/49 6%
Good communication 1 1/49 2%
skills
Must have heart 1 1/49 2%
Must have flexibility as 1 1/49 2%
a leader
Professionalism 1 1/49 2%
Education 1 1/49 2%
Working hard 1 1/49 2%
Good decision making 1 1/49 2%
Diversity of cultures 1 1/49 2%
Diversity in settings 1 1/49 2%
Organization abilities 1 1/49 2%
Analytical skills 1 1/49 2%
Charismatic style 1 1/49 2%
Total 49 64/49 (1.31%) 128%
Table 6
Interview Question 4_Describe Institutional Support
Participants Column 1 Column 2 Column 3 Column 4 Categorical

column
Nurse Extremely Helpful by Allowed me to Former Extremely
CEO-01 supportive putting up with take risks organization supportive
my mistakes encouraged me
204
to take risks
Nurse Supervisors had Felt supported Felt
CEO-02 a chance to supported
observe me
Nurse Allowed me Felt
CEO-03 administrative supported
sabbatical for a
little more than
10 years
Nurse Provided Supported my Helped Felt
CEO-04 organizational continuing significantly in supported
flexibility to educational my efforts to
have broader efforts become a fellow
administrative in the American
responsibilities College
Healthcare
Executives and
Wharton Nursing
Fellow
Nurse Supportive from Felt limited
CEO-05 a mentoring support
standpoint
Nurse Did not receive It was a constant Did not feel
CEO-06 support battle support
Nurse Combination of Overall Felt
CEO-07 sources, such as supported supported
chemistry of throughout the
management, organization
staff, and overall
teamwork
Nurse Institutional Was supported Felt
CEO-08 support from throughout the supported
fellow nurses organization
Nurse Institutional Support from Felt systems
CEO-09 support from CEO support
individuals
beginning in
medical school
Nurse Support from an Felt light
CEO-10 individual quite support
different than
self
Nurse Support from Organization Organization Felt systems
CEO-11 Board of allowed allow room for support
Directors, the flexibility in mistakes and to
nursing staff, and various roles learn from them
doctors
Nurse Mentors From Felt external
CEO-12 organization with support
professional
associations
Nurse Support of Financial support Education Felt little
CEO-13 leadership skills support support
in other places
Nurse Internal ranks by Support from Felt specific
CEO-14 going through organization support
205
the ranks based on

community
activity and
programs
Nurse Support from Educational Felt specific
CEO-15 hospital CEO support support
Nurse Support from Support from Support from Felt partial
CEO-16 former Board mentoring systems
administration support
Nurse Mentors Support in each Felt external
CEO-17 of my roles and
hierarchical
support
Nurse Support in Helpful by Support for Felt
CEO-18 various non- putting up with being able to be supported
paying roles my mistakes creative and
innovative in the
workplace
Nurse Support due to Mentors Helpful by Felt
CEO-19 good work ethics putting up with supported
my mistakes
Total All 19/19 offered All 16/19 offered 7/19 1/19 Felt
insight insight offered insight offered insight supported
100% 84% 37% 5% with
influence
Yes -18/19
[95%]
No 1/19
[5%]
Table 7
Interview Question 5_Leadership Skills Needed To Become CEO
Participants Column 1 Column 2 Column 3 Column 4

Nurse CEO-01 Learn as much as Be charismatic Be active listener Critical thinking
possible about the and process
totality of hospital transformational
in approach
Nurse CEO-02 Open door policy Be a visionary Be on one accord Ensure personal
with the mission of morals are same as
the hospital organization
Nurse CEO-03 Business Financial Systems design
administration accounting
Nurse CEO-04 Financial Continuing
assessment education
Nurse CEO-05 Sound leadership Good problem Good delegation Need to know and
and management solving skills skills master effective
solutions follow up strategies
Nurse CEO-06 Career transition Must be aware of Do not become too
the entire hospital focused on work
Nurse CEO-07 Must desire to Must be assertive
manage people
Nurse CEO-08 Must be resilient Be a visionary
with plans and
206
adaptability with
the new project
Nurse CEO-09 Team leadership Diversity training Know how to lead, Must be able to set
skills assist, encourage priorities and learn
and redirect to plan the work and
work the plan
Nurse CEO-10 Communicate with Education - Mutual respect Care, listening skills,
others Clinical being open and
knowledge honest
Nurse CEO-11 Financial piece Understanding Understanding Group dynamics,
people organizational communication
dynamics skills, conflict
resolution,
organizational
development theory
Nurse CEO-12 Experience and Ability to be Ability to listen Ability to work with
credibility flexible colleagues
Nurse CEO-13 Manage conflict Understand the
resolution financial picture
Nurse CEO-14 Motivation Must be firm, Listening,
consistent, and communication,
room for fun and working
through process
are important
Nurse CEO-15 Conflict Team building Informal and Visibility
management formal
communication
Nurse CEO-16 Ability to speak Strategic planning Organizational
financial is critical around patient skills around
care patient care
Nurse CEO-17 Independent thinker Must be a Must be objective Must be fair
visionary
Nurse CEO-18 Education View systems to Finances Human resources
be able to affect
change through
large groups
Nurse CEO-19 Teamwork Need high level of Develop good Learn to be balanced
emotional orientation and
intelligence analytical ways of
dealing with issues
Total All 19/19 offered All 19/19 offered 15/19 11/19
insight insight offered insight offered insight
100% 100% 79% 58%
Table 8
Interview Question 6_Clinical Background Advantages and Disadvantages
AN=Advantage
Negative
Participants Column 1 Column 2 Column 3 Column 4 AP=Advantage
Positive
Nurse CEO- Talk to Great deal of Ask a lot of Clinical AP
01 doctors and interest in questions to background
207
understand science and physician group keeps me

their language in new ways busy
of dealing
with patients
Nurse CEO- Remain Clinical Clinical AN/AP
02 focused on background background
patient and has been makes it difficult
their needs positive with financial
decisions for
patients
Nurse CEO- Clinical Problem Developing and Strategically AP
03 background solving, implementing aligning
has helped making your plan principles
positive assessments, with strategic
and agenda of the
principles organization
Nurse CEO- Allow more Push and Cannot be AP/AN
04 empathy remind staff bamboozled by
about plight to be patient threats of scary
of patients centered tactics
Nurse CEO- Allow me to Good Non-clinical Do not get AP/AN
05 cut through assessment people just view the same
major hurdles skills/Gende you as a nurse level of
that non- r bias respect as
clinical CEOs non-clinical
deal with CEOs
Nurse CEO- Clinical Clinical AP/AN
06 background is background
a doubled- is invaluable
edge sword
Nurse CEO- Clinical Speaking the Have been able Clinical AP
07 background language of to build a better background
has been physician team helped to run
positive because of a successful
clinical facility
background
has been
invaluable
Nurse CEO- Focus on View Viewing Lack in AP/AN
08 patient scenarios situations from financial and
satisfaction from a patient and business
and clinical clinical family background
outcomes perspective perspectives is
critical
Nurse CEO- Clinical Clinical Received AP/AN
09 background background negative note
has been has not been from physician
positive positive with
certain
physicians
Nurse CEO- Flexible Reminds us AP
10 individual and that patient-
clinical centered is
background key
helped
tremendously
208
Nurse CEO- Helped me to Helped to Clinical AP

11 understand deliver background
clinical arena excellent helped me to
patient care focus on
importance of
quality care
Nurse CEO- Helped to Disadvantag Disadvantage is AN/AP
12 understand e is not the view of
clinical arena being having a human-
exposed to side or being
financial touchy feely
side
Nurse CEO- Clear view of Helped to AP
13 clinical keep my
mission of eyes of
hospital clinical
outcomes of
hospital
Nurse CEO- Helped in Patients Administration Help in AP
14 certain recognize recognized current role in
projects care former nursing understanding
positions both the
nursing
concerns and
the non-
nursing
concerns
Nurse CEO- Helped to Enhanced Negative Hindrance of AP/AN
15 understand ability to perception of working
organizational discuss, nurse versus a relationships
and debate and doctor/Authority and the roles
institutional negotiate is questioned of nurse and
issues more issues with doctors
clearly physicians
in leadership
roles
Nurse CEO- Provided Good Can understand Can speak AP
16 credibility positive physicians language of
when working relationships physicians
with with medical
physicians staff and
throughout
system
Nurse CEO- Helps with Helps to Helps to Helps with AP
17 working with understand dialogue with dealing with
large numbers the language others physicians
of clinical and
people interacting
with them
Nurse CEO- Credibility Resentment You have Seeing the AP/AN
18 from staff from staff firsthand bigger picture
because of because you knowledge of based on
nursing are not a what is needed background
background doctor and warranted helped with
overall financial
decisions
209
Nurse CEO- Teaching Can clearly AP

19 background in see the
a nurse clinical
practitioner impact in
program the decision
helped with making
current role process
Total All 19/19 All 19/19 15/19 10/19 AP-10 (52%)
offered offered offered insight offered AP/AN 9 (47%)
insight insight 79% insight AP/ [AP/AN] =
100% 100% 53% 2.11%
Table 9
Comments Number Total AN-Advantage Percentage

Count (Counts/ Negative
No. of AP=
Comments) Advantage
Positive
Teaching background in a nurse practitioner 1 1/51 AP 2%
program helped with current role
Can clearly see the clinical impact in the 1 1/51 AP 2%
decision making process
You have firsthand knowledge of what is 1 1/51 AP 2%
needed and warranted overall
Resentment from staff because you are not a 1 1/51 AN 2%
doctor
Credibility from staff because of nursing 1 1/51 AP 2%
background
Seeing the bigger picture based on 1 1/51 AP 2%
background helped with financial decisions
Helps with working with large numbers of 1 1/51 AP 2%
clinical people
Helps to understand the language 1111 4/51 AP 9%
Helps to dialogue with others 1 1/51 AP 2%
Helps with dealing with physicians and 1 1/51 AP 2%
interacting with them
Provided credibility when working with 1 1/51 AP 2%
physicians
Good positive relationships with medical 1 1/51 AP 2%
staff and throughout system
Can understand physicians 1 1/51 AP 2%
Disadvantage is the view of having a 1 1/51 AN 2%
human-side or being touchy feely
Disadvantage is not being exposed to 1 1/51 AN 2%
financial side
Reminds us that patient-centered is key 1 1/51 AP 2%
Flexible individual and clinical background 1111111 7/51 AP 14%
helped tremendously
Received negative note from physician 1 1/51 AN 2%
Viewing situations from patient and family 1 1/51 AP 2%
perspectives is critical
210
Good assessment skills 1 1/51 AP 2%

Clinical background has not been positive 1 1/51 AP 2%
with certain physicians
Gender bias 1 1/51 AN 2%
Helped to keep my eyes of clinical 111 3/51 AP 6%
outcomes of hospital
Allow me to cut through major hurdles that 1 1/51 AP 2%
non-clinical CEOs deal with
Non-clinical people just view you as a nurse 1 1/51 AN 2%
Do not get the same level of respect as non- 1 1/51 AP 2%
clinical CEOs
Clear view of clinical mission of hospital 1 1/51 AP 2%
Have been able to build a better team 1 1/51 AP 2%
Lack in financial and business background 1 1/51 AN 2%
Focus on patient satisfaction 1 1/51 AP 2%
Help in current role in understanding both 1 1/51 AP 2%
the nursing concerns and the non-nursing
concerns
Administration recognized former nursing 1 1/51 AP 2%
positions
Patients recognize care 1 1/51 AP 2%
Helped in certain projects 1 1/51 AP 2%
Hindrance of working relationships and the 1 1/51 AN 2%
roles of nurse and doctors
Negative perception of nurse versus a doctor 1 1/51 AN 2%
Authority is questioned 1 1/51 AN 2%
Enhanced ability to discuss, debate and 1 1/51 AP 2%
negotiate issues with physicians in
leadership roles
Helped to understand organizational and 1 1/51 AP 2%
institutional issues more clearly
Great deal of interest in science and in new 1 1/51 AP 2%
ways of dealing with patients
Helped to understand clinical arena 1 1/51 AP 2%
Ask a lot of questions to physician group 1 1/51 AP 2%
Clinical background keeps me busy 1 1/51 AP 2%
Talk to doctors and understand their 1 1/51 AP 2%
language
Allow more empathy about plight of 1 1/51 AP 2%
patients
Push and remind staff to be patient centered 11 2/51 AP 4%
Cannot be bamboozled by threats of scary 1 1/51 AN 2%
tactics
Problem solving, making assessments, and 1 1/51 AP 2%
principles
Developing and implementing your plan 1 1/51 AP 2%
Strategically aligning principles with 1 1/51 AP 2%
strategic agenda of the organization
Clinical background makes it difficult with 1 1/51 AN 2%
financial decisions for patients
Total 51 63/51 AN=39/51 127%
(1.24%) (76%)
AP=12/51
(24%)
211
Table 10
Interview Question 7 Importance of Business/Finance Degrees for Nurse CEOs
Participants Categorical
column
Column 1 Column 2 Column 3 Column 4
Nurse Must understand Must be Must have Does not EI; how
CEO-01 negotiation competent so competencies matter how competence is
techniques, you can do the in business and you know as obtained is
managed care, right thing and finance; long as you individual choice
how hospitals make right learned from know about
get paid, and decisions for the spouse who business and
how to read a organization was CFO finance
balance sheet
Nurse Thorough Must be Must Must be able EI; degree is
CEO-02 understanding of competent to understand how to pick up an preferred
basic accounting read a profit and to analyze and audit,
loss statement defend your understand it,
budget and then
speak to
variances
Nurse Analytical skills Must have It takes more EI; degree is not
CEO-03 are most courses in than the needed
important business and process
finance
Nurse You must have a Certification in Something in EI; degree is
CEO-04 skill these areas are budget and needed
helpful finance is
needed; but not
necessarily a
degree
Nurse Would add to Learned Would have EI
CEO-05 ones personal financial been beneficial
skill mix and business from to have broader
enhance comfort hands on based on
level of training from knowledge
employer work with finances
and the
organization
Nurse Do not have a Mentor Did not note
CEO-06 business or suggested not to whether it is
financial degree pursue MBA important or not
because
experience thus
far exceeds an
MBA
Nurse Business or Did not note
CEO-07 financial degrees whether it is
assisting in important or not;
processing some sort of
information at a degree is
faster rate recommended;
not necessarily a
212
MBA
Nurse Numbers are Need to Must EI; degree would
CEO-08 important understand all understand how be
aspects of to look at staff complimentary
business and variable to nursing degree
costs
Nurse Degrees are Need for Needed to EI; degrees are
CEO-09 good and are one managerial make decisions good
measure of accounting skills for the future
emphasis and financial
accounting
Nurse Could not Both are needed They give you Weighs EI, additional
CEO-10 advance without different heavily degrees are
the additional perspective on needed
education in business
these areas
Nurse Essential to have Must have EI; Not
CEO-11 understanding of understanding of necessary to
finances business side as have MBA
well
Nurse Adds to Adds to your EI; degree and
CEO-12 credibility to ability to discuss additional classes
discuss financial financial pieces are
pieces complimentary
Nurse Knowing the Merely taking MBA is not Reply on Did not note
CEO-13 lingo/ courses in needed for role experts in whether it is
language is a business and of CEO organization important or not;
good thing finance are fine an MBA is not
needed
Nurse Must know the Did not answer
CEO-14 aspects of the the question
business world asked; but
believes a MBA
is valuable
Nurse Understanding Did not answer
CEO-15 business and question asked.
finances are
absolutely
necessary
Nurse Gives credibility Gives foot on EI
CEO-16 especially non- both camps,
clinical people which really
help
Nurse Need to have Cannot rely on Did not note
CEO-17 good working the experts in whether it is
knowledge of organization important or not;
finance does not require
an MBA
Nurse Degrees are Understanding EI
CEO-18 extremely how to spend
important money, where it
comes from,
budgeting and
positions and
contracts are
helpful
213
Nurse These degrees Need a strong Must be able to EI

CEO-19 are critical financial read the
background spreadsheets,
know where the
dollars are
going, and how
to balance a
budget
Total All 19/19 offered 17/19 offered 10/19 4/19 EI 13/19 (68%)
insight insight offered insight offered DNA 6/19 (31%)
100% 89% 53% insight Degree Needed
21% Yes 8/19
(42%)
No 4/19 (21%)
COI 1/19 (5%)
NA 6/19 (32%)
Table 11
Comments Number Count Total (Counts/ Percentage

No. of Comments)
Must be able to read the 1 1/19 5%
spreadsheets, know
where the dollars are
going, and how to
balance a budget
Need a strong financial 1 1/19 5%
background
These degrees are 1111 4/19 21%
critical
Understanding how to 1 1/19 5%
spend money, where it
comes from, budgeting
and positions and
contracts are helpful
Cannot rely on the 1 1/19 5%
experts in organization
Need to have good 1 1/19 5%
working knowledge of
finance
Gives foot on both 1 1/19 5%
camps, which really help
Gives credibility 1 1/19 5%
especially non-clinical
people
Must know the aspects 1 1/19 5%
of the business world
Reply on experts in 1 1/19 5%
organization
MBA is not needed for 1 1/19 5%
role of CEO
Merely taking courses in 1 1/19 5%
214
business and finance are

fine
Knowing the 1 1/19 5%
lingo/language is a good
thing
Adds to your ability to 1 1/19 5%
discuss financial pieces
Adds to credibility to 1 1/19 5%
discuss financial pieces
Must have understanding 11 2/19 10%
of business side as well
Essential to have 1 1/19 5%
understanding of
finances
Could not advance 1 1/19 5%
without the additional
education in these areas
Needed to make 1 1/19 5%
decisions for the future
Total 19 23/19 (1.21%) 116%
Table 12
Interview Question 8_Describe Mentorship Relationships
Participants If so, Gender and position Was the Was the relationship
Had mentors? how of mentor, if any relationship positive, negative or
Column 1 many? Column 3 influential? both?
Column 2 Column 4 Column 5
Nurse Yes Two Female-Nursing Yes Positive
CEO-01 School Instructor/
Male-CEO
Nurse Yes One Male/CEO Yes Positive
CEO-02
Nurse Yes Three Female/Not noted Yes Both/ Constructive
CEO-03
Nurse Sort of One Female/Not noted Yes Positive
CEO-04
Nurse Yes One Male/High Position Yes Positive
CEO-05
Nurse Sort of One Male/CEO Yes Both/ Constructive
CEO-06
Nurse Yes Two Female-Nurse Yes Positive
CEO-07 /Male-CEO
Nurse No; but had N/A; N/A N/A, from a Positive; from a role
CEO-08 role models several role model model perspective
from whom I role point of view
emulated models
Nurse Yes One Male/Major in Air Yes Positive
CEO-09 Force
Nurse Yes One Male/CFO Yes Both/Constructive
CEO-10
Nurse Yes One Male/Local Yes Positive
215
CEO-11 businessman-
Chairman of the
Board
Nurse Yes One Male/CEO Yes Both/Constructive
CEO-12
Nurse Yes Two Male/CEO & Yes Positive
CEO-13 Systems CEO
Nurse Yes One Female/Director of Yes Positive
CEO-14 Nursing
Nurse Yes One Male/CEO Yes Positive
CEO-15
Nurse Yes Two Female- Yes Positive
CEO-16 Nurse/Male-COO
Nurse Yes Two N/A Yes Positive
CEO-17
Nurse Yes One Male/CEO Yes Both/Constructive
CEO-18
Nurse Sort of One Male/Chief of Yes Positive
CEO-19 Pathology
Total All 19/19 All 19/19 All 19/19 offered All 19/19 All 19/19 offered
offered offered insight offered insight insight
insight insight 100% 100% 100%
100% 100%
Table 13
Interview Question 9 - Advice to Nurses Aspiring to be Hospital CEOs
Participants Individual Organization Education Programs

Column 1 view Column 3 Column 4
Column 2
Nurse CEO-01 Be inquisitive; Be involved in Take advantage
ask questions committees and bring outside of nursing
about change in
department/unit
Nurse CEO-02 Have a Must have
leadership role understanding of
operations of
organization
Nurse CEO-03 Mentor others Understand decisions
and be mentored with political
by others when ramifications and
possible implications
Nurse CEO-04 Develop peer Understand that
and service relationship building
relationships is pivotal
Nurse CEO-05 Know the Networking in the
business you are organization is
in; Try to be seen important
as a can do
person; Learn to
sacrifice for a
short period of
time; Learn to
network
216
Nurse CEO-06 Go the route of Cross over to general

nursing patience operations
care
Nurse CEO-07 Be assertive and
seek out
opportunities; Be
willing to
sacrifice
sometimes; Take
on opportunities
and be the best
you can
Nurse CEO-08 Persevere,
especially
through
challenges
Nurse CEO-09 Consider Consider how do we
learning best do best practices and
practices and how do we make an
how to improve improvement each
health systems day in the way we do
business
Nurse CEO-10 Learn to listen to Must be able to look Get a Masters
people with globally and degree
whom you work determine the impact
with; For nurses, of decisions and
learn to take the situations
nursing hat off;
Put on the
nursing hat when
needed
Nurse CEO-11 Let go of how a
nurse thinks to
gather and obtain
new perspectives
of the field of
nursing
Nurse CEO-12 Shift focus from Find a venue to touch Take advantage of on
CEO to the on other than the the job opportunities
continuing care hospital side; this will and programs to
arena and the set you ahead of the expand knowledge
long-term care curve base
arena
Nurse CEO-13 Get into nursing Learn one segment
leadership roles; and others segments
Go through steps will be easier to
of being in follow and learn
primary nursing
leadership roles
Nurse CEO-14 Work on Advance education
leadership skills; on the business
Give self time to side of healthcare
learn what
nursing and
healthcare is all
about; Take time
217
and not rush into

leadership
positions; Take
advantage of
differing
opportunities
Nurse CEO-15 Be a Nurse
Manager on a
unit for a long
time; This
position is a
perfect growth,
learning position
Nurse CEO-16 Take different Get involved in If you do not Get involved with
promotions or committees that are possess an other programs
opportunities cross-functional advanced degree, outside of nursing
along the way to pursue a business
expand the degree at the
breadth of their Masters level
experience
Nurse CEO-17 Begin to do a lot Learn about the
of work around different aspects of
leadership; the hospital
Develop an open
mind; Learn to
focus outside of
the box
Nurse CEO-18 Take on some Take some
projects that no business courses
one else wants
and do it well;
Make self
visible; Place
self in position
of comfort (push
comfort level)
Nurse CEO-19 Look for Start to take

promotional finance courses
opportunities
such as director;
Be willing to
take on special
projects, seek
mentoring; Self-
evaluate and
build
relationships;
Learn to deal
with setbacks
and do not take it
personal; Learn
to communicate
218
and be humble;
Have good self-
confidence
Total All 19/19 offered 12/19 offered insight 6/19 2/19
insight 63% offered insight offered insight
100% 32% 11%
Table 14
Comments Number Count Total (Counts/ Percentage

No. of Comments)
Ask questions 1 1/44 2%
Take advantage of 11 2/44 5%
opportunities or
promotions
Be involved in 1 1/44 2%
committees and in
bringing about change in
department/unit
Engage in educational 111 3/44 7%
opportunities
Have an understanding 11 2/44 5%
of entire operation
Take on leadership roles 1 1/44 2%
Understanding decisions 1 1/44 2%
have political
ramifications and
implications
Seek mentoring 11 2/44 5%
relationship
Be available to be 1 1/44 2%
mentored by someone
Relationship building 1 1/44 2%
Nurses need to have 1 1/44 2%
service relationships
Nurses need peer 1 1/44 2%
relationships
Need to network outside 1 1/44 2%
of nursing box
Know that business that 11 2/44 5%
you are in
Be willing to sacrifice 1 1/44 2%
Learn to network with 1 1/44 2%
right people
Go to route of nursing 1 1/44 2%
patient care
Find a way to crossover 1 1/44 2%
to general operations
Seek out all 1 1/44 2%
opportunities
Persevere 1 1/44 2%
Consider learning best 1 1/44 2%
practices
219
Consider learning to 1 1/44 2%

improve health systems
Consider how do we do 1 1/44 2%
best practices
Consider do we make an 1 1/44 2%
improvement each day
in the way we do
business
Get a Masters degree 1 1/44 2%
Learn to listen to the 1 1/44 2%
people you are working
with
Set aside the nursing 11 2/44 5%
mentality
Do not forget the nursing 11 2/44 5%
side of the job
Learn to determine how 1 1/44 2%
it affects or is affecting
the rest of the
organization
Think of other venues to 1 1/44 2%
take on leadership
positions
Take advantage of hands 1 1/44 2%
on learning
Get into nursing 1 1/44 2%
leadership roles
Work on leadership 11 2/44 5%
skills
Advance education in 11 2/44 5%
business side of
healthcare
Give time to learn what 1 1/44 2%
nursing and healthcare is
all about
Make wise decisions 1 1/44 2%
Be a Nurse Manager for 1 1/44 2%
a long time
Get involved in 1 1/44 2%
committees, activities, or
operations
Need good coaching 1 1/44 2%
skills and the ability to
manage
Need an open mind 1 1/44 2%
Take on projects that no 1 1/44 2%
one else wants
Learn to push your 1 1/44 2%
comfort level
Conduct self-assessment 1 1/44 2%
of internal relationships
Learn to deal with 1 1/44 2%
setbacks
Total 44 54/44 (1.23%) 107%
220
Table 15
Interview Question 10_Key Areas in Hospital Administration Needed for CEOs
Participants
Column 1 Column 2 Column 3 Column 4 Column 5
Nurse CEO- Finance Facilitation Negotiation of Challenge Strategic
01 conflict of creative planning skills
resolution of problem
solving
Nurse CEO- Finance Knowledge of Knowledge of Knowledge Develop a
02 financial institutional of succession vision and
vehicles planning planning increase
awareness of
political
environment
Nurse CEO- Knowledge of General Organizational Organization Organizational
03 systems principle of development coaching design
design hospital finance
Nurse CEO- Strategic Metric based Effective Peer relationship Team building
04 planning operations finance skills building to bring
skills together those
that usually
may not and
allow
innovation and
diversity of
thinking
Nurse CEO- Finance Budgeting (how Quality Leadership skills Management
05 it relates to improvement skills
finance)
Nurse CEO- Marketing Labor relations Human Quality control
06 and business resources
development
Nurse CEO- Finance Ability to Develop
07 formulate teams listening skills
Nurse CEO- Understand Understand the Expanded Finance Business
08 the importance of knowledge of management management
importance of business political,
community relationship regulatory
influences in
healthcare
today
Nurse CEO- Knowledge of Solid financial Team
09 process decision leadership (all
improvement making levels of
administration)
Nurse CEO- Working with Knowledge of Knowledge of
10 medical staff finance human
resources
Nurse CEO- Finance People skills Organizational
11 knowledge dynamics
Nurse CEO- Measurement Aspire to be Understanding How to negotiate How to work
12 s in the truly apparent of physician and interact with with Board of
quality arena in sharing with relationships physicians Directors,
221
all stakeholders community

and organization,
shareholders sharing the
organizations
perspective
and vision
Nurse CEO- Good How hospitals Knowledge
13 knowledge of are financed, about
how to write a especially governance
business plan reimbursement
finance
Nurse CEO- Business Finance acumen Leadership
14 acumen acumen
Nurse CEO- Development Be involved in Communicatio
15 of business start up of new n skills
plans service or new
department
Nurse CEO- Understand Building Finance
16 how relationships
reimbursemen
t works
Nurse CEO- Finance Leadership Building teams
17 skills
Nurse CEO- Human Business How do deal
18 resources administration with media
Nurse CEO- Budget Finance How to plan Exposure in Strategic

19 system works for programs community, planning
especially
linkage between
hospital and the
community
Total All 19/19 All 19/19 19/19 8/19 8/19
offered offered insight offered insight offered insight offered insight
insight 100% 100% 42% 42%
100%
222
Table 16
Comments Number Total (Counts/ Percentage

Count No. of
Comments)
Finance 11111111111 11/50 22%
Facilitation 1 1/50 2%
Negotiation of conflict resolution 1 1/50 2%
Challenge of creativity of problem solving 1 1/50 2%
Strategic planning skills 111 3/50 6%
Knowledge of financial vehicles 1 1/50 2%
Knowledge of institutional planning 1 1/50 2%
Knowledge of succession planning 1 1/50 2%
Develop a vision 1 1/50 2%
Develop awareness of political environment 1 1/50 2%
Knowledge of systems design 1 1/50 2%
General principles of hospital finance 11 2/50 4%
Organizational development 1 1/50 2%
Organizational coaching 1 1/50 2%
Organizational design 1 1/50 2%
Metric based operations 1 1/50 2%
Effective finance skills 1 1/50 2%
Peer relationship building 1 1/50 2%
Knowing how to bring people together 1 1/50 2%
Budgeting 11 2/50 4%
Acquiring knowledge and understanding of quality 11 2/50 4%
improvement, JCAHO, CMS, and other related regulations
Be focused while managing organization 1 1/50 2%
Marketing and business development 1 1/50 2%
Labor relations 1 1/50 2%
Human resource 11 2/50 4%
Leadership skills 111 3/50 6%
Ability to formulate teams 11 2/50 4%
Develop listening skills 1 1/50 2%
Understand the importance of community and business 11 2/50 4%
relationships
Expanded knowledge in political, regulatory influences in 1 1/50 2%
healthcare today is needed
Finance and business management 1 1/50 2%
Knowledge of process improvement 1 1/50 2%
Solid financial decision making 1 1/50 2%
Team leadership 1 1/50 2%
Working with medical staff 1 1/50 2%
Organizational dynamics 1 1/50 2%
People skills 1 1/50 2%
Understanding the measurements in the quality arena 1 1/50 2%
Aspire to be truly transparent in sharing with shareholders 1 1/50 2%
and stakeholders
Understanding and acquiring expanded knowledge of 1 1/50 2%
physician relationships
How to interact and negotiate with physicians 1 1/50 2%
How to work with Boards of Directors, community 1 1/50 2%
organizations, sharing the organizations perspective and
223
vision
How to write a business plan 1 1/50 2%
Knowledge of how hospitals are financed 1 1/50 2%
Knowledge of reimbursement finance 11 2/50 4%
Knowledge about governance 1 1/50 2%
Business acumen 1 1/50 2%
Communication skills 1 1/50 2%
Be involved in start up of new service of new department 1 1/50 2%
Building relationships 1 1/50 2%
How to deal with media 1 1/50 2%
Business administration 1 1/50 2%
How to plan for programs 1 1/50 2%
Exposure in the community 1 1/50 2%
Total 50 76/50 (1.52%) 152%

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A PHENOMENOLOGICAL STUDY OF THE CAREER TRANSITION OF NURSES

INTO HOSPITAL CHIEF EXECUTIVE OFFICER ROLES

A Dissertation Proposal Presented in Partial Fulfillment

of the Requirements for the Degree

DOCTOR OF HEALTH ADMINISTRATION

All rights reserved.

UMI Microform 3270978

ProQuest Information and Learning Company

HOSPITAL CHIEF EXECUTIVE OFFICER ROLES

Karen Bammel, Ph.D. Mentor

Suzanne Richins, DHA, Committee Member

Patricia A. Quigley, Ph.D., Committee Member

Accepted and Signed:

Accepted and Signed:

Dawn Iwamoto, Ed.D.

listen and communicate effectively, involvement in a mentoring relationship, acquisition

I dedicate this dissertation in loving memory of my grandmother Isaline Ismay

Weekes, whose presence in my formative years nurtured me and provided an important

foundation for the rest of my life.

source of strength and faith as I journeyed towards my goal of achieving a doctorate

me throughout my doctoral journey. I would like to thank my University of Phoenix

enlightening source of inspiration, motivation, and honesty in providing detailed

feedback on my progress through my doctoral journey. Karen, your guidance inspired my

committee and for her honesty in advising me to consider different perspectives in my

LIST OF FIGURES ........................................................................................................... xi

CHAPTER 1: INTRODUCTION ....................................................................................... 1

Nurse Executives .................................................................................................... 6

Statement of the Problem.................................................................................................... 9

Purpose of the Study ......................................................................................................... 11

Significance of the Study .................................................................................................. 13

Significance of the Study to Health Care Leadership....................................................... 14

Nature of the Study ........................................................................................................... 16

Transformational Leadership ................................................................................ 19

Stratified Systems Theory..................................................................................... 21

Grounded Theory .................................................................................................. 21

Scope, Limitations, and Delimitations.............................................................................. 25

CHAPTER 2: REVIEW OF THE LITERATURE ........................................................... 29

Title Searches, Articles, Research Documents, and Journals ........................................... 31

Introduction to the Literature Areas.................................................................................. 33

Clinical and Educational Backgrounds................................................................. 42

Emotional Intelligence .......................................................................................... 46

Stratified Systems Theory................................................................................................. 52

Grounded Theory .............................................................................................................. 53

CHAPTER 3: RESEARCH METHODOLOGY .............................................................. 57

Phenomenological Approach ................................................................................ 58

Qualitative Design ................................................................................................ 59

Sampling Frame ................................................................................................................ 64

Data Collection ................................................................................................................. 68

Semistructured Interview Questions ................................................................................. 69

Data Analysis .................................................................................................................... 70

Validity and Reliability..................................................................................................... 72

Review of Data Collection Process................................................................................... 78

Research Questions, Purpose and Findings ...................................................................... 83

Interview Question 1............................................................................................. 83

Findings from Interview Question 1 ..................................................................... 83

Interview Question 2............................................................................................. 85

Findings from Interview Question 2 ..................................................................... 85

Interview Question 3............................................................................................. 86

Findings from Interview Question 3 ..................................................................... 87

Interview Question 4............................................................................................. 88

Findings from Interview Question 4 ..................................................................... 89

Interview Question 5............................................................................................. 90

Findings from Interview Question 5 ..................................................................... 91

Interview Question 6............................................................................................. 94