Building the Nurse Executive Pipeline

Purpose:

Never before has the demand for executive nurse talent been so great. Never before has the opportunity for nurses to drive change in health care been so critical. Never before has the potential for nurses to ascend into executive positions been so promising. Nurses now work in numerous industries, in a wide variety of roles, in not for profit organizations and for profit companies. Yet, proportionate to those in finance or other business related professions, few nurses ascend into executive positions, and when they do, they typically hold positions of lesser stature than their counterparts in other professions.

This is not surprising. The aspiring nurse executive often has a very progressive resume with significant financial responsibility, a large span of control, and critical accountability for operations by the time he or she is ready for an executive position. He or she may also have one or more advanced degrees. But typically, the aspiring nurse executive has had limited career sponsorship and little opportunity to develop the requisite competencies for an executive role. The path to the next level is difficult, if not impossible, without structure and support in the process.

The Center for Nursing Advancement at UnitedHealth Group sought to reverse that trend and build a pipeline of nurse executive talent ready to take on the challenges of a health care system in transition and to lead change to improve health.

Methods:

Unlike typical executive development programs that include aspiring leaders from all disciplines and experiences, the Nurse Leader Executive Program (NLEP) was designed by nurse executives exclusively for high potential nursing talent.  Competence development was focused on competencies critical to success in executive roles such as strategic thinking, executive communication, financial acumen and change leadership - the very competencies that are often identified to be missing in nurse leaders. 

The Nurse Leader Executive Program was designed to launch with two week-long academic learning experiences at a local university and expose UnitedHealth Group nurse leaders to other colleagues from across Minnesota.  The academic content aligned to the targeted compentencies and allowed the nurse leaders to learn from academic experts as well as a senior nurse executive industry lead.  The year-long program also included 360 degree pre and post program feedback, career sponsorship, presentation skills training, and cross-company cohort connections.  The most visible and critical element of the program was an action learning project focused on addressing real-life, complex business problems and required each participant to create a project team, drive change toward sustainable improvements, and present results and metrics to executive audiences.  Ultimately, through this program, participants built their business acumen, executive presence and mindset, and better positioned themselves to drive change across the company.

The program was purposefully designed to be completed in addition to the participants' normal role responsibilities and align with other talent development initiatives in the company.

Results:

Twenty-two nurses and three years later, aspiring nurse executives at UnitedHealth Group are clearly benefitting from this developmental experience.  Program results speak for themselves in participant satisfaction and development, participant visibility and advancement, and business results, including return on investment.  The 2013 longitudinal study of past participants indicated 58% had been promoted since entering the program; 92% had expanded role responsibilities; and 75% had a personal impact on their profession development and/or engagement outside of the company (e.g. professional associations, mentorship, sponsorship, professional certification, academic degree, and board positons.)  Several participants felt compelled to "pay it forward" by supporting participants in subsequent years.  The financial return in terms of project success has been estimated at over $1 million and further assessment is underway.

Conclusion:

Executive nurse development is essential for nurses to play a key role in the transformation of the health care system.  To be full partners in the redesign of care and to lead health reform related initiatives, nurses need to be seen as viable and credible partners with physicians and other business leaders.  They need to be invited to, and comfortable at, "the table."  Programs that support executive competence development for nurses are the right path to get there.  Working together and sharing best practices, we can build the pipeline of executive nurse talent and assure the professional leadership necessary for nurses to play a leading role in health system transformation.