Business and nursing. These two words seem to contradict each other. Nursing is synonymous with adjectives like caring, compassion, warmth, kindness, competence, and safety—and for years has been the most trusted profession (Gallup, 2016). Business is notoriously stereotyped as cruel, cutthroat, fast-paced, and self-centered. Yet healthcare systems are businesses, and many nurses are thrown into management positions early in their careers without any business knowledge.
When I graduated from nursing school in the early 1990s, my plan was to work as a clinician for a few years and then go back to school and become a nurse practitioner. During that time, the payment system in healthcare was changing from a fee-for-service model to a managed care model. Diagnosis-related groups (DRGs) became the standard payment method. This change caused chaos. Revenue declined significantly, and health systems across the country were forced to reduce costs to remain solvent. Because labor is typically the highest expense in healthcare, organizations began flattening management structures and increasing the span and scope of many leaders. My organization was no different.
I remember the turning point of my nursing career, when my director asked me to apply for an assistant director position during the payment-system changes. I hesitated, knowing this was not my career path, but I eventually gave in with one condition: I could go back to bedside nursing if I didn’t like it.
Once in the new job, I quickly realized that I lacked critical business knowledge. I knew how to balance my checkbook and manage my home, but I did not have the skills or knowledge to manage my department, the budget, the financial statements, and the daily operations. I decided the best way to learn was to step outside of healthcare and immerse myself in the business world. With a little help from my first husband, who said, “You’ll never make it in the business world,” I enrolled in a non-healthcare master of business administration (MBA) program. This was a huge win that propelled me into executive leadership and opened my world to many of the concepts and ideas you will read about in this book.
Fast forward to 2010. I had the opportunity to enroll in a doctor of nursing practice (DNP) program. Because I had an MBA rather than a master of science in nursing (MSN), I had to take a few prerequisite courses before starting the actual program—including a course titled “Nursing Theory.” This is when I met my dear friend Suzanne (Suzi) Waddill-Goad, the author of this book. We had very similar career paths as we both chose the MBA instead of the MSN route, were executive nursing leaders, and had a continued desire to translate our knowledge into practice. Neither one of us was thrilled to go back to Nursing 101, but in retrospect it provided some levity to our intense work as executives while grounding us, again, in the foundational aspects of our role as nurse leaders.
As you read this book, you’ll see that Suzi has used both her nursing and business background in most aspects of her career. During our DNP program, she was known as the “idea girl.” Some of those ideas were far-reaching, some of them walked the edge, and others were just plain fun! (Some secrets I won’t tell.) No matter how impossible the task ahead seemed, Suzi brought humor, optimism, and enthusiasm to the table.
Healthcare is now going through yet another transformation. The complexity of services, definition of value, and intensity of payment reform are just a few topics on the agenda. Blending the science of nursing and business is no longer an oxymoron—it is a necessity. Business Basics for Nurses provides a valuable resource for nurses not only in leadership, but also those at the bedside who are ultimately driving the value proposition for healthcare.
–Kristin Schmidt, DNP, MBA, RN, NEA-BC, CENP, CPHQ, FACHE
Chief Nursing Officer, Tenet Healthcare
Fountain Valley Regional Hospital and Medical Center
Fountain Valley, California