In my prior post, I made the case that physicians in leadership roles should maintain a clinical practice. Doing so informs their administrative actions, affords them greater credibility with their peers and strengthens a vital link between the bedside and organizational activities. All of those benefits would accrue to nursing leaders who did the same.
In many organizations, as soon as a nurse takes on a defined managerial role (beyond being the “charge” for a shift) he or she leaves the bedside, never to return. They start to dress differently, with the whites or scrubs replaced with business attire and (often) a white coat. In fact, when I was a resident, we referred to the managerial, non-clinical nursing leaders collectively as “plain clothed nurses.” More importantly, I believe they also start to think and act differently.
Some of that difference is important and appropriate. As they advance organizationally, all leaders – not just nurses — must adjust to new responsibilities, acquire and develop new skills and broaden their perspective. Unfortunately, it also often seems as though clinical leaders lose an important attachment to patient care and to their staff when they are no longer “in the trenches” with them. In fact, it seems that much of what nursing leaders are now asked to do by “rounding” on their staff or regularly visiting nursing units is an attempt to replace what they have lost by leaving the bedside – credibility, first-hand knowledge of organizational effectiveness, and connection to purpose.
I think it would be better if they worked a shift now and again instead.
What do you think?
A recent opinion piece in the Annals of Internal Medicine really resonated with me. It is entitled “Why Physician Leaders of Health Care Organizations Should Participate in Direct Patient Care” and made many of the same points I cite for my own ongoing clinical practice, and which I often point out to maturing or aspiring physician leaders.
The authors lay out 4 reasons for physician leaders to remain clinically active:
- Access to information about how the organization really works. I can tell you from personal experience that this is absolutely true. When I was a hospital chief medical officer, I used to joke (but truly meant) that I learned more about how the hospital really worked by being on call on a Sunday than by going to hours of meetings during the week.
- Credibility. This also rang true for me personally. I have had physicians’ attitudes toward me turn on a dime when they learned that I was still seeing patients and had not become a full-time “suit.” Despite the fact that effective organizational leadership requires a distinct skill set from clinical expertise, it is exceedingly difficult to be a physician leader without having genuine clinical bona fides.
- Personal fulfillment. Amen to that too. I refer to this as having an opportunity to “connect to purpose” by getting back to the reason why we became physicians in the first place – to forge intimate bonds with others, and to make a positive difference in their lives.
- Job security. OK, so they didn’t call it that, but they did say that physician leaders should maintain their clinical skills so that they can go back to being clinicians when their leadership roles expire. This reason fell a little flat for me. Most leaders I have seen do not go back to full-time (or predominantly) clinical practice, and it seemed like a hedge against failing rather than a positive game plan.
Here’s a big reason for physician leaders to continue to practice that the authors didn’t discuss. For me, physician leadership is an extension of clinical practice. Clinicians have the sacred and honorable ability (and responsibility) to make a positive difference for each patient that they see. I have always embraced the idea that physician leadership is about extending that ability and responsibility from one patient at a time to many patients at a time. I think that maintaining the one-on-one connection that can only be had through clinical practice is an important reminder of that higher calling.
What do you think?